Ros Bramwell

Health professionals' and service users' interpretation of screening test results: experimental study

Abstract Objective To investigate the accuracy of interpretation of probabilistic screening information by different stakeholder groups and whether presentation as frequencies improves accuracy. Design Between participants experimental design; participants responded to screening information embedded in a scenario. Setting Regional maternity service and national conferences and training days. Participants 43 pregnant women attending their first antenatal appointment in a regional maternity service; 40 companions accompanying the women to their appointments; 42 midwives; 41 obstetricians. Participation rates were 56%, 48%, 89%, and 71% respectively. Measures Participants estimated the probability that a positive screening test result meant that a baby actually had Downs syndrome on the basis of all the relevant information, which was presented in a scenario. They were randomly assigned to scenarios that presented the information in percentage (n = 86) or frequency (n = 83) format. They also gave basic demographic information and rated their confidence in their estimate. Results Most responses (86%) were incorrect. Obstetricians gave significantly more correct answers (although still only 43%) than either midwives (0%) or pregnant women (9%). Overall, the proportion of correct answers was higher for presentation as frequencies (24%) than for presentation as percentages (6%), but further analysis showed that this difference occurred only in responses from obstetricians. Many health professionals were confident in their incorrect responses. Conclusions Most stakeholders in pregnancy screening draw incorrect inferences from probabilistic information, and health professionals need to be aware of the difficulties that both they and their patients have with such information. Moreover, they should be aware that different people make different mistakes and that ways of conveying information that help some people will not help others.

Expectations and experience of labial reduction: a qualitative study

Objective  To understand women’s reasons for undergoing labial reduction surgery, their expectations and experiences.

Blood and Milk: Constructions of Female Bodily Fluids in Western Society

ABSTRACT This paper explores ways in which these essentially ‘female’ bodily fluids are constructed in Western societies. It first reviews the context of menstruation and lactation in modern Western societies. It next considers menstruation and breastfeeding as affirmations of womanhood, and then the extent to which breast milk and menstrual blood are considered ‘good,’ ‘different’ to other milk and blood, sexual and disgusting. Finally, it discusses pressures which arise from the marketing of related products. The paper suggests that womens belief in their ability to nourish their infant from their own body may be undermined by negative constructions of womens bodily fluids which ‘product’-based promotion of breast milk may fail to address.

An empirical evaluation of a psychoanalytic theory of mothering orientation: implications for the antenatal prediction of postnatal depression

This study was designed to determine (a) whether womens antenatal expectations of childbirth, their future baby and early motherhood vary in line with Raphael‐Leffs Facilitator–Reciprocator–Regulator model of mothering orientation, and (b) whether a Regulator orientation confers greater relative risk for early postnatal depression. A sociodemographically representative sample of 205 primiparous women completed a maternal orientation measure and the General Health Questionnaire in late pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) at 6–8 weeks postpartum. Hierarchical cluster analysis was employed to cluster cases on the basis of antenatal expectations of their future baby and early motherhood and yielded a clear three‐cluster solution. Between‐cluster comparisons of womens ratings on these variables, and of childbirth and feeding expectations, suggested cluster membership did correspond with Facilitator, Regulator and Reciprocator mothering orientations. In line with theory, women reporting a Regulator mothering orientation were at increased independent risk (OR 3.28, 95% CI 1.23–9.25) for above‐threshold postnatal depression symptom levels (EPDS>10.5). Furthermore, in a hierarchical regression analysis, Regulator mothering orientation accounted for a significant proportion of variance in postnatal symptom level even after controlling for antenatal depression symptom level.

A new stressor scale for parents experiencing neonatal intensive care: The NUPS (Neonatal Unit Parental Stress) Scale

Whilst stress in parents experiencing neonatal intensive care is widely reported, relatively little is known about the sources, frequency and magnitude of the stress reactions of mothers and fathers at various stages of the experience. General scales of anxiety and/or depression reveal high levels of mood disorder; however, they fail to highlight particular issues which may inform the development of effective intervention strategies. Studies have used various theoretical models, and the instruments and methods vary considerably. The PSS:NICU is the only situation‐specific scale in current use; however, there may be questions as to its comprehensiveness. This study reports on the psychometric properties of a revised and expanded stressor scale given to parents early in their stay and where applicable at a second stage, along with a concurrent assessment of general anxiety/depression (HADS) and a rating of the quality of perceived social support (FAD‐GF). 748 parental responses were obtained (mothers 55%, fathers 45%) at 48–72 h, and 10–14 days post birth. Exploratory and confirmatory factor analyses reduced data to three constructs, social/practical, illness/treatments, and role/relationships stress. The scale produced internally reliable results. The study produced reports of stress associated with social and practical difficulties which have not been previously measured. The scale appears to be valid and reliable and discriminates differing aspects of the experience. The stress response must be measured at differing stages of the experience to understand the changing situation.

An intervention study using a breastfeeding positioning and attachment tool

Objective: To investigate whether the introduction of a systematic positioning and attachment checklist in the postnatal ward can improve breastfeeding outcomes. Design: A longitudinal quasi-experimental between-groups design. Setting: A large maternity unit within a British general hospital covering a variety of rural, urban and inner-city areas. Participants: A total of 122 women were recruited with no refusals, 60 to the control and 62 to the intervention phases of the study. All were singleton pregnancies, had not previously breastfed and intended to breastfeed. Intervention: A printed checklist, including diagrams, demonstrating effective positioning and attachment was used every time the women received breastfeeding support from any member of the postnatal ward staff. Measurements: Outcome data was collected by questionnaire at seven days and six weeks. Key outcome measures were method of feeding and degree of nipple pain. Findings: There were trends towards higher rate of exclusive breastfeeding and less nipple pain in the intervention group at both seven days and six weeks, but these differences were not statistically significant. Key conclusions: The findings merit further research with a larger sample, as it has the potential to provide a cost-effective way to improve breastfeeding outcomes.

The development andvalidation of the Breastfeeding Support Skills Tool (BeSST)

Objective to develop and validate a reliable tool which will effectively assess clinical skills in relation to breast feeding. Design the development of the tool followed progressive stages, generating a pool of questionnaire items and then subjecting them to a series of rigorous tests of reliability and validity, in order to produce a tested tool. Setting the North of England. Participants the following groups were recruited for the validation process: 32 breast-feeding experts; 31 working midwives with no specific expertise in breast feeding; and 22 first-year pre-registration student midwives with little or no professional experience in this area. Measures the tool consisted of video footage and a pen and paper questionnaire withboth open and closed questions which were then scored numerically. Results the final validated tool consisted of video footage and 30 items (20 open and 10 closed). All open items showed high inter-rater reliability (κ≥0.6). All items produced a good spread of scores and were able to distinguish significantly between level of expertise ( P Conclusions the Breastfeeding Support Skills Tool developed has demonstrated reliability and validity.

Do maternal screening tests provide psychologically meaningful results? Cognitive psychology in an applied setting

Prenatal screening tests such as maternal serum screening for Down Syndrome, Edwards Syndrome and neural tube defects are now a routine feature of antenatal care. These tests assess the probability that the foetus has one of these conditions, and those at high risk are offered further testing. This paper seeks to examine whether the screening tests provide a benefit to women being screened. Cognitive psychology research suggests that our reasoning based on probabilistic information is not usually consistent with the formal laws of mathematics. Instead, we may rely on reasoning heuristics such as ‘representativeness’. Research has consistently shown that, when provided with all information relevant to a screening test, we tend to either over‐ or underestimate the probability that the screening result indicates a ‘true’ as opposed to ‘false’ positive result. Applied research into the experience of prenatal screening has used very different methodologies, but the findings are consistent with those from lab‐based cognitive psychology research. The implications may be that probabilistic screening information does not provide useable information and therefore does not promote informed choice. Tests may also fail to offer reassurance, or offer false reassurance.

An initial quantitative study of the relationship between attitudes to menstruation and breastfeeding

Objective: This study took a feminist psychology perspective, postulating that attitudes to breastfeeding can be understood in terms of broader attitudes towards the female body. It was a first test of the hypothesis that breastfeeding attitudes and behaviour would be related to attitudes to menstruation. Study design: Correlational questionnaire study with a British general population sample of 457 respondents (75% response rate) aged from 16 to 68 (mean = 30). Questionnaires included the Menstrual Attitudes Questionnaire, positive attitudes to breast and to bottlefeeding, and reactions to breastfeeding scenarios, along with questions on demographics and past breastfeeding behaviour. Results: The results showed weak but significant relationships between some menstrual attitudes and attitudes to breastfeeding, and with past breastfeeding behaviour. Conclusions: Feminist theory about the negative construction of the female body suggests that broader social attitudes may undermine womens belief in their ability to nourish their infant from their own body, and these results are consistent with this hypothesis. Such attitudes may need to be addressed if breastfeeding is to become more prevalent.

Guest Editorial: Perspectives on menstrual cycle experiences

When we were asked to edit a special edition on the menstrual cycle, our aim was to gather a range of papers which reflected the diversity of theoretical and research perspectives in the area. The result is a collection of papers which approach a range of aspects of menstrual experience from diverse and even competing perspectives. The first four papers in the special issue consider experiences of the menstrual cycle across the lifespan, while later papers consider the historical development of PMS and evidence for self-help and alternative treatments. The four papers which examine women’s experience of the menstrual cycle take very different perspectives. The paper by Janette Perz and Jane Usher is based on feminist psychology theory, whilst that by Tamara Newton, Rebecca Weigel and Cherie Watters takes an evolutionary approach based on socio-ethological animal models, and Ros Bramwell and Rabia Zeb adopt a cultural perspective. Jerilynn Prior views menstruation in middle life from a viewpoint which, interestingly, combines personal reflection with physiological research. These approaches seem to be completely contrasting, but while they draw on a wide variety of methods, they all share the same central conclusion: women’s experiences—physiological and psychological—are positioned within their social world and can change and deviate from the ‘norm’. In contrast to medical models of the cycle, women’s experiences do not necessarily fit either a ‘normal’ 28 day cycle or a definition of ‘illness’. Newton, Weigel and Watters discuss the causes and consequences of different cycle lengths in younger women, whilst Prior looks at our experiences as cycles change in the perimenopause. Menstrual cycle research has tended to centre on younger women and standard 28 day cycles. These papers provide thought-provoking analysis of periods when the cycles are not standard—at the beginning and the end of menstruating. The menstrual cycle, and especially the premenstrual phase, is experienced negatively by many women, many of whom seek treatment for the condition. A great deal of research has focussed on PMS and pharmacotherapy. In a historical review, Uriel Halbreich, who has himself a long history in biomedical menstrual cycle research, reflects on how different perspectives have driven different treatment approaches. If Horney, rather than Dalton, had become the ‘mother’ of PMS treatment, would pharmacological approaches have been less common and psychological ones more supported by research and practice? Halbreich argues that the Anglo-centric research base which favours research published in English has meant that important JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY, VOL. 24, NO. 4, NOVEMBER 2006, pp. 287–288