Pub Date : 2025-01-06DOI: 10.1016/j.midw.2024.104279
Joanne Rack , Vanora Hundley , Edwin van Teijlingen , Ann Luce
{"title":"The pregnant pause: Engaging and involving public contributors in maternal health research","authors":"Joanne Rack , Vanora Hundley , Edwin van Teijlingen , Ann Luce","doi":"10.1016/j.midw.2024.104279","DOIUrl":"10.1016/j.midw.2024.104279","url":null,"abstract":"","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"142 ","pages":"Article 104279"},"PeriodicalIF":2.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-03DOI: 10.1016/j.midw.2025.104282
A.E. Burton, H. Cassidy, J. Taylor, A. Owen
<div><h3>Problem</h3><div>Tongue tie is an added complication when breastfeeding, but little is known about the role tongue tie might play when breastfeeding twins.</div></div><div><h3>Background</h3><div>Twins are much less likely to be breastfed than singleton babies due to added complications regarding pregnancy, birth and ongoing care. Tongue tie can cause breastfeeding barriers including poor latch, inefficient milk transfer and nipple pain.</div></div><div><h3>Aim</h3><div>The aim of this study was to conduct an in-depth exploration of the experiences of mothers who have breastfeed twins with suspected or diagnosed tongue tie.</div></div><div><h3>Methods</h3><div>Interview and qualitative survey data exploring the experience of breastfeeding twins and multiples were analysed with a focus on the experiences of participants reporting on suspected or diagnosed tongue tie. Data were analysed using reflexive thematic analysis.</div></div><div><h3>Findings</h3><div>Three themes were developed. These were: 1) feeling disempowered by tongue tie denial; which illustrated the experience of dismissal by healthcare professionals, 2) the avoidable impact of diagnostic delay; highlighting the practical, physical and psychological impact of tongue tie, and 3) improvements following intervention; illustrating the immediate improvements experienced following frenotomy.</div></div><div><h3>Discussion</h3><div>Mothers who suspect tongue tie find themselves disempowered by denial of their experiences and needing to fight for intervention. Long delays lead to distress for both mother and child while intervention often leads to instant improvement.</div></div><div><h3>Conclusion</h3><div>Improved healthcare professional training and healthcare policy changes are needed to improve tongue tie support and intervention for parents of twins and reduce the threat to mother and child health and wellbeing.</div></div><div><h3>Statement of Significance</h3><div><strong>Problem or Issue:</strong> Breastfeeding rates for twins are much lower than for singleton babies. For some infants tongue tie may be an additional barrier to breastfeeding success.</div><div><strong>What is Already Known:</strong> Research with parents of singleton babies has shown that tongue tie can cause distress, frustration and physical pain for mothers who report dismissal by healthcare professionals and a need to fight for support.</div><div><strong>What this Paper Adds:</strong> The voices of parents of infants with tongue tie who have successfully breastfed twins are presented. Like parents of singleton infants, they experienced diagnostic delays and psychological and physical impacts of tongue tie. Intervention was often sought privately when NHS support was lacking. Regardless of source, tongue tie intervention often led to immediate improvement highlighting how the added stresses and challenges created by tongue tie for twin parents could be prevented with appropriate support and intervention
{"title":"Experiences of tongue tie when breastfeeding twins: A qualitative study","authors":"A.E. Burton, H. Cassidy, J. Taylor, A. Owen","doi":"10.1016/j.midw.2025.104282","DOIUrl":"10.1016/j.midw.2025.104282","url":null,"abstract":"<div><h3>Problem</h3><div>Tongue tie is an added complication when breastfeeding, but little is known about the role tongue tie might play when breastfeeding twins.</div></div><div><h3>Background</h3><div>Twins are much less likely to be breastfed than singleton babies due to added complications regarding pregnancy, birth and ongoing care. Tongue tie can cause breastfeeding barriers including poor latch, inefficient milk transfer and nipple pain.</div></div><div><h3>Aim</h3><div>The aim of this study was to conduct an in-depth exploration of the experiences of mothers who have breastfeed twins with suspected or diagnosed tongue tie.</div></div><div><h3>Methods</h3><div>Interview and qualitative survey data exploring the experience of breastfeeding twins and multiples were analysed with a focus on the experiences of participants reporting on suspected or diagnosed tongue tie. Data were analysed using reflexive thematic analysis.</div></div><div><h3>Findings</h3><div>Three themes were developed. These were: 1) feeling disempowered by tongue tie denial; which illustrated the experience of dismissal by healthcare professionals, 2) the avoidable impact of diagnostic delay; highlighting the practical, physical and psychological impact of tongue tie, and 3) improvements following intervention; illustrating the immediate improvements experienced following frenotomy.</div></div><div><h3>Discussion</h3><div>Mothers who suspect tongue tie find themselves disempowered by denial of their experiences and needing to fight for intervention. Long delays lead to distress for both mother and child while intervention often leads to instant improvement.</div></div><div><h3>Conclusion</h3><div>Improved healthcare professional training and healthcare policy changes are needed to improve tongue tie support and intervention for parents of twins and reduce the threat to mother and child health and wellbeing.</div></div><div><h3>Statement of Significance</h3><div><strong>Problem or Issue:</strong> Breastfeeding rates for twins are much lower than for singleton babies. For some infants tongue tie may be an additional barrier to breastfeeding success.</div><div><strong>What is Already Known:</strong> Research with parents of singleton babies has shown that tongue tie can cause distress, frustration and physical pain for mothers who report dismissal by healthcare professionals and a need to fight for support.</div><div><strong>What this Paper Adds:</strong> The voices of parents of infants with tongue tie who have successfully breastfed twins are presented. Like parents of singleton infants, they experienced diagnostic delays and psychological and physical impacts of tongue tie. Intervention was often sought privately when NHS support was lacking. Regardless of source, tongue tie intervention often led to immediate improvement highlighting how the added stresses and challenges created by tongue tie for twin parents could be prevented with appropriate support and intervention ","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"142 ","pages":"Article 104282"},"PeriodicalIF":2.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31DOI: 10.1016/j.midw.2024.104281
Shu-Ling Lin , Chih-Feng Yen , Chia-Jung Hsieh , Wen-Pei Chang , Chia-Hui Wang
Background
Abdominal binders are a prominent non-pharmacological intervention aimed at mitigating adverse outcomes following Cesarean delivery (CD), including pain and distress.
Aim
We conducted a meta-analysis to quantitatively evaluate the effects of abdominal binders on women undergoing CD.
Methods
A systematic search was conducted using terms such as "abdominal binder," "clinical trials," and variations of "cesarean" across multiple electronic databases, including PubMed, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), and Wan-Fang database, up to November 2024. Study quality was assessed using the Cochrane Risk of Bias Tool 2.0. Statistical analysis was performed using Review Manager 5.4 and Comprehensive Meta-Analysis 4.0. Randomized controlled trials (RCTs) evaluating the use of abdominal binders compared to no binder usage following CD were included. The outcomes analyzed were postoperative pain, symptom distress, ambulatory function, and the occurrence of adverse effects.
Results
Thirteen RCTs were included. Abdominal binders demonstrated a strong safety profile with no significant differences in postoperative complications between groups. Significant pain reductions were observed at 6, 12, 24, and 48 h postoperatively (weighted mean differences [WMD]: -1.13, 95 % confidence interval [CI]: -2.15 to -0.10, p = 0.03; WMD: -1.48, 95 % CI: -2.90 to -0.06, p = 0.04;WMD: -0.95, 95 % CI: -1.49 to -0.41, p = 0.0005; and WMD: -0.70, 95 % CI: -1.17 to -0.22, p = 0.004, respectively). Pain interference with breastfeeding was significantly lower in the binder group (WMD: -1.30, 95 % CI: -2.24 to -0.36, p = 0.006). Symptom Distress Scale scores were significantly reduced at 24 and 48 h (WMD: -1.22, 95 % CI: -2.05 to -0.39, p = 0.004; WMD: -1.63, 95 % CI: -2.67 to -0.60, p = 0.002). Improved ambulatory function was also observed at 8, 12, and 24 h (WMD: 20.57, 95 % CI: 16.91 to 24.23, p < 0.00001; WMD: 11.97, 95 % CI: 7.67 to 16.27, p < 0.00001; WMD: 10.14, 95 % CI: 1.89 to 18.40, p = 0.02, respectively).
Conclusions
This study uniquely demonstrates the temporal effects of abdominal binder use, with significant pain reductions noted at 6, 12, 24, and 48 h post-CD. These results provide actionable guidance for the timing of abdominal binder application, emphasizing their importance as an early intervention to optimize postoperative recovery. As a secure, cost-effective, and non-pharmacological solution, abdominal binders are strongly recommended as part of routine postpartum care for women following CD
{"title":"The efficacy of abdominal binder in women undergoing cesarean delivery: A meta-analysis of randomized controlled trials","authors":"Shu-Ling Lin , Chih-Feng Yen , Chia-Jung Hsieh , Wen-Pei Chang , Chia-Hui Wang","doi":"10.1016/j.midw.2024.104281","DOIUrl":"10.1016/j.midw.2024.104281","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal binders are a prominent non-pharmacological intervention aimed at mitigating adverse outcomes following Cesarean delivery (CD), including pain and distress.</div></div><div><h3>Aim</h3><div>We conducted a meta-analysis to quantitatively evaluate the effects of abdominal binders on women undergoing CD.</div></div><div><h3>Methods</h3><div>A systematic search was conducted using terms such as \"abdominal binder,\" \"clinical trials,\" and variations of \"cesarean\" across multiple electronic databases, including PubMed, Google Scholar, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), and Wan-Fang database, up to November 2024. Study quality was assessed using the Cochrane Risk of Bias Tool 2.0. Statistical analysis was performed using Review Manager 5.4 and Comprehensive Meta-Analysis 4.0. Randomized controlled trials (RCTs) evaluating the use of abdominal binders compared to no binder usage following CD were included. The outcomes analyzed were postoperative pain, symptom distress, ambulatory function, and the occurrence of adverse effects.</div></div><div><h3>Results</h3><div>Thirteen RCTs were included. Abdominal binders demonstrated a strong safety profile with no significant differences in postoperative complications between groups. Significant pain reductions were observed at 6, 12, 24, and 48 h postoperatively (weighted mean differences [WMD]: -1.13, 95 % confidence interval [CI]: -2.15 to -0.10, <em>p</em> = 0.03; WMD: -1.48, 95 % CI: -2.90 to -0.06, <em>p</em> = 0.04;WMD: -0.95, 95 % CI: -1.49 to -0.41, <em>p</em> = 0.0005; and WMD: -0.70, 95 % CI: -1.17 to -0.22, <em>p</em> = 0.004, respectively). Pain interference with breastfeeding was significantly lower in the binder group (WMD: -1.30, 95 % CI: -2.24 to -0.36, <em>p</em> = 0.006). Symptom Distress Scale scores were significantly reduced at 24 and 48 h (WMD: -1.22, 95 % CI: -2.05 to -0.39, <em>p</em> = 0.004; WMD: -1.63, 95 % CI: -2.67 to -0.60, <em>p</em> = 0.002). Improved ambulatory function was also observed at 8, 12, and 24 h (WMD: 20.57, 95 % CI: 16.91 to 24.23, <em>p</em> < 0.00001; WMD: 11.97, 95 % CI: 7.67 to 16.27, <em>p</em> < 0.00001; WMD: 10.14, 95 % CI: 1.89 to 18.40, <em>p</em> = 0.02, respectively).</div></div><div><h3>Conclusions</h3><div>This study uniquely demonstrates the temporal effects of abdominal binder use, with significant pain reductions noted at 6, 12, 24, and 48 h post-CD. These results provide actionable guidance for the timing of abdominal binder application, emphasizing their importance as an early intervention to optimize postoperative recovery. As a secure, cost-effective, and non-pharmacological solution, abdominal binders are strongly recommended as part of routine postpartum care for women following CD</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"142 ","pages":"Article 104281"},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-31DOI: 10.1016/j.midw.2024.104280
Sheila Pham , Kate Churruca , Louise A. Ellis , Jeffrey Braithwaite
Problem and background
Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy, and the emerging evidence demonstrates how GDM online communities have a positive impact on promoting self-management and improving outcomes. Further analysis of such groups can increase understanding of how peer support in GDM online communities is enabled and enacted.
Aim
To examine women's experiences of GDM online communities on Facebook, their motivations for participation, and perceptions of dynamics within the community.
Methods
Semi-structured phone interviews were conducted with 28 participants, recruited from an online survey posted in two self-organised Australian GDM Facebook groups.
Results
From our thematic analysis of the interview data, four themes were identified from participants’ views about GDM online communities: ‘A safe community’ encapsulated a desire to be connected with others having similar experiences in a non-judgmental space; ‘A supportive and informative group’ concerned the need for, and giving of, support, and gaining knowledge; ‘An adjunct to healthcare’ referred to participants’ use of GDM online communities to inform their healthcare experiences; and ‘A waiting room’ reflected participants’ continued involvement in GDM online communities, in part due to future uncertainty.
Discussion and Conclusion
Our findings affirm the value of GDM online communities on Facebook for community, support and information. GDM online communities serve as an adjunct to formal healthcare, augmenting clinic-based appointments and clinical management of GDM, encouraging informed decision-making and self-advocacy. We highlight how, in such spaces, women collaboratively navigate self-management and healthcare.
{"title":"Women's views about online communities for gestational diabetes mellitus: A qualitative interview study","authors":"Sheila Pham , Kate Churruca , Louise A. Ellis , Jeffrey Braithwaite","doi":"10.1016/j.midw.2024.104280","DOIUrl":"10.1016/j.midw.2024.104280","url":null,"abstract":"<div><h3>Problem and background</h3><div>Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy, and the emerging evidence demonstrates how GDM online communities have a positive impact on promoting self-management and improving outcomes. Further analysis of such groups can increase understanding of how peer support in GDM online communities is enabled and enacted.</div></div><div><h3>Aim</h3><div>To examine women's experiences of GDM online communities on Facebook, their motivations for participation, and perceptions of dynamics within the community.</div></div><div><h3>Methods</h3><div>Semi-structured phone interviews were conducted with 28 participants, recruited from an online survey posted in two self-organised Australian GDM Facebook groups.</div></div><div><h3>Results</h3><div>From our thematic analysis of the interview data, four themes were identified from participants’ views about GDM online communities: ‘A safe community’ encapsulated a desire to be connected with others having similar experiences in a non-judgmental space; ‘A supportive and informative group’ concerned the need for, and giving of, support, and gaining knowledge; ‘An adjunct to healthcare’ referred to participants’ use of GDM online communities to inform their healthcare experiences; and ‘A waiting room’ reflected participants’ continued involvement in GDM online communities, in part due to future uncertainty.</div></div><div><h3>Discussion and Conclusion</h3><div>Our findings affirm the value of GDM online communities on Facebook for community, support and information. GDM online communities serve as an adjunct to formal healthcare, augmenting clinic-based appointments and clinical management of GDM, encouraging informed decision-making and self-advocacy. We highlight how, in such spaces, women collaboratively navigate self-management and healthcare.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"142 ","pages":"Article 104280"},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Practice placements are an essential component of midwifery education, enabling students to apply their theoretical knowledge in a real-world midwifery setting. Exposure and immersion to practice is a core focus of midwifery education internationally. These placements are crucial for students to develop the skills and expertise needed to become safe, competent, and compassionate midwife practitioners. However, access to appropriate placements has become a significant challenge, compounded by increasing student numbers. This review aims to synthesise knowledge on practice placements used in midwifery education and identify strategies to increase placement capacity.
Methods
A scoping review framework was utilised to present a broad understanding and knowledge synthesis of the available literature to identify the types of practice placements currently used within pre-registration midwifery education and identify opportunities to increase capacity for the future. Arksey and O'Malley's five-step framework was utilised and this review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR).
Findings
The review identified eleven papers from five different countries. These papers highlight different practice placements utilised to develop competencies and potentially increase practice placement capacity for midwifery students. Community-based placements helped students understand practitioners' roles, while continuity of care models facilitated skill development and positive practice outcomes. Innovative settings such as student-led clinics and rural placements improved students' competence and learning experiences and are seen as successful strategies to develop competency and increase capacity. However, challenges like work-life balance issues and unclear role delineation were observed in some placements, which had a negative impact on student experiences.
Conclusion
This review emphasises the importance of developing and establishing new practice placement locations to develop competencies and increase the practice placement capacity in pre-registration midwifery education, ultimately leading to more qualified midwives. To achieve this objective, it is essential to explore opportunities in various settings, including midwifery group practices in the community, caseload midwifery practice, birth centres, private midwifery practice, rural placements, student-led activities, and primary care settings such as community health clinics. These findings can guide educational institutions and policymakers in developing diverse, sustainable placement opportunities to meet the growing demand for skilled midwives.
{"title":"Expanding the practice placement capacity in pre-registration midwifery education: A scoping review","authors":"Barbara Lloyd , Carmel Bradshaw , Khayla Timothy , Owen Doody","doi":"10.1016/j.midw.2024.104269","DOIUrl":"10.1016/j.midw.2024.104269","url":null,"abstract":"<div><h3>Background</h3><div>Practice placements are an essential component of midwifery education, enabling students to apply their theoretical knowledge in a real-world midwifery setting. Exposure and immersion to practice is a core focus of midwifery education internationally. These placements are crucial for students to develop the skills and expertise needed to become safe, competent, and compassionate midwife practitioners. However, access to appropriate placements has become a significant challenge, compounded by increasing student numbers. This review aims to synthesise knowledge on practice placements used in midwifery education and identify strategies to increase placement capacity.</div></div><div><h3>Methods</h3><div>A scoping review framework was utilised to present a broad understanding and knowledge synthesis of the available literature to identify the types of practice placements currently used within pre-registration midwifery education and identify opportunities to increase capacity for the future. Arksey and O'Malley's five-step framework was utilised and this review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR).</div></div><div><h3>Findings</h3><div>The review identified eleven papers from five different countries. These papers highlight different practice placements utilised to develop competencies and potentially increase practice placement capacity for midwifery students. Community-based placements helped students understand practitioners' roles, while continuity of care models facilitated skill development and positive practice outcomes. Innovative settings such as student-led clinics and rural placements improved students' competence and learning experiences and are seen as successful strategies to develop competency and increase capacity. However, challenges like work-life balance issues and unclear role delineation were observed in some placements, which had a negative impact on student experiences.</div></div><div><h3>Conclusion</h3><div>This review emphasises the importance of developing and establishing new practice placement locations to develop competencies and increase the practice placement capacity in pre-registration midwifery education, ultimately leading to more qualified midwives. To achieve this objective, it is essential to explore opportunities in various settings, including midwifery group practices in the community, caseload midwifery practice, birth centres, private midwifery practice, rural placements, student-led activities, and primary care settings such as community health clinics. These findings can guide educational institutions and policymakers in developing diverse, sustainable placement opportunities to meet the growing demand for skilled midwives.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"142 ","pages":"Article 104269"},"PeriodicalIF":2.6,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-25DOI: 10.1016/j.midw.2024.104276
Dr Giliane McKelvin , Prof Soo Downe , Prof Gillian Thomson
Women's experiences of childbirth have generally been considered through a pathological lens. Wider sociological arguments associated with salutogenesis stress the need to depict health on a continuum to help understand what constitutes positive health as well as ill-health. Similarly, to fully understand women's experiences of childbirth, it needs to be explored on a continuum, considering salutogenic and pathogenic factors. In this paper we report on qualitative data collected as part of a wider mixed-methods study to describe the continuum of women's different childbirth experiences (‘positive’ ‘neutral’ or ‘traumatic’). A mixed-method explanatory sequential design was undertaken comprising validated measures and in-depth interviews. Primiparous women who were expecting a healthy term infant were recruited and participated in an in-depth semi-structured interview at 12 weeks postnatal. Thematic analysis was used to analyse the data. Ten women took part in an interview and three main themes were identified. The first theme ‘before it all started’ showed how stories impacted women, with women trying to ‘keep an open mind’ or ‘accepting and expecting the worst’. The second theme ‘arriving at the destination’ emphasised the importance of midwifery support through ‘continuous compassionate presence’ while others reported ‘feeling forgotten’. Finally, ‘the days that followed’ highlighted how women tried to ‘focus on the outcome’ while others ‘wished it had gone better’. This study identified how women's subjective appraisals of childbirth are on a continuum and influenced by several factors including birth narratives and the quality of midwifery care from the early onset of labour. The kinds of experiences associated with reports that the birth was ‘neutral’ are reported for the first time.
{"title":"Exploring childbirth experiences through a Salutogenic lens","authors":"Dr Giliane McKelvin , Prof Soo Downe , Prof Gillian Thomson","doi":"10.1016/j.midw.2024.104276","DOIUrl":"10.1016/j.midw.2024.104276","url":null,"abstract":"<div><div>Women's experiences of childbirth have generally been considered through a pathological lens. Wider sociological arguments associated with salutogenesis stress the need to depict health on a continuum to help understand what constitutes positive health as well as ill-health. Similarly, to fully understand women's experiences of childbirth, it needs to be explored on a continuum, considering salutogenic and pathogenic factors. In this paper we report on qualitative data collected as part of a wider mixed-methods study to describe the continuum of women's different childbirth experiences (‘positive’ ‘neutral’ or ‘traumatic’). A mixed-method explanatory sequential design was undertaken comprising validated measures and in-depth interviews. Primiparous women who were expecting a healthy term infant were recruited and participated in an in-depth semi-structured interview at 12 weeks postnatal. Thematic analysis was used to analyse the data. Ten women took part in an interview and three main themes were identified. The first theme ‘before it all started’ showed how stories impacted women, with women trying to ‘keep an open mind’ or ‘accepting and expecting the worst’. The second theme ‘arriving at the destination’ emphasised the importance of midwifery support through ‘continuous compassionate presence’ while others reported ‘feeling forgotten’. Finally, ‘the days that followed’ highlighted how women tried to ‘focus on the outcome’ while others ‘wished it had gone better’. This study identified how women's subjective appraisals of childbirth are on a continuum and influenced by several factors including birth narratives and the quality of midwifery care from the early onset of labour. The kinds of experiences associated with reports that the birth was ‘neutral’ are reported for the first time.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"142 ","pages":"Article 104276"},"PeriodicalIF":2.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-20DOI: 10.1016/j.midw.2024.104274
Kateřina Roberts , Jan Havlíček , S. Craig Roberts , Pavel Calda , Šárka Kaňková
Problem
The aetiology of nausea and vomiting in pregnancy is still not well understood.
Background
Previous research suggests that its incidence and severity are influenced by many different factors, including demographic, lifestyle and psychosocial factors.
Aim
This study aimed to test the effect of multiple factors (use of combined oral contraception (COC) on meeting the father, sex of the foetus, age when pregnant, parity, education, life standard/income, smoking before pregnancy and BMI) on levels of nausea and vomiting in pregnancy.
Methods
We collected data from two independent samples of women attending the same pregnancy clinic in the Czech Republic (Study 1, N = 448; Study 2, N = 508) and tested the effect of multiple factors using two different methodological designs: retrospective self-report (Study 1) and self-reports on their current state (Study 2).
Findings
In Study 1, we found that lower levels of nausea and vomiting were reported by women who used COC when they met their partner, as well as in those who smoked before pregnancy. In Study 2, we found that younger women and women who reported higher household income had relatively severe NVP symptoms.
Discussion
We discuss the pros and cons of the two methodological approaches, as we found different predictors in two otherwise comparable samples.
Conclusion
We suggest that future studies use longitudinal designs and combinations of both current and retrospective measures of nausea and vomiting in pregnancy.
{"title":"Predictors of inter-individual variation in nausea and vomiting in pregnancy in two samples of women attending a pregnancy clinic","authors":"Kateřina Roberts , Jan Havlíček , S. Craig Roberts , Pavel Calda , Šárka Kaňková","doi":"10.1016/j.midw.2024.104274","DOIUrl":"10.1016/j.midw.2024.104274","url":null,"abstract":"<div><h3>Problem</h3><div>The aetiology of nausea and vomiting in pregnancy is still not well understood.</div></div><div><h3>Background</h3><div>Previous research suggests that its incidence and severity are influenced by many different factors, including demographic, lifestyle and psychosocial factors.</div></div><div><h3>Aim</h3><div>This study aimed to test the effect of multiple factors (use of combined oral contraception (COC) on meeting the father, sex of the foetus, age when pregnant, parity, education, life standard/income, smoking before pregnancy and BMI) on levels of nausea and vomiting in pregnancy.</div></div><div><h3>Methods</h3><div>We collected data from two independent samples of women attending the same pregnancy clinic in the Czech Republic (Study 1, <em>N</em> = 448; Study 2, <em>N</em> = 508) and tested the effect of multiple factors using two different methodological designs: retrospective self-report (Study 1) and self-reports on their current state (Study 2).</div></div><div><h3>Findings</h3><div>In Study 1, we found that lower levels of nausea and vomiting were reported by women who used COC when they met their partner, as well as in those who smoked before pregnancy. In Study 2, we found that younger women and women who reported higher household income had relatively severe NVP symptoms.</div></div><div><h3>Discussion</h3><div>We discuss the pros and cons of the two methodological approaches, as we found different predictors in two otherwise comparable samples.</div></div><div><h3>Conclusion</h3><div>We suggest that future studies use longitudinal designs and combinations of both current and retrospective measures of nausea and vomiting in pregnancy.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"142 ","pages":"Article 104274"},"PeriodicalIF":2.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-27DOI: 10.1016/j.midw.2024.104254
Karyn Anderson , Lynn Sadler , John M.D. Thompson , Richard Edlin
Problem
Women who receive midwifery continuity-of-care require fewer interventions, generating significant cost savings for health services. Existing cost models were based on studies including low-risk pregnancies, limiting generalisability.
Background
New Zealand (NZ) is the only high-income country with a fully integrated midwifery continuity of care model facilitating study of real-world costs by model of care.
Aim
To compare healthcare utilisation and pregnancy-related public healthcare cost for private obstetricians and other community maternity caregivers (GPs, midwives), and planned caesarean compared to intended vaginal birth, within the NZ continuity-of-care maternity system.
Methods
Population-based cohort study including singleton pregnancies under private obstetrician and community maternity care with live birth January 2016 - June 2020. Administrative data were used to identify healthcare utilisation and associated cost for mothers and their infant(s) until 1 year post birth, using generalised linear model techniques.
Findings
248,424 singleton pregnancies were included. Adjusted mean costs were significantly higher for private obstetricians than community maternity caregivers (mostly midwives) ($1,096, 95 % CI $813 – 1,378). Elective caesarean section was more costly than intended vaginal birth ($4,316, 95 % CI $4,105 – 4,527). Within each intended mode of birth, pregnancies cared for by private obstetricians were more costly than community maternity caregivers.
Discussion
Consistent with existing literature, continuity of care by independently practicing midwives was less costly in NZ after adjustment for demographic and clinical differences.
Conclusions
Funding structures and population pregnancy risk profile are important considerations in the implementation of midwifery-led continuity of care models.
Statement of significance
Problem: Health systems seek to improve maternity care and contain healthcare budgets.
What is already known: Women cared for by continuity-of-care midwives experience lower rates of preterm birth, obstetric intervention, and improved satisfaction compared to other models of care. It has been reported as cost-effective in a clinical trial setting among low-risk women.
What this paper adds: This study uses real-world data from New Zealand, the only country with fully integrated midwifery continuity-of-care, to establish that midwifery care is cost-saving for public healthcare systems compared to maternity care provided by private obstetricians, when adjusted for obstetric risk factors.
{"title":"The impact of caregiver and intended mode of birth on the public cost of care: Cost analysis of maternity and neonatal care in New Zealand","authors":"Karyn Anderson , Lynn Sadler , John M.D. Thompson , Richard Edlin","doi":"10.1016/j.midw.2024.104254","DOIUrl":"10.1016/j.midw.2024.104254","url":null,"abstract":"<div><h3>Problem</h3><div>Women who receive midwifery continuity-of-care require fewer interventions, generating significant cost savings for health services. Existing cost models were based on studies including low-risk pregnancies, limiting generalisability.</div></div><div><h3>Background</h3><div>New Zealand (NZ) is the only high-income country with a fully integrated midwifery continuity of care model facilitating study of real-world costs by model of care.</div></div><div><h3>Aim</h3><div>To compare healthcare utilisation and pregnancy-related public healthcare cost for private obstetricians and other community maternity caregivers (GPs, midwives), and planned caesarean compared to intended vaginal birth, within the NZ continuity-of-care maternity system.</div></div><div><h3>Methods</h3><div>Population-based cohort study including singleton pregnancies under private obstetrician and community maternity care with live birth January 2016 - June 2020. Administrative data were used to identify healthcare utilisation and associated cost for mothers and their infant(s) until 1 year post birth, using generalised linear model techniques.</div></div><div><h3>Findings</h3><div>248,424 singleton pregnancies were included. Adjusted mean costs were significantly higher for private obstetricians than community maternity caregivers (mostly midwives) ($1,096, 95 % CI $813 – 1,378). Elective caesarean section was more costly than intended vaginal birth ($4,316, 95 % CI $4,105 – 4,527). Within each intended mode of birth, pregnancies cared for by private obstetricians were more costly than community maternity caregivers.</div></div><div><h3>Discussion</h3><div>Consistent with existing literature, continuity of care by independently practicing midwives was less costly in NZ after adjustment for demographic and clinical differences.</div></div><div><h3>Conclusions</h3><div>Funding structures and population pregnancy risk profile are important considerations in the implementation of midwifery-led continuity of care models.</div></div><div><h3>Statement of significance</h3><div><strong>Problem:</strong> Health systems seek to improve maternity care and contain healthcare budgets.</div><div><strong>What is already known:</strong> Women cared for by continuity-of-care midwives experience lower rates of preterm birth, obstetric intervention, and improved satisfaction compared to other models of care. It has been reported as cost-effective in a clinical trial setting among low-risk women.</div><div><strong>What this paper adds:</strong> This study uses real-world data from New Zealand, the only country with fully integrated midwifery continuity-of-care, to establish that midwifery care is cost-saving for public healthcare systems compared to maternity care provided by private obstetricians, when adjusted for obstetric risk factors.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"141 ","pages":"Article 104254"},"PeriodicalIF":2.6,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-22DOI: 10.1016/j.midw.2024.104250
Adele Baldwin , Tanya Capper , Simone Naughton
Problem
Many global health strategies are developed to optimise ‘maternal wellbeing’. However, what is meant by this term and therefore how it is interpreted and understood by different groups of people is currently poorly understood.
Background
For midwives to provide woman-centred care they must recognise the diverse understandings of what is considered ‘maternal wellbeing’ and be able to identify factors underpinning this.
Aim
To identify and synthesise the literature related to the meaning and understanding of the term ‘maternal wellbeing.’
Methods
A search of PubMed, CINAHL Ultimate, OVID and Emcare databases was conducted between 2015 and 2024 for studies related to maternal wellbeing. Data from fourteen studies were charted and thematically analysed.
Findings
Two overarching but interrelated themes were identified. One refers to the inner self, and the second to the woman's place in her social world. Theme 1, sense of self, comprises two sub-themes: finding a sense of self and sustaining a sense of self. Theme 2, the sense of place, comprises two sub-themes: sustaining place and making space in place.
Discussion
Disconnects between the practice-oriented concept of wellbeing and wellbeing as perceived by women exist. Current maternal wellbeing assessment methods only measure the woman's sense of identity, and sense of self in their changed worlds.
Conclusion
Clear articulation of maternal wellbeing is needed to operationalise health strategies, institutional policies, procedures and standards of care that support positive maternal and infant outcomes. Midwives are pivotal to promoting maternal wellbeing during transitions across the pregnancy, birth, and motherhood continuum.
{"title":"My ‘normal’ isn't your normal...What is maternal wellbeing? A scoping review","authors":"Adele Baldwin , Tanya Capper , Simone Naughton","doi":"10.1016/j.midw.2024.104250","DOIUrl":"10.1016/j.midw.2024.104250","url":null,"abstract":"<div><h3>Problem</h3><div>Many global health strategies are developed to optimise ‘maternal wellbeing’. However, what is <em>meant</em> by this term and therefore how it is <em>interpreted</em> and <em>understood</em> by different groups of people is currently poorly understood.</div></div><div><h3>Background</h3><div>For midwives to provide woman-centred care they must recognise the diverse understandings of what is considered ‘maternal wellbeing’ and be able to identify factors underpinning this.</div></div><div><h3>Aim</h3><div>To identify and synthesise the literature related to the meaning and understanding of the term ‘maternal wellbeing.’</div></div><div><h3>Methods</h3><div>A search of PubMed, CINAHL Ultimate, OVID and Emcare databases was conducted between 2015 and 2024 for studies related to maternal wellbeing. Data from fourteen studies were charted and thematically analysed.</div></div><div><h3>Findings</h3><div>Two overarching but interrelated themes were identified. One refers to the inner self, and the second to the woman's place in her social world. Theme 1, sense of self, comprises two sub-themes: finding a sense of self and sustaining a sense of self. Theme 2, the sense of place, comprises two sub-themes: sustaining place and making space in place.</div></div><div><h3>Discussion</h3><div>Disconnects between the practice-oriented concept of wellbeing and wellbeing as perceived by women exist. Current maternal wellbeing assessment methods only measure the woman's sense of identity, and sense of self in their changed worlds.</div></div><div><h3>Conclusion</h3><div>Clear articulation of maternal wellbeing is needed to operationalise health strategies, institutional policies, procedures and standards of care that support positive maternal and infant outcomes. Midwives are pivotal to promoting maternal wellbeing during transitions across the pregnancy, birth, and motherhood continuum.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"141 ","pages":"Article 104250"},"PeriodicalIF":2.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142746962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-19DOI: 10.1016/j.midw.2024.104241
Annemarie (Annie) De Leo , Linda Sweet , Peter Palamara , Dianne Bloxsome , Sara Bayes
Background
Incorporating evidence-based approaches in maternity care throughout the entire trajectory from pregnancy through to the postnatal phase is integral to good public health. Yet, despite developing theories, frameworks, and models to guide midwives’ implementation efforts, implementing new evidence-based practices in midwifery practice settings remains challenging.
Methods
An exploratory study design was used to conduct an initial assessment of the appeal and suitability of an implementation ‘how to’ Toolkit for Australian change-leader midwives. We aimed to determine the effectiveness of the intervention by evaluating midwives’ experience of using the Toolkit, and report on the usability of the Toolkit in maternity care. We also sought to establish the degree to which the intervention could reach a broad cross-section of midwives, confirming the usability of the Toolkit across a range of public and private maternity services.
Results
Twenty-four midwives participated in our study. Participants provided practical Toolkit evaluation data, contextual information related to Toolkit content, their understanding of what implementation in a healthcare context is, and factors that hindered midwives' implementation efforts in clinical settings. The importance of co-design research and involving end-users in product development were also highlighted as crucial factors underpinning the effectiveness of resources like ours, particularly those designed to support specialist disciplines and the implementation challenges experienced by health practitioners in clinical environments.
Conclusions
It is crucial to progress health care practitioners understanding of how to accelerate the implementation and sustainment of new evidence-based practices in clinical settings, including strategies to support organisational readiness, local barriers or challenges, and partnerships between researchers and end-users. Evaluation of our midwifery-specific implementation Toolkit indicates health professionals require tailored materials and information specific to their disciplines and clinical work environments; ideally, packaged in a centalised, open-access format. Future research is required to evaluate the mid-to-longterm impact of our Toolkit on implementation initiatives in midwifery contexts, and to establish the adaptability of our Toolkit in other settings, and with other disciplines.
{"title":"How valuable is an implementation toolkit for midwives? An exploratory study","authors":"Annemarie (Annie) De Leo , Linda Sweet , Peter Palamara , Dianne Bloxsome , Sara Bayes","doi":"10.1016/j.midw.2024.104241","DOIUrl":"10.1016/j.midw.2024.104241","url":null,"abstract":"<div><h3>Background</h3><div>Incorporating evidence-based approaches in maternity care throughout the entire trajectory from pregnancy through to the postnatal phase is integral to good public health. Yet, despite developing theories, frameworks, and models to guide midwives’ implementation efforts, implementing new evidence-based practices in midwifery practice settings remains challenging.</div></div><div><h3>Methods</h3><div>An exploratory study design was used to conduct an initial assessment of the appeal and suitability of an implementation ‘how to’ Toolkit for Australian change-leader midwives. We aimed to determine the effectiveness of the intervention by evaluating midwives’ experience of using the Toolkit, and report on the usability of the Toolkit in maternity care. We also sought to establish the degree to which the intervention could reach a broad cross-section of midwives, confirming the usability of the Toolkit across a range of public and private maternity services.</div></div><div><h3>Results</h3><div>Twenty-four midwives participated in our study. Participants provided practical Toolkit evaluation data, contextual information related to Toolkit content, their understanding of what implementation in a healthcare context is, and factors that hindered midwives' implementation efforts in clinical settings. The importance of co-design research and involving end-users in product development were also highlighted as crucial factors underpinning the effectiveness of resources like ours, particularly those designed to support specialist disciplines and the implementation challenges experienced by health practitioners in clinical environments.</div></div><div><h3>Conclusions</h3><div>It is crucial to progress health care practitioners understanding of how to accelerate the implementation and sustainment of new evidence-based practices in clinical settings, including strategies to support organisational readiness, local barriers or challenges, and partnerships between researchers and end-users. Evaluation of our midwifery-specific implementation Toolkit indicates health professionals require tailored materials and information specific to their disciplines and clinical work environments; ideally, packaged in a centalised, open-access format. Future research is required to evaluate the mid-to-longterm impact of our Toolkit on implementation initiatives in midwifery contexts, and to establish the adaptability of our Toolkit in other settings, and with other disciplines.</div></div>","PeriodicalId":18495,"journal":{"name":"Midwifery","volume":"141 ","pages":"Article 104241"},"PeriodicalIF":2.6,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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