From worry to hope : an ethnography of midwife – woman interactions in the antenatal appointment

Better outcomes for mother and baby observed in 'midwifery continuity of carer' programmes are attributed to positive midwife-woman relationships formed within these models, but this effect is not fully understood. Like midwife-led care, continuity of midwifery carer in Australia continues not to be seen as mainstream. To advocate for and better understand this continuity of carer model, this study used video ethnography framed by feminism and a critical approach. Midwife-woman interactions in a number of late pregnancy antenatal appointments were observed and filmed. These were at two Sydney hospitals with either the midwifery continuity of carer programme or in standard maternity care. Focus groups and interviews were undertaken. Thematic and content analysis techniques were used. Worry was a common feature of the antenatal appointment. It reflects the worry pregnant women report: worry about pregnancy, their baby, uncertainty about birth and transition to motherhood. 'Dysfunctional' or 'iatrogenic' worry occurred with system-focused midwives invested in standardised/medicalised tasks, whereas 'functional' worry occurred with woman-centred midwives invested in the woman. Hope creation was also seen, although less frequently. It occurred when worry was moderated and linked with adaptation of standardised and medicalised appointment factors, including environment, time, and midwife investment (how she interacted with the woman). Regardless of where they worked, some midwives were 'adaptive experts', but in most instances the midwives in continuity had greater opportunity to adapt. This adaptation resulted in midwife-woman interactions being bidirectional and shared, with discussing and storytelling taking place, rather than one-way midwife telling. These shared interactions created connection, or reflected the connection created by continuity of carer. This study showed the benefit of the midwifery continuity of carer programme. It provided opportunity for midwives to adapt, worry was moderated, and women appeared more hopeful. Being more hopeful may enable women to better manage their labours and parenting, creating these improved outcomes

Introducing video into maternity care research : lessons learned

Introduction: Media can have powerful influences on the public perception of birth, including women and families and health care professionals. Examination of media is critical to understanding its influence and to using it as a potential intervention in the health care of women and their families. Methods: This workshop will present an introduction to aspects of researching the effect of media and its use as an intervention and as research tool. The presenters will describe several research methods in media analysis, demonstrate methodological approaches, present findings from their own studies, and will discuss future areas for research. Results: Participants will be encouraged to bring their own ideas for media research, which will be explored in an interactive group process. At the end of the workshop ideas for future collaboration and an interest group will be identified. Conclusion: The future of media research in health care is promising. Capturing its power to influence women's perceptions of pregnancy and birth as opportunities to establish the health of their infant is an important goal for researchers and health professionals

The experience of women following first acute coronary syndrome: An integrative literature review

Aim There is lack of evidence and research understanding among women\u27s lived experiences following first acute coronary syndrome, thus their recovery process remains poorly understood. To date research has largely focused on men\u27s experience of acute coronary syndrome while this area of health care and recovery has considerable impact on women\u27s health and quality of life. Our aim was to review the literature exploring lived experience of women following first acute coronary syndrome. Design Integrative review of the literature. Data Source We searched PubMed, MEDLINE, EMBASE, CINAHL and Scopus from 2008–2018 for articles published in English. Review Method Of 1675 publications identified, 18 qualitative, quantitative, and mixed method studies met our inclusion criteria. Quality of included studies was assessed using Joanna Briggs Institute quality assessment tools. Findings were integrated using thematic synthesis. Results Experiencing acute coronary syndrome was reported to have significant impacts on women\u27s lives. The most common issues reported were physical limitations, fear, and uncertainties about the future, sexual dissatisfaction, and social isolation. Women also reported to have higher short- and long-term mortality rate, stroke, recurrent, and hospital readmissions compared with men. Conclusion This review identified current knowledge and gaps about lived experience of women following first acute coronary syndrome. It is anticipated that the information gained from this literature review will support new research aimed at improving the care women receive following acute coronary syndrome and therefore enhance their recovery and quality of life. Impact This review contributes to the current body of knowledge by addressing women\u27s physical, psychosocial, and sexual state following acute coronary syndrome. Improvement in women\u27s quality of life after acute coronary syndrome necessitates further research which ultimately results in better management and treatment of women and their recovery following first acute coronary syndrome

The midwives' and women's interaction study

Introduction: Cochrane reviews report better outcomes for women receiving midwife-led care but these do not explain the nature or components midwifery continuity of carer (MCOC) interactions that achieve improved results. Aim: To gain greater understanding of midwife-woman interactions in antenatal appointment in order to identify facilitators and inhibitor of exemplary practice and translate this knowledge into improved midwifery care. Method: A critical feminist ethnography was used. Data collection included videoed observations of midwife-woman interactions in late pregnancy antenatal appointments, interviews and focus groups with women, midwives and managers. Ten midwife-woman pairs from Midwifery Group Practice (MGP) and from Standard Midwifery Care (SMC) and four managers from two Sydney, suburban hospitals participated. Thematic and descriptive analysis was used. Findings: Factors enhancing the woman's experience included midwife communication style, appointment environment, midwife investment in the woman's care and repeated antenatal appointment encounters between the same midwife and woman in MGP. Shared storytelling was identified as important to women's experiences, engendering compassion and enhanced healthcare messages. Environmental influences included appointment location, room setup and midwife strategies to engage with the woman. Factors inhibiting woman-centred care included a lack of acute-care hospital system knowledge about midwife-led care and MCOC. Conclusion: Concepts of respect; trust; protection of women's autonomy; flexibility; time and access to continuity of care were more evident in MGP. Conversely, the acute-care hospitals demonstrated they struggled to establish MGP and more ‘woman centred’ programs because focusing on these concepts was ‘at odds’ with the fragmented organisation of healthcare. Strategies identified to improve midwifery care include: more community-based and home-based antenatal care; more midwifery-led care programs offering MCOC; training strategies focused on midwifery communication and knowledge of woman-centred care; and support for hospitals to provide woman-centred healthcare

Working with worry and inspiring hope : relationships with anxious and fearful women

This chapter will focus on how women and their families know and trust midwives and doctors, and why this is important for the journey they make. How does fear and anxiety influence women in the choices they make for their care during pregnancy, birth and beyond? The power of a trusting relationship and how this can change the experiences for women during their childbirthing journey. Some women choose care that may be considered out of step with current evidence, why is that and what do we need to do so that care meets everyone’s needs