Lois McKellar

Enhancing Fathers' Educational Experiences During the Early Postnatal Period

Since the 1970s, men have been encouraged to actively participate in the childbirth process, resulting in a shared experience for couples. Nevertheless, after the baby is born, many fathers find themselves displaced, unsure of how to embrace the transition to parenthood. The shift in cultural practice and evolving needs of families calls for the recognition of fathers as well as mothers in the provision of midwifery services. Innovative strategies must be considered to enhance postnatal education that is father-inclusive and responsive to the needs of families in the 21st century. This article introduces one strategy created from an action research study conducted to develop, implement, and evaluate strategies to improve postnatal education for parents.

Nausea and vomiting in pregnancy: Blooming or bloomin' awful? A review of the literature

BACKGROUND Nausea and vomiting in pregnancy (NVP) is a normal, commonly experienced affliction of early pregnancy. Despite this, its impact on womens lives is not necessarily minimal. For some women, the implications of NVP are substantial with multi-faceted effects, hindering their ability to maintain usual life activities, and particularly their ability to work. In an effort to understand the effect of NVP, several researchers have developed NVP measurement tools, which enable an understanding of NVPs effect on quality of life (QOL). PROBLEM This paper seeks to provide a review of the literature to explore the impact of NVP on womens quality of life, particularly their ability to maintain social and professional commitments. METHOD Medline, CINAHL, PsychINFO, Ebsco, Science Direct, Health Source, Academic Search Premiere, Cochrane databases were extensively searched using Boolean operators with various combinations of relevant terms: nausea, vomiting, pregnancy, emesis, quality of life, QOL, NVPQOL, PUQE, SF-12, SF-36 and limited to those published from 1999 onwards. Papers were scrutinised to include those discussing the impact of normal NVP on womens lives, particularly their QOL with careful exclusion of those addressing hyperemesis gravidarum (HG). FINDINGS NVP has a significant effect on womens QOL and therefore their ability to maintain day-to-day activities as well as work capacity. This has implications for the woman, her partner, her family and her employers. CONCLUSION It is important that all maternity care workers consider the impact of NVP on the womans QOL and that care is given not to minimise this experience. Further research is warranted which considers ways in which women can best manage this experience in relation to social and professional commitments. Given the authors were able to identify only one Australian study in this area, published in 2000 and utilising non-NVP specific QOL measurement tools, there exists scope for additional local studies using NVP-specific QOL tools to determine the impact of QOL for Australian women and therefore Australian society.

Access or Egress? Questioning the "Ethics" of Ethics Committee Review for an Ethnographic Doctoral Research Study in a Childbirth Setting

In this article, we discuss the principal difficulties in gaining ethics approval for an ethnographic midwifery doctoral research project in a hospital setting in South Australia. The research focus is on the various personal, social, institutional and cultural influences on women making a choice about whether or not to use epidural analgesia in labour. The obstacles encountered in gaining human research ethics committee (HREC) approval are discussed within the wider context of the benefits of ethnography as a research methodology, as well as the potential consequences to ethnography when assessed by quantitative research standards. By sharing our experience, we add to the current literature debating the “ethics” of ethics committee review in qualitative research approval. Engaging with the academic debate surrounding “ethics creep” – the increasing jurisdiction of ethics committees over research design – we consider the possibility of moving beyond principle-based ethics towards an ethical theory that more fully addresses the complexities of ethnographic research.

Paradox of the institution: findings from a hospital labour ward ethnography

BackgroundInterest in the influence of culture on birth practices is on the rise, and with it comes a sense of urgency to implement practices that aid the normalisation and humanisation of birth. This groundswell is occurring despite a broader cultural milieu of escalating technology-use and medicalisation of birth across the globe. Against this background, rates of epidural analgesia use by women in labour are increasing, despite the risk of side effects. Socio-cultural norms and beliefs are likely to influence pain relief choices but there is currently scant research on this topic.MethodsThis study was undertaken to gain insight into the personal, social, cultural and institutional influences on women in deciding whether or not to use epidural analgesia in labour. The study had an ethnographic approach within a theoretical framework of Critical Medical Anthropology (CMA), Foucauldian and feminist theory. Given the nature of ethnographic research, it was assumed that using the subject of epidural analgesia to gain insight into Western birth practices could illuminate broader cultural ideals and that the epidural itself may not remain the focus of the research.ResultsFindings from the study showed how institutional surveillance, symbolised by the Journey Board led to an institutional momentum that in its attempt to keep women safe actually introduced new areas of risk, a situation which we named the Paradox of the institution.ConclusionsThese findings, showing a risk/safety paradox at the centre of institutionalised birth, add a qualitative dimension to the growing number of quantitative studies asserting that acute medical settings can be detrimental to normal birth practices and outcomes.

‘It's your body, but…’ Mixed messages in childbirth education: Findings from a hospital ethnography

OBJECTIVE to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth. DESIGN ethnography. SETTING tertiary hospital in Australian city. PARTICIPANTS sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork. FINDINGS women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence. KEY CONCLUSIONS informed consent is an oft-cited human right in health care, yet in maternity care the micro-politics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices. IMPLICATIONS FOR PRACTICE as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.

‘Determined to breastfeed’: A case study of exclusive breastfeeding using interpretative phenomenological analysis

BACKGROUND Given the significant benefits of breastfeeding, the World Health Organization (WHO) recommend exclusive breastfeeding for six months. Despite numerous strategies aimed at increasing the percentage of babies who are exclusively breastfed, Australia currently has one of the lowest six-month exclusive breastfeeding rates in the developed world. Notably, most research focuses on the early postnatal period (birth-two months) yet the largest decline in exclusive breastfeeding rates is observed between two and six months. AIM This study aimed to understand what enabled a first-time mother to continue exclusively breastfeeding between two and six months in Australia. METHODS The qualitative approach known as interpretative phenomenological analysis (IPA) was used to explore how the new mother understood her exclusive breastfeeding journey. Data was collected retrospectively through a face-to-face, semi-structured interview, then transcribed in full and analyzed using IPAs approach to data analysis. FINDINGS Three main themes were identified as self-determination to achieve exclusive breastfeeding, the influence of social norms in Australian culture, and the impact social supports have on maintaining exclusive breastfeeding. CONCLUSION For this mother, her self-determination to exclusively breastfeed, along with positive social support, outweighed the impact of perceived social norms and negative pressure from significant others to stop exclusive breastfeeding. This qualitative reflection contributes to an understanding of the individual in the breastfeeding journey, uncovering nuances around exclusive breastfeeding that may be helpful in providing support for mothers and direction for further research.

We're all in this together: Midwifery student peer mentoring

Many higher education institutions have adopted mentoring programs for students as a means of providing support, improve learning and enhance the student experience. The aim of this project was to improve midwifery students experience by offering a peer mentoring program to commencing students to assist with the transition to university life and the rigours of the midwifery program. This paper reports the evaluation of this specific mentoring program and the ongoing development and implementation of a sustainable program within an Australian University. A survey design was adopted to gather feedback from both mentees to evaluate if the peer mentoring program enhanced the first year midwifery student experience and ascertain how the program could be further developed. Fifty-five students engaged with the peer mentors and completed the questionnaire regarding the mentoring program. Specifically valuable was the positive impact that mentoring had on midwifery student confidence, managing the demands of the program and being motivated to keep going when the program requirements were challenging. The success of this program rested largely with mentoring students sharing their own experiences and providing reassurance that other students could also succeed.

Critical Medical Anthropology in Midwifery Research: A Framework for Ethnographic Analysis

In this article, we discuss the use of critical medical anthropology (CMA) as a theoretical framework for research in the maternity care setting. With reference to the doctoral research of the first author, we argue for the relevance of using CMA for research into the maternity care setting, particularly as it relates to midwifery. We then give an overview of an existing analytic model within CMA that we adapted for looking specifically at childbirth practices and which was then used in both analyzing the data and structuring the thesis. There is often no clear guide to the analysis or writing up of data in ethnographic research; we therefore offer this Critical analytic model of childbirth practices for other researchers conducting ethnographic research into childbirth or maternity care.

A review of the literature to inform a best-practice clinical supervision model for midwifery students in Australia.

Effective clinical supervision in midwifery programs leading to registration is essential to ensure that students can provide safe and competent woman centred care by the completion of their program. A number of different clinical supervision models exist in Australia and internationally, with varying levels of support and facilitation of student learning opportunities. In Australia, midwifery students must achieve specified learning outcomes and midwifery practice requirements to be eligible to register as a midwife. Identifying a best practice clinical supervision model for Australian midwifery students is therefore a priority for all key stakeholders, particularly education and maternity care providers. The aim of this literature review was to explore different types of clinical supervision models in order to develop and implement a best practice model in midwifery education programs.

Making Sense of Participant Experiences: Interpretative Phenomenological Analysis in Midwifery Research

Selecting the most appropriate methodology for research as a doctoral student is one of the most important yet difficult decisions. Not only should the methodology suit the research question, it is important that it resonates with the philosophy of one’s discipline and produces needed results that will contribute to knowledge. Interpretative phenomenological analysis (IPA) is an approach to qualitative enquiry. IPA seeks to explore how individuals make sense of their major life experiences and is committed to the detailed study of each particular case before moving to broader claims. In the field of midwifery, midwives work with women throughout pregnancy, childbirth and the early postnatal period, offering individualized care based on the unique needs of each woman. IPA aligns with this women-centered philosophy as it offers a methodological approach that considers the individual in a local context. By capturing context specific situations, IPA allows broad-based knowledge to be contextualized within a social and cultural context, producing relevant findings. Thus the access to IPA studies will enable midwives to better care for women and their families through understanding the experiences and perceptions of those in their scope of practice. This paper presents the theoretical framework leading to practical guidelines on how to conduct a doctoral-level IPA study, as experienced by the first author. It also addresses the advantages and challenges around utilizing IPA, illustrated through examples from the doctoral student’s study on the journey of exclusive breastfeeding in Australia.