Integrating a sense of coherence into the neonatal environment

Background: Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes. Discussion: In this paper we present a new perspective to neonatal care based on Aaron Antonovksy’s Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed. Summary: Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned

What works for breastfeeding peer support - time to get real

Policymakers from developed countries who are looking to commission breastfeeding peer support (BPS) services have every cause to be puzzled as to whether or not they can improve continuation rates. On the one hand, BPS interventions are internationally recognised as having the potential to contribute to improving breastfeeding durations.1 A recent Cochrane review found that additional support from lay and professional supporters can have an impact on rates,2 and UK-based qualitative studies suggest that BPS can encourage and enable women to breastfeed for longer periods.3,4 In the UK, peer support for breastfeeding forms part of NHS commissioning guidance.5 On the other hand, a recent meta-regression of BPS randomised controlled trials (RCTs) found little evidence that BPS interventions improve breastfeeding durations in high-income countries6 and concluded that peer support for breastfeeding was ‘unlikely to be effective’ in the UK. This paper highlights issues of intervention design and implementation that problematise interpretation of trial data drawn from the meta-regression analysis within high income countries. The paper then goes on to consider the potential for alternative approaches to review evidence for BPS, highlighting the need to integrate insights from qualitative research studies. Drawing on findings of a preliminary scoping review, we make the case for a shift towards a realist interpretation of the evidence base. We argue that a realist approach would allow findings emergent from different methodological traditions to be meaningfully integrated and the theoretical basis for BPS to be explored and tested through the construction of context-mechanism-outcome configurations. We believe this will provide a firmer basis for future intervention design and for the development of theoretically-driven evaluation studies, leading to improved clarity for delivery organisations and commissioning agencies. We contend that policy makers and researchers need to stop merely asking ‘does BPS work?’ and look towards approaches which enlighten ‘what works for whom, in what circumstances, in what respects, and how?’

Loneliness in Pregnancy and Parenthood: Impacts, Outcomes, and Costs

: Becoming a parent has been highlighted as a period associated with increased risks for loneliness, with around one-third of parents reporting feeling lonely often or always. However, as most understanding of loneliness is based on elderly or student cohorts, further insights into the costs of parental loneliness is needed. : We conducted a literature review of impacts of loneliness in pregnancy and parenthood and present a synthesis of the health, social, societal, and economic costs. We draw on evidence about impacts and costs of loneliness in other cohorts to help provide a wider context to understand the impacts and costs and how parental loneliness differs from other populations. : Similar to literature with elderly cohorts, parental loneliness has impacts on health and wellbeing, such as depression in new parents and increased general practitioner (GP) visits in pregnancy. But also has intergenerational impacts via its association with poor mental health and social competence and increased respiratory tract infections in the child. Physical health impacts widely associated with loneliness in other cohorts have yet to be examined in parents. Loneliness in parents is likely to result in social withdrawal further isolating parents and wider societal and economic costs relating to absence from employment and informal caring roles. : Parental loneliness has the potential for negative and pervasive impacts. As parental loneliness has wide ranging and intergenerational impacts it is important that a multi-sectoral perspective is used when examining its costs. [Abstract copyright: Copyright ©2024, Yale Journal of Biology and Medicine.

Breast pumps as an incentive for breastfeeding: a mixed methods study of acceptability

Increasing breastfeeding rates would improve maternal and child health, but multiple barriers to breastfeeding persist. Breast pump provision has been used as an incentive for breastfeeding, although effectiveness is unclear. Women's use of breast pumps is increasing and a high proportion of mothers express breastmilk. No research has yet reported women's and health professionals' perspectives on breast pumps as an incentive for breastfeeding. In the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study, mixed methods research explored women's and professionals' views of breast pumps as an incentive for breastfeeding. A survey of health professionals across Scotland and North West England measured agreement with ‘a breast pump costing around£40 provided for free on the NHS’ as an incentive strategy. Qualitative interviews and focus groups were conducted in two UK regions with a total of 68 participants (pregnant women, new mothers, and their significant others and health professionals) and thematic analysis undertaken. The survey of 497 health professionals found net agreement of 67.8% (337/497) with the breast pump incentive strategy, with no predictors of agreement shown by a multiple ordered logistic regression model. Qualitative research found interrelated themes of the ‘appeal and value of breast pumps’, ‘sharing the load’, ‘perceived benefits’, ‘perceived risks’ and issues related to ‘timing’. Qualitative participants expressed mixed views on the acceptability of breast pumps as an incentive for breastfeeding. Understanding the mechanisms of action for pump type, timing and additional support required for effectiveness is required to underpin trials of breast pump provision as an incentive for improving breastfeeding outcomes

The 2000 outburst of the recurrent nova CI Aquilae: optical spectroscopy

We present low- and medium resolution spectra of the recurrent nova CI Aquilae taken at 14 epochs in May and June, 2000. The overall appearance is similar to other U Sco-type recurrent novae (U Sco, V394 CrA). Medium resolution (R=7000-10000) hydrogen and iron profiles suggest an early expansion velocity of 2000-2500 km/s. The H\alpha evolution is followed from Dt = -0.6 d to +53 d, starting from a nearly Gaussian shape to a double peaked profile through strong P-Cyg profiles. The interstellar component of the sodium D line and two diffuse interstellar bands put constraints on the interstellar reddening which is estimated to be E(B-V)=0.85\pm0.3. The available visual and CCD-V observations are used to determine t0,t2 and t3. The resulting parameters are: t0=2451669.5\pm0.1, t2=30\pm1 d, t3=36\pm1 d. The recent lightcurve is found to be generally similar to that observed in 1917 with departures as large as 1-2 mag in certain phases. This behaviour is also typical for the U Sco subclass.Comment: 8 pages, 7 figures, accepted for publication in A&

“Bringing forth” skills and knowledge of newly qualified midwives in free-standing birth centres: A hermeneutic phenomenological study

Aim: to understand and interpret the lived experience of newly qualified midwives as they acquire skills to work in free-standing birth centres, as well as the lived experience of experienced midwives in free-standing birth centres in Germany who work with newly qualified midwives. Background: In many high-, middle-, and low-income countries, the scope of practice of midwives includes autonomous care of labouring women in all settings, including hospitals, home, and free-standing birth centres. There has been to date no research detailing the skills acquired when midwives who have trained in hospitals offer care in out-of-hospital settings. Methods: This study was underpinned by hermeneutic phenomenology. Fifteen newly qualified midwives in their orientation period in a free-standing birth centre were interviewed three times in their first year. In addition to this, focus groups were conducted in 13 freestanding birth centres. Data were collected between 2021-2023. Findings: Using Heidegger’s theory of technology as the philosophical underpinning, the results illustrate that the newly qualified midwives were facilitated to bring forth competencies to interpret women’s unique variations of physiological labour, comprehending when they could enact intervention-free care, when the women necessitated a gentle intervention, and when acceleration of labour or transfer to hospital was necessary. Conclusion: Newly qualified midwives learned to effectively integrate medical knowledge with midwifery skills and knowledge, creating a bridge between the medical and midwifery approaches to care. Implications: This paper showed the positive effects that an orientation and familiarization period with an experienced team of midwives have on the skill development of novice practitioners in FSBCs. Impact: The findings of this study will have an impact on training and orientation for nurse midwives and direct-entry midwives when they begin to practice in out-of-hospital settings after training and working in hospital labour wards. Patient or Public Contribution: This research study has four cooperating partners: MotherHood, Network of Birth Centres, the Association for Quality at Out-of-Hospital Birth, and the German Association of Midwifery Science. The cooperating partners met six times in a period of 2 ½ years to hear reports on the preliminary research findings and discuss these from the point of view of each organisation. In addition, at each meeting, three midwives from various freestanding birth centres were present to discuss the results and implications. The cooperating partners also helped disseminate study information that facilitated recruitment

Callers’ attitudes and experiences of UK breastfeeding helpline support

Background: Breastfeeding peer support, is considered to be a key intervention for increasing breastfeeding duration rates. Whilst a number of national organisations provide telephone based breastfeeding peer support, to date there have been no published evaluations into callers’ experiences and attitudes of this support. In this study we report on the descriptive and qualitative insights provided by 908 callers as part of an evaluation of UK-based breastfeeding helpline(s). Methods: A structured telephone interview, incorporating Likert scale responses and open-ended questions was undertaken with 908 callers over May to August, 2011 to explore callers’ experiences of the help and support received via the breastfeeding helpline(s). Results: Overall satisfaction with the helpline was high, with the vast majority of callers’ recalling positive experiences of the help and support received. Thematic analysis was undertaken on all qualitative and descriptive data recorded during the evaluation, contextualised within the main areas addressed within the interview schedule in terms of ‘contact with the helplines’; ‘experiences of the helpline service’, ‘perceived effectiveness of support provision’ and ‘impact on caller wellbeing’. Conclusion: Callers valued the opportunity for accessible, targeted, non-judgmental and convenient support. Whilst the telephone support did not necessarily influence women’s breastfeeding decisions, the support they received left them feeling reassured, confident and more determined to continue breastfeeding. We recommend extending the helpline service to ensure support can be accessed when needed, and ongoing training and support for volunteers. Further advertising and promotion of the service within wider demographic groups is warranted

Nova Cygni 2001/2 = V2275 Cyg

We present an analysis of low- and medium resolution spectra of the very fast nova, Nova Cygni 2001/2 (V2275 Cyg) obtained at nine epochs in August, September and October, 2001. The expansion velocity from hydrogen Balmer lines is found to be 2100 km/s, although early H-alpha profile showed a weak feature at -3500 km/s, too. The overall appearance of the optical spectrum is dominated by broad lines of H, He and N, therefore, the star belongs to the ``He/N'' subclass of novae defined by Williams (1992). Interstellar lines and bands, as well as BV photometry taken from the literature yielded to a fairly high reddening of E(B-V)=1.0+/-0.1 mag. The visual light curve was used to deduce M_V by the maximum magnitude versus rate of decline relationship. The resulting parameters are: t_0=2452141.4(+0.1)(-0.5), t_2=2.9+/-0.5 days, t_3=7+/-1 days, M_V=-9.7+/-0.7 mag. Adopting these parameters, the star lies between 3 kpc and 8 kpc from the Sun.Comment: 5 pages, 5 figures, accepted for publication in A&

The design, delivery and evaluation of ‘Human Perspectives VR’: An immersive educational programme designed to raise awareness of contributory factors for a traumatic childbirth experience and PTSD

Background A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women’s relationships with maternity care providers. Aims To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women’s experiences of childbirth. Methods A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women’s experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient – provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. Findings Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. Conclusion While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants’ care practices

Skills and Knowledge of Midwives at Free-Standing Birth Centres and Home Birth: A metaethnography

Problem: When midwives offer birth assistance at home birth and free-standing birth centres, they must adapt their skill set. Currently, there are no comprehensive insights on the skills and knowledge that midwives need to work in those settings. Background: Midwifery care at home birth and in free-standing birth centres requires context specific skills, including the ability to offer low-intervention care for women who choose physiological birth in these settings. Aim: To synthesise existing qualitative research that describes the skills and knowledge of certified midwives at home births and free-standing birth centres. Study design: We conducted a systematic review that included searches on 5 databases, author runs, citation tracking, journal searches, and reference checking. Meta-ethnographic techniques of reciprocal translation were used to interpret the data set, and a line of argument synthesis was developed. Results: The search identified 13 papers, twelve papers from seven countries, and one paper that included five Nordic countries. Three overarching themes and seven sub-themes were developed: ‘Building trustworthy connections,’ ‘Midwife as instrument,’ and ‘Creating an environment conducive to birth.’ Conclusion: The findings highlight that midwives integrated their sensorial experiences with their clinical knowledge of anatomy and physiology to care for women at home birth and in free-standing birth centres. The interactive relationship between midwives and women is at the core of creating an environment that supports physiological birth while integrating the lived experience of labouring women. Further research is needed to elicit how midwives develop these proficiencies