Views from women and maternity care professionals on routine discussion of previous trauma in the perinatal period: A qualitative evidence synthesis.

BACKGROUND: Over a third of pregnant women (around 250,000) each year in the United Kingdom have experienced trauma such as domestic abuse, childhood trauma or sexual assault. These experiences can have a long-term impact on women's mental and physical health. This global qualitative evidence synthesis explores the views of women and maternity care professionals on routine discussion of previous trauma in the perinatal period. METHODS: Systematic database searches (MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and Global Index Medicus) were conducted in July 2021 and updated in April 2022. The quality of each study was assessed using the Critical Appraisal Skills Programme. We thematically synthesised the data and assessed confidence in findings using GRADE-CERQual. RESULTS: We included 25 papers, from five countries, published between 2001 and 2022. All the studies were conducted in high-income countries; therefore findings cannot be applied to low- or middle-income countries. Confidence in most of the review findings was moderate or high. The findings are presented in six themes. These themes described how women and clinicians felt trauma discussions were valuable and worthwhile, provided there was adequate time and appropriate referral pathways. However, women often found being asked about previous trauma to be unexpected and intrusive, and women with limited English faced additional challenges. Many pregnant women were unaware of the extent of the trauma they have suffered, or its impact on their lives. Before disclosing trauma, women needed to have a trusting relationship with a clinician; even so, some women chose not to share their histories. Hearing trauma disclosures could be distressing for clinicians. CONCLUSION: Discussions of previous trauma should be undertaken when women want to have the discussion, when there is time to understand and respond to the needs and concerns of each individual, and when there are effective resources available for follow up if needed. Continuity of carer should be considered a key feature of routine trauma discussion, as many women will not disclose their histories to a stranger. All women should be provided with information about the impact of trauma and how to independently access support in the event of non-disclosures. Care providers need support to carry out these discussions.

Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives.

OBJECTIVES: To explore stakeholders' and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study. SETTING: Maternity care provision in England. PARTICIPANTS: Interviews were held with 26 national governmental, professional and service-user organisation leads (July-December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February-December 2020). RESULTS: Six themes emerged: 'Postcode lottery of care' highlights variations in companionship and visiting practices between trusts/locations, 'Confusion and stress around 'rules'' relates to a lack of and variable information concerning companionship/visiting, 'Unintended consequences' concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, 'Need for flexibility' highlights concerns about applying companionship and visiting policies irrespective of need, ''Acceptable' time for support' highlights variations in when and if companionship was 'allowed' antenatally and intrapartum and 'Loss of human rights for gain in infection control' emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights. CONCLUSIONS: Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.

"Overwhelmed and out of my depth": Responses from early career midwives in the United Kingdom to the Work, Health and Emotional Lives of Midwives study.

BACKGROUND: Efforts to resolve the longstanding and growing staffing crisis in midwifery in the United Kingdom have been hampered by very poor retention rates, with early career midwives the most likely to report burnout and intention to leave the profession. AIMS: To establish the key, self-described factors of satisfaction and dissatisfaction at work for early career midwives in the United Kingdom, and suggest appropriate and effective retention strategies. METHODS: Thematic analysis was undertaken on a subset of free text responses from midwives who had been qualified for five years or less, collected as part of the United Kingdom arm of the Work, Health and Emotional Lives of Midwives project. FINDINGS: Midwives described feeling immense pressure caused by an unremittingly heavy workload and poor staffing. Where relationships with colleagues were strong, they were described as a protective factor against stress; conversely, negative working relationships compounded pressures. Despite the challenges, many of the midwives reported taking great pleasure in their work, describing it as a source of pride and self-esteem. Midwives valued being treated as individuals and having some control over their shift pattern and area of work. DISCUSSION: These results, which reveal the strain on early career midwives, are consistent with the findings of other large studies on midwives' wellbeing. All available levers should be used to retain and motivate existing staff, and recruit new staff; in the meantime, considerable creativity and effort should be exercised to improve working conditions. CONCLUSION: This analysis provides a 'roadmap' for improving staff wellbeing and potentially retention.