Margaret Duff

Contradictions and conflict : a meta-ethnographic study of migrant women's experiences of breastfeeding in a new country

BackgroundStudies report mixed findings about rates of both exclusive and partial breastfeeding amongst women who are migrants or refugees in high income countries. It is important to understand the beliefs and experiences that impact on migrant and refugee women’s infant feeding decisions in order to appropriately support women to breastfeed in a new country. The aim of this paper is to report the findings of a meta-ethnographic study that explored migrant and refugee women’s experiences and practices related to breastfeeding in a new country.MethodsCINAHL, MEDLINE, PubMed, SCOPUS and the Cochrane Library with Full Text databases were searched for the period January 2000 to May 2012. Out of 2355 papers retrieved 11 met the inclusion criteria. A meta-ethnographic synthesis was undertaken using the analytic strategies and theme synthesis techniques of reciprocal translation and refutational investigation. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.ResultsEight qualitative studies and three studies reporting both qualitative and quantitative data were included and one overarching theme emerged: ‘Breastfeeding in a new country: facing contradictions and conflict’. This theme comprised four sub-themes ‘Mother’s milk is best’; ‘Contradictions and conflict in breastfeeding practices’; ‘Producing breast milk requires energy and good health’; and ‘The dominant role of female relatives’. Migrant women who valued, but did not have access to, traditional postpartum practices, were more likely to cease breastfeeding. Women reported a clash between their individual beliefs and practices and the dominant practices in the new country, and also a tension with family members either in the country of origin or in the new country.ConclusionMigrant women experience tensions in their breastfeeding experience and require support from professionals who can sensitively address their individual needs. Strategies to engage grandmothers in educational opportunities may offer a novel approach to breastfeeding support.

Midwives and oral health care during pregnancy: perceptions of pregnant women in south-western Sydney, Australia.

AIMS AND OBJECTIVE This study sought to explore the perceptions of pregnant women in Australia towards oral health care during pregnancy and their views regarding midwives providing oral health education, assessment and referrals as part of antenatal care. BACKGROUND Maintaining oral health during pregnancy is important. Yet, many pregnant women do not access dental services during this time. Antenatal care providers are now recommended to promote maternal oral health, and various countries have adopted this strategy. However, in Australia, a lack of emphasis is placed on maternal oral health especially by antenatal care providers. Currently, a preventive programme is being developed to promote maternal oral health with the help of midwives in Australia. Very little is known about the perceptions of such an approach from pregnant women. DESIGN Qualitative approach. METHOD Data were collected via semi-structured telephone interviews with 10 pregnant women residing in south-western Sydney. RESULTS Thematic analyses of the data suggest a high prevalence of poor oral health among pregnant women, especially those socioeconomically disadvantaged. The findings also highlight various barriers deterring these women from seeking dental care the most significant being lack of dental awareness, high treatment costs and misconceptions about dental treatment during pregnancy. The absence of affordable dental care remains a major barrier in Australia. The proposed preventive programme was well received by women although issues such as education for midwives and referral pathways were highlighted. CONCLUSIONS The findings suggest that a tailored midwifery-initiated oral health programme has potential in Australia, especially for low-income families as it addresses many existing barriers to dental care. RELEVANCE TO CLINICAL PRACTICE Antenatal care providers in Australia should provide more information about oral health. These health professionals should be adequately educated to promote oral health. Health services should also consider offering pregnant women affordable and accessible dental services.

Piloting of an oral health education programme and knowledge test for midwives

Abstract Research shows limited emphasis being placed on oral health by midwives in Australia and the need for further education in this area. The study aim was to pilot a midwifery oral health education programme and knowledge test and identify any flaws in its content and design. Twenty-two midwives from an antenatal ward in South-Western Sydney completed the programme and 12 feedback forms/knowledge tests were returned. Data was analysed using descriptive statistics and content analysis. Feedback data showed all midwives appreciated that the programme was available online and self-paced. Most found the programme extremely informative and following completion were more confident in promoting maternal oral health. The mean correct responses in the knowledge test was 79% (SD = 12.3) which suggests most items were suitable for assessing knowledge improvement. However, in three items midwives had low correct responses. Various aspects that could be improved or clarified were identified and suggestions discussed.

Vaginal Examination During Normal Labor: Routine Examination or Routine Intervention?

Despite a continuing lack of good quality studies of the effect of routine vaginal examination, it is often routinely used in clinical practice. Indeed, internationally respected authorities such as the U.K. National Institute for Health and Clinical Excellence (NICE) continue to recommend the offer of a vaginal examination when a woman enters a hospital in suspected established labor and 4 hourly vaginal examinations as labor progresses. In this article, we explore historical and clinical drivers for the widespread implementation of routine vaginal examination in labor to predominantly assess the dilation of the cervical os and examine some of the reasons for continuing use of the procedure, current critiques of its routine use, and possible alternatives for assessing labor progress. We discuss the possibility that both covert and overt knowledge operate in the assessment of labor progress, and we consider the consequent potential for dissonance between what midwives actually do and what they record as having been done. The final discussion theorizes these findings and suggests alternative ways of framing labor progress for the future.

Historical perspectives: a snapshot of women admitted to psychiatric facilities with psychosis or mania after childbirth in the late Victorian and inter-war periods

AIM This study analysed historical healthcare records to investigate how women diagnosed with mania or psychosis and admitted to two mental health facilities in Australia following childbirth, were described in the late Victorian (1885-1895) and inter-war period (1925-1935). BACKGROUND Although historians have examined the history of mental health systems in Australia, there is no published scholarship that considers the healthcare records of these women. This was a unique opportunity to explore these documents. DESIGN An historical study examining healthcare records. The data collection occurred in 2012. METHODS Women admitted to mental health facilities with a diagnosis of psychosis or mania were identified in the admission registers found in the State Record Office of New South Wales and, if available, their healthcare record was transcribed verbatim. The records were imported into NVivo 10 for content analysis to determine the range and scope of information. A further textual analysis was conducted to see if the womans diagnosis was congruent with the outcome of her admission. RESULTS/FINDINGS 155 cases were identified across the two periods. Although, demographic data and the description of the women on admission were remarkably similar, 17% of women were physically, rather than mentally, ill and died soon after admission. The findings demonstrate the importance of current practices such as taking a comprehensive healthcare assessment and the use of antibiotics and sanitary measures during labour and in the postnatal period. CONCLUSION Historical investigations of healthcare records provide legitimacy for current healthcare practices.

Understanding the experience of women admitted to a psychiatric hospital in Sydney with psychosis or mania following childbirth after World War II (1945–1955)

In the present study, we investigated a unique set of historical health-care records of women admitted to a psychiatric hospital in Sydney, Australia with a diagnosis of psychosis or mania after childbirth in the post-World War II (WWII) period, from 1945 to 1955. This research is part of a larger project examining how the descriptions of these women documented in the health-care records from 1885 to 1975 affected their treatment and the outcome of their admission. In the present paper, we report on the findings from an intensive examination of the post WWII documents. Eighteen health-care records from a psychiatric facility (Gladesville Hospital) were identified from admission registers housed in the State Records Office of New South Wales in 2014. Although seven records had been destroyed, 11 were transcribed verbatim. The records contain demographic information; descriptions of the womens signs and symptoms on admission; and information about the women before, during, and after their admission found in letters from relatives or medical staff. A content analysis of admission information showed how the women were described by health-care professionals, but a textual analysis of the records revealed that there were other factors that could have contributed to the womens condition, which might not have been taken into consideration when treatment and care were devised. The present study demonstrates the value of investigating historical health-care records to understand how prevailing attitudes and practices might affect diagnosis and treatment.