Mary Steen

“My midwife said that having a glass of red wine was actually better for the baby”: a focus group study of women and their partner’s knowledge and experiences relating to alcohol consumption in pregnancy

BackgroundWhile it is well established that alcohol can cross the placenta to the foetus and can affect an infant’s development, many women continue to drink during pregnancy. For this reason it is important to determine what information is being provided, what information may be missing, and the preferred sources of information on this issue. In order to improve prevention strategies, we sought to understand the knowledge and experiences of pregnant women and their partners regarding the effects of alcohol consumption during pregnancy.MethodsThe current study utilised a qualitative study design in order to gain insight into the views and experiences of pregnant women, newly delivered mothers and their partners. Focus groups examined the participant’s knowledge about the effects of alcohol consumption during pregnancy, the sources of information on this issue, and the psycho-social influences on their drinking behaviour. Five focus groups were conducted involving a total of 21 participants (17 female). A six-stage thematic analysis framework was used to analyse all focus group discussions in a systematic way.ResultsSeven major themes were identified from the focus group data: 1) knowledge of Foetal Alcohol Spectrum Disorders; 2) message content and sources; 3) healthcare system; 4) society and culture; 5) partner role; 6) evaluation of risk; and 7) motivation. The findings indicated that although the majority of participants knew not to drink alcohol in pregnancy they had limited information on the specific harmful effects. In addition, routine enquiry and the provision of information by health care professionals were seen as lacking.ConclusionsThe findings of this research provide important insights in to the relationship between pregnant women, their partners, and their healthcare providers. Several recommendations can be made on the basis of these findings. Firstly, public health messages and educational materials need to provide clear and consistent information about the effects of alcohol consumption on the developing baby. Additionally, more thorough and consistent routine enquiry for alcohol consumption in pregnant women needs to occur. Finally, it is important to ensure ongoing education for health professionals on the issue of alcohol consumption during pregnancy.

If you can have one glass of wine now and then, why are you denying that to a woman with no evidence: Knowledge and practices of health professionals concerning alcohol consumption during pregnancy

BACKGROUND Alcohol consumption during pregnancy has the potential to cause significant harm to the foetus and the current Australian guidelines state that it is safest not to drink alcohol while pregnant. However, conflicting messages often appear in the media and it is unclear if the message to avoid alcohol is being effectively conveyed to pregnant women. AIMS This research aims to explore the advice that health professionals provide to pregnant women about alcohol consumption; the knowledge of health professionals regarding the effects of alcohol consumption; and their consistency with following the Australian guidelines. METHODS Ten semi-structured face to face interviews were conducted with health professionals who regularly provide antenatal care. These include midwives, obstetricians, and shared care general practitioners. A six-stage thematic analysis framework was used to analyse the interview data in a systematic way to ensure rigour and transparency. The analysis involved coding data extracts, followed by identifying the major themes. FINDINGS Health professionals displayed adequate knowledge that alcohol can cause physical and mental difficulties that are lifelong; however, knowledge of the term FASD and the broad spectrum of difficulties associated with alcohol consumption during pregnancy was limited. Although health professionals were willing to discuss alcohol with pregnant women, many did not make this a routine part of practice, and several concerning judgements were noted. CONCLUSION Communication between health professionals and pregnant women needs to be improved to ensure that accurate information about alcohol use in pregnancy is being provided. Further, it is important to ensure that the national guidelines are being supported by health professionals.

Length of perineal pain relief after ice pack application: A quasi-experimental study

INTRODUCTION Ice pack is effective for alleviating postpartum perineal pain in primiparous women while multiparous womens levels of perineal pain appear to be poorly explored. Ice pack is a low-cost non-invasive localised treatment that can be used with no impact on breastfeeding. However, how long perineal analgesia persists after applying an ice pack is still unknown. OBJECTIVE To evaluate if perineal analgesia is maintained up to 2h after applying an ice pack to the perineum for 20min. METHOD A quasi-experimental study, using a pre and post-test design, was undertaken with a sample size of 50 multiparous women in Brazil. Data was collected by structured interview. The intervention involved a single application of an ice pack applied for 20min to the perineal area of women who reported perineal pain ≥3 by use of a numeric rating scale (0-10), with intact perineum, 1st or 2nd degree lacerations or episiotomy, between 6 and 24h after spontaneous vaginal birth. Perineal pain was evaluated at three points of time: before, immediately after and 2h after applying an ice pack. RESULTS Immediately after applying an ice pack to the perineal area, there was a significant reduction in the severity of perineal pain reported (5.4 vs. 1.0, p<0.0005), which continued for 1h 35min up to 2h after the local application. CONCLUSION Ice pack application for 20min is effective for alleviating postpartum perineal pain and continues to be effective between 1h 35min for up to 2h.

Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study.

BACKGROUND Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries. AIMS To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma. METHODS A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearsons chi-square test was used to measure association between birthing positions and perineal trauma. FINDINGS Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, n=106 (96%) and midwives, n=97 (88%) reported they would be willing to use alternative positions. Majority of mothers had an episiotomy, n=80 (73%) and n=76 (69%) reported they did not give their consent. N=59 (53%) reported they were not given local anaesthesia for an episiotomy. n=30 (27%) of midwives confirmed they performed an episiotomy without local anaesthesia. CONCLUSION Care is not based on current evidence and embedded practices, i.e. birthing in lithotomy position and routine episiotomies are commonly used. However, this survey did find a willingness to change, adapt practice and consider different birthing positions and this may lead to fewer episiotomies being performed.

Promoting continence in women following childbirth.

Continence in women during pregnancy and following childbirth is an important issue that needs to be managed appropriately. Urinary and bowel problems can have numerous negative physical and psychological consequences, and women may be too embarrassed to seek help. Healthcare professionals need to encourage and support women to identify any changes in their normal bowel and bladder habits. They also need to have knowledge of the anatomy and physiology of the urinary, reproductive and digestive systems to understand how continence may be affected during pregnancy and following childbirth.

How to repair an episiotomy.

Rationale and key points Skilful repair of an episiotomy is an important aspect of maternal health care. It is essential that midwives and doctors have the knowledge and skills to undertake this procedure in a safe and effective manner. ▶ An episiotomy should be repaired promptly to reduce blood loss and prevent infection. ▶ Repair of an episiotomy is undertaken in three stages: repair of the vaginal mucosa, repair of the muscle layer and repair of the skin layer. ▶ Adequate pain relief should be provided before suturing. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. Why a rectal examination is recommended before and following repair of an episiotomy. 2. What you would do to improve your suturing skills. 3. The factors that may prevent or delay an episiotomy from healing. Subscribers can upload their reflective accounts at rcni.com/portfolio .

How to perform an episiotomy.

RATIONALE AND KEY POINTS: An episiotomy may be necessary to assist some women to give birth. An episiotomy is a surgical incision intentionally made to increase the diameter of the vulval outlet to enable childbirth. ▶ Midwives and doctors should use their clinical judgement and skills to assess when to perform an episiotomy. ▶ An episiotomy should not be performed routinely; its use should be restricted to certain indications. ▶ Adequate pain relief should be provided before performing an episiotomy. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice. 2. The risk factors that can predispose a woman to having an episiotomy. 3. What you would do if a woman refused to have an episiotomy despite the presence of a clinical indication, such as fetal distress. Subscribers can upload their reflective accounts at: rcni.com/portfolio.

Doing and rethinking. Building resilience with men

Purpose – The purpose of this paper is to present findings from an evaluation of a mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of activities within a multi-dimensional men’s mental health programme, and exploring interactions between social context factors and models of change. Design/methodology/approach – The paper draws on before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning activities, social support and coping strategies, and to situate these within wider environments. Findings – The programme significantly raised the perceived resilience of participants. Activities were engaging for men, while the complex intersection between activities, social networking, and coping strategies course provided opportunities for men to develop resilience in contexts resonant with their male identities. Research limitations/implicat...

Peer support as a resilience building practice with men

Purpose – The purpose of this paper is to present findings from an evaluation of a community mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of facilitated peer support within a multi-dimensional men’s mental health programme, and exploring implications for resilience building delivery approaches for men. Design/methodology/approach – The paper draws on a mixed methodology design involving before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning peer support, and to situate these within wider community environments. Findings – The programme significantly raised the perceived resilience of participants. Project activities promoted trusting informal social connections, gains in social capital arose through trusting relations and skill-sharing, and peer-peer action-focused talk and planning enhanced men’s resilience. Research limi...

Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial

BACKGROUND Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy. AIMS To evaluate if a 10min ice-pack application relieved postpartum perineal pain and if the analgesic effect was maintained for up to 2h. METHODS A randomised controlled trial conducted from December 2012 to February 2013 with 69 primiparous women ≥18 years old, 6-24h postpartum, with perineal pain ≥3, who had not received anti-inflammatory medication or analgesics after childbirth, who were randomised to a single ice-pack application on the perineum for 10min or standard care. The primary and secondary outcomes were a reduction ≥30% in perineal pain intensity, immediately after the application and the maintenance of the analgesic effect for up to 2h, respectively. FINDINGS Immediately post-intervention, the proportion of women whose perineal pain decreased ≥30% was significantly higher in the experimental group. Within 2h, there was no significant difference in the pain levels in both groups. Within 2h, for 61.9% and 89.3% of women in the experimental and control group, respectively, the perineal pain levels remained unchanged. For the remaining participants, perineal pain was increasing after an average time of 1h 45min and 1h 56min for the experimental and control groups, respectively. CONCLUSION By applying an ice-pack for 10min to the perineum, effective pain relief is achieved, that is maintained for between 1h 45min and 2h.