The experience of planned home birth: views of the first 500 women.

BACKGROUND: Home birth remains a contentious issue in North America. Professional regulatory bodies are in conflict about the safety of home birth as an option for healthy women. The voices of women have largely been ignored in this debate. The purpose of this study is to report on the experiences of 559 women who had a planned home birth over a 2-year period in British Columbia, Canada. METHODS: We asked all women in the Province of British Columbia who had planned for their birth to be at home with a regulated midwife in attendance to answer an open-ended question about positive and negative aspects of their birth. The qualitative method of interpretive description was used to understand what women believed to be the essence of their experience. RESULTS: Women felt strongly positive about their trust in their midwife's skill and knowledge, a sense of emotional support and empowerment attained through their relationship with the midwife, perceptions of relaxation in their own home, being informed and included in the planning of their care, and the amount of time the midwife spent with their family. They believed that the confidence arising from their intense preparation and partnership with their midwives permitted them to choreograph their birth experience to a degree that would not be possible in a formal setting. CONCLUSIONS: Women who planned a home birth with a registered midwife in British Columbia were overwhelmingly positive about their experience. Our qualitative report underscores the value women place on having the choice to give birth at home.

Family violence and maternal mortality in the south Asian community: the role of obstetrical care providers.

OBJECTIVE: South Asian women face multiple barriers to accessing information and support if they are experiencing spousal abuse. We conducted a study among South Asian women in Surrey, British Columbia, to define a role for obstetrical care providers in assisting women who experience family violence. METHODS: South Asian women survivors of abuse participated with representatives of family and victim services agencies in a workshop to identify key opportunities for violence prevention and intervention by obstetrical care providers. Participants grouped issues affecting women's vulnerability to violence into four themes and identified strategies to address them. RESULTS: Themes focused on cultural issues, services and supports, education and prevention, and policy and advocacy. Participants highlighted challenges posed by the patriarchal nature of their culture and, for many families, by recent immigration. They emphasized the importance of routine assessment for family violence by obstetrical care providers and stressed the need to treat the entire family, not just the identified victim. They focused on the role of the caregiver as a conduit of information about social services and other resources. Community-level interventions to address abuse were endorsed, including the use of lay media to deliver key messages about health and safety. CONCLUSION: Pregnancy offers caregivers an opportunity to be advocates and to provide information and referrals for women in the South Asian community who may be at risk of violence. Obstetrical caregivers may be an important influence in protecting women from lethal harm.

Restorative health: lessening the impact of previous abuse and violence in the lives of vulnerable girls.

"Restorative health" is the idea that those who have been denied access to the social determinants of health, particularly as young children, should have the right to restoration of healthy functioning. In interviewing a group of vulnerable young women, ranging in age from 15 to 22, we discovered how they experience the link between health and justice in their lives. Participants were living on the street, in extreme poverty, or both. Traumatic early childhood events continued to affect their ability to function healthy. We conclude and suggest that certain rights-based principles need to ground the development of interventions with this group.

The problematic allure of the binary in nursing theoretical discourse.

Recent ideological positioning on the world stage has borne a startling resemblance to a form of positioning within nursing theory--that of taking complex ideas, reducing them to a simplistic binary form, and uncritically adopting one half of that form. In some cases, this adoption of a binary position has led to a passionately held form of "othering" that prohibits a healthy and critical engagement with ideas. As alluring as settling for the binary form may be--we argue for holding binaries in tension as a catalyst for stimulating dialogue--reasoning and exploration of new ways of wrestling with the social and moral complexity of nursing.

Intimate partner violence and adverse pregnancy outcomes: a population-based study.

OBJECTIVES: The purpose of this study was to measure the prevalence of exposure to intimate partner violence during pregnancy and to determine whether such exposure is associated with adverse pregnancy outcomes. STUDY DESIGN: We measured the prevalence of exposure to intimate partner violence and fear of a partner during pregnancy among 4750 residents of Vancouver, British Columbia, who gave birth between January 1999 and December 2000. We undertook a multivariate analysis to examine the associations with second- or third-trimester hemorrhage, preterm labor and delivery, intrauterine growth restriction, and perinatal death. RESULTS: We report a prevalence rate of 1.2% for exposure to physical violence by an intimate partner during pregnancy and 1.5% for fear of a partner. Physical violence was associated with an increased risk of antepartum hemorrhage (adjusted odds ratio [OR]: 3.79, 95% CI 1.38-10.40), intrauterine growth restriction (OR: 3.06, 95% CI 1.02-9.14), and perinatal death (OR: 8.06, 95% CI 1.42-45.63). Fear of a partner in the absence of physical violence was not associated with an elevated risk of adverse pregnancy outcomes. CONCLUSION: Our study confirms prior work reporting an association of physical abuse during pregnancy with intrauterine growth retardation and, in addition, reports an association with antepartum hemorrhage and perinatal death.

Nurses and workplace violence: nurses' experiences of verbal and physical abuse at work.

This paper describes nurses' experiences of violence and abuse in the workplace and the ways in which those experiences influence their abilities to care for patients. The original purpose of the research from which these findings derive was to explore nurses' work with abused women. The qualitative study utilizing a Social Constructivism approach was conducted in two countries: Canada and the United Kingdom. Forty-nine nurses from four clinical areas were interviewed, both in focus groups and individually, about factors influencing their care of abused women. In the course of the original study, the degree of verbal abuse and physical violence that nurses routinely encounter in their work became apparent. It also became clear that abuse against nurses is an important issue that has a significant impact on nurses' abilities to offer effective care. Findings indicated that nurses experience significant threat, frequently in the context of their work, at the hands of patients and their relatives; that verbal abuse is an almost daily occurrence; and that support from other healthcare professionals or from administration in addressing the issue, while improving somewhat, is inadequate. This work has implications not only for nurses' health and safety but also, in the broader sense, for the profession's ability to attract and retain nurses within the healthcare system.