A qualitative study investigating the barriers to returning to work for breastfeeding mothers in Ireland

Background: The World Health Organization (WHO) recommends that mothers exclusively breastfeed for the first 6 months of an infant’s life. In Ireland, currently paid maternity leave is 26 weeks and the expectant mother is required by law to finish work 2 weeks before her expected delivery date. Mothers wishing to exclusively breastfeed for 6 months or longer find themselves having to take holiday leave or unpaid leave from work in order to meet the WHO’s guidelines. The aim of this study is to explore women’s experiences of breastfeeding after their return to work in Ireland. Methods: This study was carried out utilizing a qualitative design. Initially 25 women who returned to the workforce while continuing to breastfeed were contacted, 16 women returned consent forms and were subsequently contacted to take part in an interview. Interviews were recorded and transcribed verbatim and thematic analysis was employed to establish recurring patterns and themes throughout the interviews. Results: Women noted that cultural attitudes in Ireland coupled with inadequate or inconsistent advice from health professionals posed the biggest challenge they had to overcome in order to achieve to 6 months exclusive breastfeeding. The findings of this study illustrate that mothers with the desire to continue to breastfeed after their return to work did so with some difficulty. Many did not disclose to their employers that they were breastfeeding and did not make enquiries about being facilitated to continue to breastfeed after their return to the workplace. The perceived lack of support from their employers as well as embarrassment about their breastfeeding status meant many women concealed that they were breastfeeding after their return to the workplace. Conclusion: While it has been suggested that WHO guidelines for exclusive breastfeeding for 6 months may be unattainable for many women due to work commitments, a different problem exists in Ireland. Mothers struggle to overcome cultural and societal obstacles coupled with inadequate support from health professionals. Encouraging and facilitating women to continue to breastfeed after they return to work will help to normalise breastfeeding within Irish culture and promote continued breastfeeding as a viable option for working mothers

Causes and consequences of pregnancy loss and perinatal death

There have been major advances in reproductive medicine, however there is still a considerable risk that a woman may experience pregnancy loss and/or perinatal death. It is acknowledged that pregnancy loss and perinatal death are traumatic events further emphasising the need for empathetic supportive care. However, there is still a dearth of research identifying not only the most appropriate bereavement care but also how best to support parents in subsequent pregnancies. The data from these studies revealed that the experiences of the bereaved parents were distinctly different depending on whether they experienced miscarriage, an ectopic pregnancy or perinatal death. These data further illustrated the profound impact that pregnancy loss and/or perinatal death has on both women and men, their relationships with each other as well as with their family and friends. Findings also indicate how the hospital environment can have a negative impact on parents when experiencing pregnancy loss and/or perinatal death. Parents emphasised the importance of dedicated clinics and wards within the hospital. These dedicated spaces give parents and couples privacy and dignity at the time of their loss. Pregnancy loss is often referred to as an ‘invisible loss’ as often the event may not publicly acknowledged. These data further illustrate the isolating effect of pregnancy loss as parents felt they could not discuss their pregnancy loss and/or perinatal death as it may create socially awkward situations. The qualitative data also indicated there is considerable misperception and misunderstanding in relation to pregnancy loss and perinatal death, which was not only evidenced in the individual interviews but also throughout social media. How society understands and responds to pregnancy loss and perinatal death can be influential on an individual’s experience. These data suggest there is a need for a better understanding of pregnancy loss and perinatal death throughout society

Perinatal outcomes of reduced fetal movements: A cohort study

Background: The perception of reduced fetal movement (RFM) is an important marker of fetal wellbeing and is associated with poor perinatal outcome (such as intra-uterine death). Methods: We conducted a prospective study of women presenting with RFM over 28 weeks’ gestation to a tertiary-level maternity hospital. We examined pregnancy outcomes and compared them to a retrospectively collected control group delivering contemporaneously. Results: In total, 275 presentations were analysed in the RFM group, with 264 in the control group. Women with RFM were more likely to be nulliparous (p?=?0.002) and have an induction of labour (p?=?0.0011). 26.5 % (n?=?73) of cases were admitted following presentation with RFM, and 79.4 % (n?=?58) delivered on primary presentation. Overall, 15.2 % (n?=?42) women were induced for RFM specifically. Conclusion: This prospective study shows the increased burden of care required by those with RFM, including increased neonatal unit admission rates, increased induction rates and higher surveillance demands, demonstrating the need for increased attention to this area of practice

Molecular Characterisation of Bacteriophage K Towards Applications for the Biocontrol of Pathogenic Staphylococci

End of project reportThe aim of this work was to characterise staphylococcal bacteriophage (a bacterial virus) and to assess their potential as therapeutic agents against pathogenic strains of Staphylococcus aureus, particularly mastitis-causing strains. The project included the use of two newly isolated phage CS1 and DW2, and an existing polyvalent phage. The new phage were isolated from the farmyard and characterised by electron microscopy and restriction analysis. Both phage were shown to belong to the Siphoviridae family and were lytic for representatives of all three clonal groups of Irish mastitis-associated staphylococci. A cocktail of three phage (CS1, DW2 and K) at 108 (plaque forming units) PFU/ml was infused into cows teats in animal trials. The lack of an increase in somatic cell counts in milks indicated strongly that the phage did not irritate the animal. In addition, the most potent phage used in this study, phage K, was further studied by genome sequencing, which revealed a linear DNA genome of 127,395 base pairs, which encodes 118 putative ORFs (open reading frames)

Experience of miscarriage: an interpretative phenomenological analysis

Objective: The objective of the study was to explore the experiences of those who have experienced miscarriage, focusing on men's and women's accounts of miscarriage. Design: This was a qualitative study using a phenomenological framework. Following in-depth semistructured interviews, analysis was undertaken in order to identify superordinate themes relating to their experience of miscarriage. Setting: A large tertiary-level maternity hospital in Ireland. Participants: A purposive sample of 16 participants, comprising 10 women and 6 men, was recruited. Results: 6 superordinate themes in relation to the participant's experience of miscarriage were identified: (1) acknowledgement of miscarriage as a valid loss; (2) misperceptions of miscarriage; (3) the hospital environment, management of miscarriage; (4) support and coping; (5) reproductive history; and (6) implications for future pregnancies. Conclusions: One of the key findings illustrates a need for increased awareness in relation to miscarriage. The study also indicates that the experience of miscarriage has a considerable impact on men and women. This study highlights that a thorough investigation of the underlying causes of miscarriage and continuity of care in subsequent pregnancies are priorities for those who experience miscarriage. Consideration should be given to the manner in which women who have not experienced recurrent miscarriage but have other potential risk factors for miscarriage could be followed up in clinical practice

‘Education will set you free?’ – A creative exploration of the experience of educational exclusion, from the perspective of prisoners and youth

This thesis is a study of educational exclusion, and the complex ways this is connected to social exclusion, based on extensive research with prisoners and youth in Ireland. Drawing on the practices and ideas of adult and community education and taking a critical Freirean (1970) approach it positions the prisoners and youth that participated in the research as the ‘experts’ and co-producers of knowledge. At the heart of the thesis are the voices of the people I worked with using participatory and arts-based methods including theatre of the oppressed, ethnodrama, forum theatre, transcript/research poetry and performative research (Boal, 1995; Faulkner, 2007; Prendergast, 2009; Richardson, 1993; Saldaňa,1999). The core of the thesis is a research play which is a creative re-presentation of what was learnt through the research in a form which retains the vitality and truth of people’s stories, and where the expression of meaning becomes central (Butterwick & Roy, 2018). The play has also been crafted as a problem-posing device (Freire, 1972) which bears witness to the complex, layered ways educational exclusion occurs, how it is rooted in wider social circumstances, and the impact, often severe, that this has on individuals and communities. The foregrounding of stories in this manner, both individual and collective, is based on the conviction that research can and should speak in a direct and accessible way to the people who participate in such processes (Leavy, 2013; Pelias, 2015), and seeks to break new ground in how research is pursued and presented, and in how we seek to learn and theorise from research. Grounding and presenting the study in this way; a 'bottom- up' perspective, is markedly and consciously different to how most research on educational exclusion has been approached, and comment and reflection on this is woven throughout the thesis. As such, the thesis not only offers a new perspective, rooted in participants’ experiences and stories, on the topic of educational exclusion, but it also documents and critically explores the craft of participatory research and creative dissemination. It makes a case, and offers an example, that the means we select to carry out and share our work can be simultaneously a methodology and a pedagogy; an instrument for social change. It approaches theory and methodology and form and content dialectically, in resistance to the dominant modes of research and dissemination which reinforce existing hierarchies in knowledge and power (Leavy, 2015). The process of inquiry and the research play aim seeks to overcome these hierarchies, but also reflexively explore the limits of critical research in the context such as prisons and in the face of deeply rooted, intergenerational inequality. The thesis comprises an introduction and three parts. Part one outlines the construction and conceptualisation of the research play. The second part is the research play ‘Education will set you free?’ based on five years of intensive, recursive, participatory research with prisoners and youth and which draws on transcript interviews, notes, reflections and participant interactions to problem-pose an array of issues with social justice, educational and policy implications. In describing the research process that took place before the writing of the ethnodrama, and new research that followed after, and in articulating and foregrounding participant voice through the medium of transcript poetry, part three examines and argues for the power of arts-based research to engage with social research questions in holistic and embodied ways. This is offered as a both a personal reflection on the research and the pleasures and challenges of the process, and also as a resource for others interested in creative and participatory methods of exploration and dissemination

An exploration of women's experience of taking part in a randomized controlled trial of a diagnostic test during pregnancy: A qualitative study

Objective: To explore pregnant women's views of participation in a clinical research trial while pregnant. Design: Prospective nested qualitative cohort study embedded within a national, multi‐site randomized controlled trial of a diagnostic test for preeclampsia: Placental Growth Factor. One‐to‐one in‐depth semi‐structured interviews were undertaken with 19 women who had recently participated in the trial at a single recruiting site. The interviews were conducted in private, recorded digitally and transcribed verbatim. Setting: Single tertiary maternity hospital currently recruiting eligible women onto an on‐going randomized controlled trial (NCT 02881073). Participants: Women who had participated in the PARROT Ireland randomized controlled trial during their recent pregnancy. Methods: Thematic analysis was utilized. Each line of the transcribed interviews was coded into a category by two researchers. The resultant categories were reviewed, and those with similarities were pooled allowing the development of themes. Main Outcome Measures: Women's opinions and experience of participation in a randomized controlled trial of an interventional diagnostic test during their pregnancy. Results: Four major themes were identified as follows: (a) Understanding of preeclampsia, (b) Motivators for clinical trial participation, (c) Barriers to decision making and (d) Influence of PARROT Ireland on pregnancy experience. Conclusions:Women are generally interested and positively inclined to participate in research during pregnancy. The potential of risk is an important consideration for eligible pregnant woman. Information and support by both researchers and clinicians are paramount in aiding women's understanding of a research trial

Oocyte donation pregnancies-non-disclosure of oocyte recipient status to obstetric care providers and perinatal outcomes

Background: Oocyte donation pregnancies-non-disclosure of oocyte recipient (OR) status to obstetric care providers and perinatal outcomes. Many studies report a higher rate of pregnancy-induced hypertension (PIH) and severe pre-eclampsia (PET) in OR pregnancies. The objective is to determine the rates of non-disclosure of OR pregnancy to obstetric care providers and also the rates of perinatal complications. Method: This was a retrospective review of all oocyte recipient (OR) pregnancies, who subsequently delivered at Cork University Maternity Hospital, between 2007-2012 inclusive. Obstetric case notes were reviewed to investigate perinatal outcomes and whether OR status had been documented (unambiguously, in code or not at all). Results Less than one-third (30.2%; n=32/106) had unambiguous documentation, one-third (33%; n=35/106) had no documentation and the remainder (36.8%; n=39/106) had a code familiar only to their obstetrician. There was a high rate of gestational hypertensive disorders (28.3%; n= 30), most frequently occurring with multiple gestation. Conclusion There was a low rate of clear documentation of OR status. Gestational hypertensive disorders occurred with increased frequency

Partially dentate patient preferences

Objective: To identify factors influencing attitudes of partially dentate adults towards dental treatment in Ireland. Background: People are retaining more teeth later in life than ever before. Management of partially dentate older adults will be a major requirement for the future and it is important to determine factors which may influence patients’ attitudes to care. Methods: Subjects: A purposive sample of 22 partially dentate patients was recruited; 12 women and 12 men, ranging in age from 45 to 75 years. Data Collection: Semi-structured individual interviews. Results: Dental patients have increasing expectations in relation to (i) a more sophisticated approach to the management of missing teeth and (ii) their right to actively participate in decision making regarding the management of their tooth loss. There is some evidence of a cohort effect with younger patients (45–64 years) having higher expectations. Conclusions: The evidence of a cohort effect within this study in relation to higher patient expectations indicates that both contemporary and future patients are likely to seek a service based on conservation and restoration of missing teeth by fixed prostheses

Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study

Objective: To explore fetal medicine specialists' experiences of caring for parents following a diagnosis of fatal fetal anomaly (FFA) during the implementation of termination of pregnancy (TOP) for FFA for the first time. Design: Qualitative study. Setting: Fetal medicine units in the Republic of Ireland. Population: Ten fetal medicine specialists from five of the six fetal medicine units. Methods: nvivo 12 assisted in the thematic analysis of semi-structured in-depth face-to-face interviews. Main outcome measures: Fetal medicine specialists' experiences of prenatal diagnosis and holistic management of pregnancies complicated by FFA. Results: Four themes were identified: 'not fatal enough', 'interactions with colleagues', 'supporting pregnant women' and 'internal conflict and emotional challenges'. Fetal medicine specialists feared getting an FFA diagnosis incorrect because of media scrutiny and criminal liability associated with the TOP for FFA legislation. Challenges with the ambiguous and 'restrictive' legislation were identified that 'ostracised' severe anomalies. Teamwork was essential to facilitate opportunities for learning and peer support; however, conflict with colleagues was experienced regarding the diagnosis of FFA, the provision of feticide and palliative care to infants born alive following TOP for FFA. Participants reported challenges implementing TOP for FFA, including the absence of institutional support and 'stretched' resources. Fetal medicine specialists experienced internal conflict and a psychological burden providing TOP for FFA, but did so to 'provide full care for women'. Conclusions: Our study identified challenges regarding the suitability of the Irish legislation for TOP for FFA and its rapid introduction into clinical practice. It illustrates the importance of institutional and peer support, as well as the need for supportive management, in the provision of a new service. Tweetable abstract: The implementation of termination services for fatal fetal anomaly is complex and requires institutional support