Maebh Barry

The Limerick Lullaby project: an intervention to relieve prenatal stress.

BACKGROUND stress during pregnancy is common and has been linked to a range of poorer maternal and infant outcomes. Treatment options are few, however, due to difficulties of diagnosis and concerns about the impact of medication on the developing fetus. Singing is an activity with stress reducing and other benefits that may be worth exploring. The aim of this study was to explore the impact of singing lullabies during pregnancy. METHODS participants were recruited at antenatal classes at a metropolitan maternity hospital in Ireland. Six pregnant women participated and learnt to sing three lullabies over four group sessions with musicians. Qualitative in depth interviews were conducted approximately three months later to capture the womens experiences. KEY FINDINGS participants unanimously reported a sense of satisfaction with their participation and all would recommend the programme to a friend. Findings suggest that learning to sing lullabies in pregnancy benefited women in terms of relaxation, in feeling closer to their infants, in connecting with other pregnant women and in providing an additional tool for communication in the early newborn period. Some women described profound feelings of love and connection with the unborn infant while singing the lullabies. IMPLICATIONS FOR PRACTICE the principal value of this intervention is that it is non-pharmacological and easy to implement. At the same time, it appears to be an enjoyable exercise for pregnant women and to have an effect on reducing maternal stress and encouraging infant attachment.

Antenatal stress: An Irish case study

BACKGROUND stress in pregnancy is common and impacts negatively on women, infants and families. A number of factors contribute to high levels of stress in pregnancy, including financial concerns, marital discord, low support systems and low socio-economic status. OBJECTIVES the aim of this study was to evaluate stress anxiety levels and depressive symptoms among low risk women in an area in Ireland that was particularly impacted by the 2008 economic crisis. DESIGN a quantitative descriptive cross-sectional design was used. Data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the Perceived Stress Scale and the State Trait Anxiety Inventory (STAI). Data was collected at a single time during the second trimester. SETTING this paper reports a case study of one maternity service in Ireland. Participants included low risk pregnant women who were attending the hospital clinic for routine antenatal care. RESULTS of 150 questionnaires distributed, 74 completed questionnaires were returned indicating a 49.3% return rate. Findings indicated high levels of stress, anxiety and depressive symptomatology among participants. There were no significant difference in mean EPDS score for different age groups (F4,69=2.48, P=0.052), living arrangements (F4,68=0.90, P=0.5) or usual occupation (F4,69=1.45, P=0.2). A score of ≥ 12 was taken as indicative of probable antenatal depression and 86.5% of participants responded with a score of 12 or above. PSS scores were also high and more than three quarters of respondents scored ≥ 15 (75.6%) and more than a third had scores ≥ 20 (35.1%), out of a total score of 40. There was a significant difference in mean PSS score between the different age groups (F4,69=3.60, P=0.010) but not for living arrangements or usual occupation. A STAI score of ≥ 39 was taken as indicative of antenatal anxiety, and 74.3% of participants responded with a score of 39 or above. There were no significant differences in mean STAI score between the different age groups (F4,68=1.68, P=0.16), living arrangements (F4,67=2.30, P=0.068) or usual occupations (F4,68=1.25, P=0.3). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE this study found high levels of antenatal stress, anxiety, and depressive symptoms in a low risk pregnant population, in an economically impacted region in Ireland. These findings have implications for fetal development and maternal health during pregnancy and in the post partum. Further studies are important to confirm rates and should be conducted over a longer time frame with data collected at more than one point in time, such as mid and late pregnancy. If findings are confirmed, early recognition and treatment of stress, anxiety and depressive symptoms is important to ameliorate some of the harmful effects of these conditions.

Experiences of pregnant women attending a lullaby programme in Limerick, Ireland: a qualitative study.

OBJECTIVE to explore womens experience of singing lullabies in pregnancy and their understanding of possible benefits for themselves and their infants. DESIGN AND PARTICIPANTS over four group sessions with musicians, six pregnant women, all expecting their first baby, learnt to sing three lullabies. Qualitative semi-structured interviews were conducted approximately three months after the birth to capture the womens experiences. Participants were recruited at antenatal classes at a metropolitan maternity hospital in Ireland. FINDINGS The women enjoyed participation in the lullaby project and all felt it benefited them and their babies. Themes uncovered included: (1) beyond words: music and the articulation of deep emotion; (2) a balm for the soul: the power and pleasure of beautiful music; and (3) music and the facilitation of infant development. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: Singing lullabies in pregnancy had a soothing and calming effect and was a pleasant experience for participants. It was also an emotional experience and appeared to facilitate the expression of difficult emotion such as fear and anxiety. This effect is likely to have a significant and positive impact on well-being for pregnant women and as such warrants further exploration.

Working and learning: Post-registration student midwives' experience of the competency assessment process

AIM to explore student midwives experiences of the Clinical Competency Assessment process utilised on the Higher Diploma in Midwifery (18 month) programme. BACKGROUND the assessment of clinical skills and practice has traditionally been an integral part of midwifery educational programmes; however the method of clinical assessment has changed and developed. Similar to other countries, in Ireland assessment of clinical practice is achieved through the utilisation of a broad competency framework provided by the regulatory body, An Bord Altranais (2005) which is yet to be evaluated from a midwifery perspective. METHOD a descriptive qualitative study was undertaken once ethical approval had been granted by the Universitys Ethics Committee. All student midwives (n=20) in one cohort were invited to participate and nine students were interviewed. Interviews were tape recorded. Data were analysed using Burnards (2006) framework. FINDINGS the process of competency assessment was perceived by many of the students to facilitate continuous assessment of clinical practice but there were issues in relation to the language and the number of competencies to be assessed. There were challenges also associated with the written evidence required as part of the assessment with many of the students questioning the usefulness of this in a clinical assessment. A variety of supports were identified and utilised by the students. Continuity and availability of preceptors were noted to be factors impacting on completion of the assessment as were the competing demands of clinical care. RECOMMENDATIONS the findings of this small study are congruent with much of the international literature focusing on clinical competency models. Consideration needs to be given to identifying and integrating into practice, a clearly defined process for competency assessment, by all the relevant stakeholders. An opportunity for feedback throughout the process is considered very significant and the mechanism for this needs to be made explicit in any competency assessment documentation Competency documentation currently in use needs to be reviewed in light of the findings of this study and the rationale for inclusion of a written evidence component needs to be carefully considered. Further research is warranted in relation to the effectiveness of the competency tool in assessing competency in practice.

An evaluation of expectant parents knowledge, satisfaction and use of a self-instructional infant CPR kit

OBJECTIVE in many parts of Europe as in Ireland, maternity services do not provide infant CPR training routinely to expectant or new parents. Little is known of the views of expectant women and their partners about learning the skills of infant CPR as part of their antenatal education. The aim of this study was to evaluate knowledge, satisfaction and use of a 22 minute Self-Instructional Infant CPR kit to facilitate the teaching of infant CPR and the relief of choking in an infant. METHODS expectant women with their partners were recruited through the antenatal education classes from one maternity hospital in Ireland. An uncontrolled pre-post-test design was used and participants were surveyed immediately pre- and post-training and six months following training. FINDINGS the study sample comprised of 77 participants including 42 nulliparous women at least 32 weeks gestation or greater. It found significant difference in knowledge scores following training compared to baseline p=<0.0001 and at six months p=<0.0001 compared to immediate post training for both infant CPR and choking prevention. There was a 70% (n=58) response rate at six months with 84.5% reporting average or above confidence levels for performance of Infant CPR. The multiplier educational effect was 37.9% with 22 out of 58 participants sharing the kits with family and friends. Participants (57 out of 58) indicated that the maternity services should facilitate infant CPR training for expectant women and their partners. CONCLUSION expectant women and their partners are very motivated to learn the skills of infant CPR. The facilitation of a 22 minute self-instructional infant CPR kit is effective in increasing infant CPR knowledge and confidence in parents at six months post training. Findings provide the views of expectant and new parents on the relevance of acquiring the skills of infant CPR as part of their preparation for parenthood.