An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS).

An evaluation of mindfulness-based childbirth and parenting courses for pregnant women and prospective fathers/partners within the UK NHS (MBCP-4-NHS). OBJECTIVE: To explore the usefulness within the National Health Service (NHS) of a brief (four week, ten hour) course based upon the Mindfulness Based Childbirth and Parenting (MBCP) programme (Duncan and Bardacke, 2010) described here as MBCP-4-NHS. BACKGROUND: The National Maternity Review (2016) and report of The Independent Mental Health Taskforce to the NHS (2016a, 2016b) in England highlight the need for significant investment into perinatal mental health services, with the Government pledging funding to improve such services through a range of measures. Whilst the field of mindfulness during the perinatal period is in need of well controlled trials and studies exploring the mechanisms of action (Hall et al., 2016) the limited research to date supports the potential for mindfulness based interventions in pregnancy and the need for further scientific study in this area (Dhillon et al., 2017; Shi and Macbeth, 2017). Particularly because it may broaden women's repertoire of coping strategies with the potential to improve the developmental trajectory of both parents and infants (Dunn et al., 2012; Duncan and Bardacke, 2010; Vieten and Astin, 2008). However, most of the studies to date have involved lengthy courses of around 8-9 weeks (24 h) duration, which may not be feasible or economical within a UK NHS setting and therefore, would be unlikely to be adopted as routine practice. DESIGN: An initial pilot study to discover if MBCP-4-NHS is acceptable and feasible within NHS maternity services, comparing maternal and paternal pre and post intervention self-report measures of mental health to begin to explore the effectiveness of this intervention. SETTING: NHS antenatal education classes held in children's centres for expectant parents across Oxfordshire. PARTICIPANTS: All expectant parents receiving Oxfordshire maternity services between October 2014 and January 2015 were invited to self-refer into the intervention, of which 155 individuals (86 women and 69 men) took part. INTERVENTION: 'MBCP-4-NHS' - A brief (four week, ten hour) course developed from the nine week Mindfulness Based Childbirth and Parenting (MBCP) intervention. MEASURES: Self-report measures of mental health including low mood/depression, mindfulness, stress, anxiety, pregnancy related distress and experiences. FINDINGS: The results showed a significant increase in both maternal and paternal mental health with women demonstrating a significant improvement in symptoms of stress, anxiety, depression, pregnancy-related distress, labour worry and positive and negative pregnancy experiences; and men improving significantly in symptoms of anxiety, depression and showing a trend for improvement in self-reported symptoms of perceived stress. CONCLUSIONS: This is a promising antenatal intervention that can be feasibly implemented within NHS which might have the potential to impact upon parental mental health and, therefore, possibly also the health of next generation. However, caution is needed interpreting these findings given that this study did not include an active control group. IMPLICATIONS FOR PRACTICE: This research provides a clear rationale and justification for a large randomised control trial of this intervention within the NHS, which should include a more diverse population, across multiple centres and should explore both the potential health benefits for parents and infants/children as well as potential economic costs/benefits.

Being there and reconnecting: Midwives' perceptions of the impact of Mindfulness training on their practice.

OBJECTIVE: To ascertain how midwives perceived attending a mindfulness course impacted on their professional practice, particularly in regard to any stress they experienced at work. DESIGN: A qualitative study using Interpretive Phenomenological Analysis. Semi-structured interviews were conducted with nine midwives. SETTING: A large maternity Trust in the United Kingdom. INTERVENTION: An eight-week mindfulness course, adapted from mindfulness-based cognitive therapy. FINDINGS: Four superordinate themes were identified as follows: "being challenged and committing," "containing the self," "reconnecting" and "moving forward with confidence." Focusing on the present moment enabled participants better to identify the boundary between self and other. This led to an increased sense of control and a reconnection with and reframing of relationships with colleagues and the women in their care. KEY CONCLUSIONS: Mindfulness may provide an effective way to address the high levels of stress, role dissatisfaction and workplace bullying found in midwifery, by improving both the working environment and patient care. The pivotal role of positive workplace relationships in this process resonates with other nursing research and with contemporary philosophical thought. RELEVANCE TO CLINICAL PRACTICE: This study adds to a body of evidence which suggests investing in the well-being of midwifery staff improves both job satisfaction and women's experiences of care.

Women's attitude towards the use of complementary and alternative medicines (CAM) in pregnancy.

BACKGROUND: the popularity of non-prescription, over-the counter (OTC) medicines, vitamins, minerals, homoeopathic remedies and herbal supplements (CAM) has grown significantly in recent years. However, we have limited knowledge relating to why pregnant women use CAM and how this may relate to the provision of maternity care. Using an interview approach this study explored the nature of over-the-counter and complementary medicines use in a sample of pregnant women. METHODS: this interview study formed part of a larger self-administered questionnaire survey on the extent of CAM use in pregnancy at large NHS Trust in England. The questionnaire provided the opportunity for women to complete a contact information reply slip if they were happy for follow-up interview. Audio recorded, face to face interviews were undertaken with a sample of 10 women. RESULTS: the reasons the women who were interviewed gave for using CAM broadly fell into two areas centred essentially on the contrasting advantages of CAM and disadvantages of conventional medicine. Doctors or midwives were rarely informed about the use of CAM medicines during pregnancy. CONCLUSION: the women saw CAM as outside of biomedicine and part of a holistic approach to health and well-being over which they are able to maintain their personal control. Non-disclosure of CAM use was common, a feature of which, appears to be some health-care professionals' lack of realisation of the importance, to women, of a holistic approach to their health, key to which is a desire to retain control over decisions associated with their well-being.

Is preceptorship valuable?

Preceptorship programmes for newly-qualified practitioners have been advocated by the UKCC (1999), therefore a preceptorship programme for midwives was introduced in Oxfordshire in 2000. The programme consisted of a three-month placement in a delivery suite (DS) and a three-month placement in an antenatal/postnatal ward environment. In 2001, it was decided to offer newly-registered midwives the opportunity to work in a community setting, rotating between DS and community on a fortnightly basis. To ascertain whether a community placement in a preceptorship programme provided the right balance between consolidation of skills and confidence, a research project was undertaken. This took the form of semi-structured interviews carried out before and after the completion of the amended programme. The project was conducted over a one-year period by the midwifery practice development team. A professional transcriber interpreted the interviews and the data was analysed by an independent reviewer. The research sample consisted of ten newly-qualified midwives and four preceptors. Findings identified that midwives valued and desired a period of initial support to consolidate their skills and knowledge, which helped to increase their confidence in their abilities regardless of the placement setting. Interestingly, midwives who had opted for a community placement continued to view childbirth as a normal life event, whereas hospital-based preceptees found their philosophy of care had changed at the end of the six-month programme. However, the midwives who had opted for a community placement found the fortnightly rotation too fragmented. The preceptorship programme also had a positive influence on retention rates, which may have been as a result of the midwives feeling more supported. In response to the findings of this research project, it was concluded that the community placement needed to be altered to a three-month placement, but should still be available to newly-qualified midwives as a placement option.