Christine Furber

A qualitative study of mild to moderate psychological distress during pregnancy

BACKGROUND Psychological distress is common in the antenatal period. In England, psychological distress is classified as mild, moderate or severe but only those who suffer severe psychological distress are referred to the specialist mental health services. Those who suffer mild to moderate psychological distress are managed by the primary care services. However, little is know about the psychosocial experiences of pregnant women who suffer from mild-moderate psychological distress. OBJECTIVE This study explored the experiences of pregnant women who self-reported mild to moderate psychological distress during antenatal care. DESIGN A qualitative study. Data were collected using digitally recorded, face-to-face, semi-structured interviews. Data were analysed using framework analysis. SETTING A large teaching maternity hospital in North West England. PARTICIPANTS Twenty-four pregnant women who self-reported mild to moderate psychological distress to their midwife during routine antenatal care. RESULTS Three main themes emerged: the causes of, impact of, and ways of controlling self-reported mild to moderate psychological distress. A range of experiences caused psychological distress including past life and childbearing experiences, and current pregnancy concerns. Mild to moderate psychological distress took over the lives of these pregnant women. The strategies used to control mild to moderate psychological distress included both positive and negative coping elements. CONCLUSIONS Psychological distress that is categorised as mild to moderate can be extremely debilitating for pregnant women. Identification of these women in clinical practice is crucial so that effective interventions can be targeted appropriately. Screening criteria that has the efficacy to identify depression and anxiety is needed. We recommend that a multidisciplinary approach to the management of care is developed to address the range of experiences that pregnant women who suffer mild to moderate prenatal psychological distress may have.

Effect on skin hydration of using baby wipes to clean the napkin area of newborn babies: assessor-blinded randomised controlled equivalence trial

BackgroundSome national guidelines recommend the use of water alone for napkin cleansing. Yet, there is a readiness, amongst many parents, to use baby wipes. Evidence from randomised controlled trials, of the effect of baby wipes on newborn skin integrity is lacking. We conducted a study to examine the hypothesis that the use of a specifically formulated cleansing wipe on the napkin area of newborn infants (<1 month) has an equivalent effect on skin hydration when compared with using cotton wool and water (usual care).MethodsA prospective, assessor-blinded, randomised controlled equivalence trial was conducted during 2010. Healthy, term babies (n = 280), recruited within 48 hours of birth, were randomly assigned to have their napkin area cleansed with an alcohol-free baby wipe (140 babies) or cotton wool and water (140 babies). Primary outcome was change in hydration from within 48 hours of birth to 4 weeks post-birth. Secondary outcomes comprised changes in trans-epidermal water loss, skin surface pH and erythema, presence of microbial skin contaminants/irritants at 4 weeks and napkin dermatitis reported by midwife at 4 weeks and mother during the 4 weeks.ResultsComplete hydration data were obtained for 254 (90.7 %) babies. Wipes were shown to be equivalent to water and cotton wool in terms of skin hydration (intention-to-treat analysis: wipes 65.4 (SD 12.4) vs. water 63.5 (14.2), p = 0.47, 95 % CI -2.5 to 4.2; per protocol analysis: wipes 64.6 (12.4) vs. water 63.6 (14.3), p = 0.53, 95 % CI -2.4 to 4.2). No significant differences were found in the secondary outcomes, except for maternal-reported napkin dermatitis, which was higher in the water group (p = 0.025 for complete responses).ConclusionsBaby wipes had an equivalent effect on skin hydration when compared with cotton wool and water. We found no evidence of any adverse effects of using these wipes. These findings offer reassurance to parents who choose to use baby wipes and to health professionals who support their use.Trial registrationCurrent Controlled Trials ISRCTN86207019

The Challenges and Realties of Diaper Area Cleansing for Parents

OBJECTIVE To explore the complexities of diaper area cleansing reported by women participating in a randomized controlled trial designed to compare optimally formulated baby wipes (Johnsons Baby Skincare fragrance free wipe) with cotton wool and water. DESIGN A mixed-method design incorporating quantitative and qualitative methods to explore maternal views and experiences of using baby wipes or cotton wool and water to cleanse their newborns diaper area over an 8-week period. SETTING Participants were recruited from a large regional maternity hospital in Northern England. PARTICIPANTS Participants included 280 women and their healthy term newborns; 252 provided 4-week data (90.0%) and 237 provided 8-week data (85.0%). METHODS Data from diaries and structured face-to-face interviews at 4 weeks and telephone interviews at 8 weeks were transcribed and thematically analyzed to identify themes. Quantitative data were compared between randomized groups using descriptive statistics and two-group tests, where appropriate. RESULTS Major themes identified highlighted the practical realities of diaper area cleansing, diaper area cleansing and everyday life, and living with the rhetoric that water is best. Baby wipes were perceived as more convenient efficient at cleansing. Some women using cotton wool and water did not cleanse skin after urination alone. Diaper changing was significantly more frequent in the baby wipes group at 4 weeks, but there was no significant difference between the groups at 8 weeks. CONCLUSION Women are faced with a complex environment regarding diaper area cleansing and need clear evidence-based advice and guidance on effective diaper area cleansing.

Promoting interdisciplinarity through educational initiative: a qualitative evaluation

This paper describes a multi-professional teaching innovation that took place at The University of Manchester during October 2001. Ideas for the project were first established in December 2000 when a multi-professional team of educationalists began exploring ways in which three disparate student groups could be brought together as part of an integrated learning activity (). For this reason, a problem-based learning scenario was developed to encourage nursing, midwifery, and medical students to share their previous knowledge and principles of care. In addition, the students were also asked to identify the type(s) of information they felt should be included in a user guide for new parents regarding the uncomplicated labour and puerperium. In total 10-second year nursing, 17-third year midwifery and 13-fourth year medical students volunteered to take part. These were subsequently divided into five integrated problem-based learning groups each supported by two teachers reflecting similar multi-professional backgrounds. In this paper, the discussion will explore a series of themes identified as being of major import by students and tutors during the qualitative phase of the study namely:

A narrative review of fathers’ involvement during labour and birth and their influence on decision making

OBJECTIVE to identify and critically review the research literature that has examined fathers׳ involvement during labour and birth and their influence on decision making. DESIGN the review follows the approach of a narrative review. Systematic searches of electronic databases Social Services Abstract, Sociological Abstracts, ASSIA, CINAHL Medline, Cochrane library, AMED, BNI, PsycINFO, Embase, Maternity and Infant care, DH-Data and the Kings Fund Database were combined with manual searches of key journals and reference lists. Studies published between 1992 and 2013 examining fathers׳ involvement during intrapartum care were included in the review. FINDINGS the findings of this review suggest that fathers׳ level of involvement during labour ranges from being a witness or passive observer of labour and birth to having an active supporting and coaching role. The findings also suggest that there are a number of facilitators and barriers to fathers׳ involvement during labour and birth. There are a limited number of studies that have examined fathers׳ involvement in decision making and specifically how fathers׳ influence decision making during labour and birth. KEY CONCLUSIONS future research needs to address the gap in the literature regarding fathers׳ involvement and influence on decision making to help midwives and obstetricians understand the process in order enhance the transition to parenthood for women and men.

Midwives’ experiences of asking the Whooley questions to assess current mental health: a qualitative interpretive study

Abstract Backgound Perinatal Mental Illness (PMI) is a key cause of maternal mortality and morbidity in the UK, with one goal of midwives to identify those at risk during pregnancy. At present, the system of preliminary identification of existing PMI in the UK involves the midwife asking pregnant women the Whooley questions at the antenatal booking interview. Aim: To explore midwives experiences of asking the Whooley questions with pregnant women. Method: A qualitative interpretive study explored midwives’ (n = 8) experiences of asking the Whooley questions in one maternity unit in England (UK). Data were gathered through semistructured interviews and analysed using Framework Analysis (FWA). Findings: Themes and subthemes identified included: (1) no clear understanding of purpose, (1a) discomfort when disclosure occurs, (2) feeling pressurised for time, (3) resultant dissatisfaction and frustration; (3a) lack of knowledge and how to refer, (3b) lack of training around PMI, (3c) relying on experience and use of intuition. Discussion: The development and evaluation of an education curriculum to prepare midwives to effectively use case-finding instruments such as the Whooley questions to identify pregnant women at risk is required.

Women’s and clinicians perspectives of presentation with reduced fetal movements: a qualitative study

BackgroundWorldwide maternal perception of fetal movements has been used for many years to evaluate fetal wellbeing. It is intuitively regarded as an expression of fetal well-being as pregnancies in which women consistently report regular fetal movements have very low morbidity and mortality. Conversely, maternal perception of reduced fetal movements is associated with adverse pregnancy outcomes. We sought to gain insight into pregnant women’s and clinicians views and experiences of reduced movements.MethodWe performed qualitative semi-structured interviews with pregnant women who experienced reduced fetal movements in their current pregnancy and health professionals who provide maternity care. Our aim was to develop a better understanding of events, facilitators and barriers to presentation with reduced fetal movements. Data analysis was conducted using framework analysis principles.ResultsTwenty-one women and 10 clinicians were interviewed. The themes that emerged following the final coding were influences of social network, facilitators and barriers to presentation and the desire for normality.ConclusionsThis study aids understanding about why women present with reduced movements and how they reach the decision to attend hospital. This should inform professionals’ views and practice, such that appreciating and addressing women’s concerns may reduce anxiety and make presentation with further reduced movements more likely, which is desirable as this group is at increased risk of adverse outcome. To address problems with information about normal and abnormal fetal movements, high-quality information is needed that is accessible to women and their families.

Group psychological intervention for maternal depression: A nested qualitative study from Karachi, Pakistan

AIM To understand the experience of maternal depression, the factors implicated in accessing health, and the acceptability of the psychosocial intervention. METHODS The participants were recruited from the paediatrics outpatient department of Civil Hospital Karachi, Pakistan. The study started in December 2009 and completed in December 2010. Women with maternal depression, aged 18-44 years with children aged 0-30 mo who had received nutritional supplements, and participated in the intervention programme [called Learning through Play (LTP) plus] were included in the study. Qualitative interviews were conducted with 8 participants before the intervention and 7 participants after the intervention. A semi structured topic guide was used to conduct the interviews. RESULTS Framework analysis procedures were used to analyse the qualitative data. Four themes emerged: (1) the women’s contextual environment: Interpersonal conflicts, lack of social support and financial issues being the major barriers in assessing healthcare; (2) women’s isolation and powerlessness within the environment: Sense of loneliness was identified as a restricting factor to access healthcare; (3) the impact of the intervention (LTP-Plus): Women felt “listened to” and seemed empowered; and (4) empowered transformed women within the same contextual environment: The facilitator provided a “gardening role” in nurturing the women resulting in a positive transformation within the same environment. The women’s homes seemed to be more happy homes and there was a positive change in their behaviour towards their children. CONCLUSION Findings informed the further development and testing of culturally-appropriate psychosocial intervention (LTP+) for addressing maternal depression.

Tackling maternal obesity: Building an evidence base to reflect the complexity of lifestyle behaviour change

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