Laid-back breastfeeding: knowledge, attitudes and practices of midwives and student midwives in Ireland.

BACKGROUND: Despite concerted efforts by policy developers, health professionals and lay groups, breastfeeding rates in Ireland remain one of the lowest in world, with 63.6% of mothers initiating breastfeeding at birth, dropping to 37.6% of mothers breastfeeding exclusively on hospital discharge. Nipple trauma and difficulties with baby latching are major contributors to the introduction of formula and discontinuation of breastfeeding. Research shows laid-back breastfeeding (LBBF) significantly reduces breast problems such as sore and cracked nipples, engorgement, and mastitis as well as facilitating a better latch. Although the benefits of LBBF are well documented, this position does not seem to be routinely suggested to mothers as an option when establishing breastfeeding. This study aims to determine midwives' and student midwives' knowledge, attitudes, and practices of using laid-back breastfeeding in Ireland. METHOD: A cross-sectional descriptive survey distributed to midwives and student midwives in three maternity hospitals in Ireland and two online midwifery groups based in the Republic of Ireland, during June, July, and August 2021. RESULTS: Two hundred and fifty-three valid responses were received from nine maternity units. Most participants (81.4%) were aware of laid-back breastfeeding. However, only 6.8% of respondents cited it as the position they most frequently use. Over one-third (38.34%) had never used this position with mothers. Those more likely to suggest LBBF had personal experience of it, were lactation consultants or working towards qualification, or had participated in specific education about LBBF. Barriers included lack of education, confidence, time, and experience. Further issues related to work culture, a tendency to continue using more familiar positions and concerns about mothers' anatomy and mothers' unfamiliarity with LBBF. CONCLUSION: Although there was a high level of awareness of laid-back breastfeeding among midwives and student midwives, there are challenges preventing its use in practice. Education specifically related to using LBBF in practice is required to overcome the barriers identified. A greater understanding of mothers' and babies' intrinsic feeding capacities may give midwives more confidence to recommend this method as a first choice, potentially leading to more successful breastfeeding establishment and maintenance.

Principles of risk decision-making.

Risk management decisions in public health require consideration of a number of complex, often conflicting factors. The aim of this review was to propose a set of 10 fundamental principles to guide risk decision-making. Although each of these principles is sound in its own right, the guidance provided by different principles might lead the decision-maker in different directions. For example, where the precautionary principle advocates for preemptive risk management action under situations of scientific uncertainty and potentially catastrophic consequences, the principle of risk-based decision-making encourages decision-makers to focus on established and modifiable risks, where a return on the investment in risk management is all but guaranteed in the near term. To evaluate the applicability of the 10 principles in practice, one needs to consider 10 diverse risk issues of broad concern and explore which of these principles are most appropriate in different contexts. The 10 principles presented here afford substantive insight into the process of risk management decision-making, although decision-makers will ultimately need to exercise judgment in reaching appropriate risk decisions, accounting for all of the scientific and extra-scientific factors relevant to the risk decision at hand.

Disconnection: Exploring transfer from midwifery-led to consultant-led care a phenomenological study of women's views.

BACKGROUND: Understanding women's feelings during the transfer process can illuminate women's perspectives thus minimising the risk for postnatal psychological and emotional morbidity, and inform midwifery practice. AIM: To explore the meaning women ascribe to their feelings when transferred from an environment emphasising a social model of pregnancy and birth in a Midwifery Led Unit, to a contrasting, more 'medicalised' setting of a Consultant Led Unit. METHODS: The study adopted an idiographic focus, by conducting semi-structured interviews with new mothers. A purposive sample of eleven women was recruited via participating midwifery led units and their 'Facebook' page. An interpretative phenomenological approach was selected to explore mothers' individual perceptions of experiences. FINDINGS: Participants described feeling a strong sense of community in the midwifery led unit, where they enjoyed a sense of belonging, safety, and support. The overarching theme of 'disconnection' signified feelings of muted agency when transferred to a different environment. Women used adaptive processes to reconcile themselves to a medicalised ideology. The impact of the transfer also resulted in a sense of alienation and 'not belonging'. CONCLUSION: Adjustment to a different model of care meant women needed to rapidly amend their notions of normality and agency, at the same time as entering motherhood. Raising awareness about the possible psychological adjustments women have to make during at this time could provide reassurance to other women. It also highlights the need for support during and after transfer. Strengthening continuity of care could help facilitate the adjustment process.

Joy, guilt and disappointment: An interpretative phenomenological analysis of the experiences of women transferred from midwifery led to consultant led care.

BACKGROUND: Irish maternity services are predominantly medicalised and consultant led, therefore women who choose midwifery led care (MLC) do so in the context of limited birth choices. Transfers to consultant led unit (CLU) for consultant led care (CLC) can be unpredictable and can affect women's birth experiences. This study provides an in-depth exploration of women's experiences of transfer fromMLC to CLC during late pregnancy or labour. METHODS: Transfer experiences are explored through qualitative explorative in-depth interviews using interpretative phenomenological analysis (IPA). SAMPLE: Mothers who had experienced transfer from MLC to CLC during late pregnancy or labour were invited to participate. A purposive sample of eleven women following birth (five to 16 months post partum) provided their views. FINDINGS: Women described choosing MLC as a means of avoiding interventions and hoping for a fulfilling natural birth experience. However, participants describe feelings of ambivalence about their experiences, leading to conflicting emotions of joy with their new baby offset with disappointment about needing to transfer to CLC. CONCLUSIONS: Choosing MLC in a risk averse culture can affect how women experience the transfer process. The impact of the transfer can involve a multilayered psychological and emotional adjustment to a different birth experience for women. The findings provide important insights into issues of policy, preparation, and communication prior to and after transfer to CLC, which should be useful for policy makers, health care professionals and educators.

Women's preferences for childbirth experiences in the Republic of Ireland; a mixed methods study.

BACKGROUND: How women experience childbirth is acknowledged as critical to the postnatal wellbeing of mother and baby. However there is a knowledge deficit in identifying the important elements of these experiences in order to enhance care. This study elicits women's preferences for the most important elements of their childbirth experiences. METHODS: A mixed methods design was used. An initial qualitative phase (reported previously) was followed by a second quantitative one using a discrete choice experiment (DCE), which is reported on here. Participants who had experienced labour, were over 18 and had a healthy baby were recruited from four randomly selected and one pilot hospital in the Republic of Ireland. Data were collected by means of a DCE survey instrument. Questions were piloted, refined, and then arranged in eight pair-wise scenarios. Women identified their preferences by choosing one scenario over another. Nine hundred and five women were sent the DCE three months after childbirth, with a response rate of 59.3% (N =531). RESULTS: Women clearly identified priorities for their childbirth experiences as: the availability of pain relief, partnership with the midwife, and individualised care being the most important attributes. In the context of other choices, women rated decision-making, presence of a consultant, and interventions as less important elements. Comments from open questions provided contextual information about their choices. CONCLUSIONS: Most women did not want to be typified as wanting the dichotomy of 'all natural' or 'all technology' births but wanted 'the best of both worlds'. The results suggest that availability of pain relief was the most important element of women's childbirth experiences, and superseded all other elements including partnership with the midwife which was the second most important attribute. The preferences identified might reflect the busy medicalised hospital environments, in which the vast majority of women had given birth, and may differ in settings such as midwifery led care or home births.

Breaking from binaries - using a sequential mixed methods design.

AIM: To outline the traditional worldviews of healthcare research and discuss the benefits and challenges of using mixed methods approaches in contributing to the development of nursing and midwifery knowledge. BACKGROUND: There has been much debate about the contribution of mixed methods research to nursing and midwifery knowledge in recent years. DATA SOURCES: A sequential exploratory design is used as an exemplar of a mixed methods approach. The study discussed used a combination of focus-group interviews and a quantitative instrument to obtain a fuller understanding of women's experiences of childbirth. REVIEW METHODS: In the mixed methods study example, qualitative data were analysed using thematic analysis and quantitative data using regression analysis. DISCUSSION: Polarised debates about the veracity, philosophical integrity and motivation for conducting mixed methods research have largely abated. A mixed methods approach can contribute to a deeper, more contextual understanding of a variety of subjects and experiences; as a result, it furthers knowledge that can be used in clinical practice. CONCLUSION: The purpose of the research study should be the main instigator when choosing from an array of mixed methods research designs. Mixed methods research offers a variety of models that can augment investigative capabilities and provide richer data than can a discrete method alone. IMPLICATIONS FOR PRACTICE/RESEARCH: This paper offers an example of an exploratory, sequential approach to investigating women's childbirth experiences. A clear framework for the conduct and integration of the different phases of the mixed methods research process is provided. This approach can be used by practitioners and policy makers to improve practice.

'Not enough people to look after you': an exploration of women's experiences of childbirth in the Republic of Ireland.

OBJECTIVE: Women's experiences of childbirth have far reaching implications for their health and that of their babies. This paper describes an exploration of women's experiences of childbirth in the Republic of Ireland. DESIGN: A qualitative descriptive study consisting of focus group interviews (FGIs) identified important aspects of women's childbirth experiences. SETTING: Four randomly selected maternity units in the Republic of Ireland. The pilot study unit was also included in the data collection. PARTICIPANTS: A convenience sample of 25 women who volunteered to participate in five focus group interviews. Eligible participants were >18 years, able to discuss their birth experiences in English, had experienced labour, and had a live healthy baby. DATA COLLECTION: Approximately three months following the birth, data were collected using a conversational low moderator style focus group interviews. FINDINGS: Three main themes were identified, 'getting started', 'getting there' and 'consequences'. Women experienced labour in a variety of contexts and with differing aspirations. Midwives played a pivotal role in enabling or disempowering positive experiences. Control was an important element of childbirth experiences. Women often felt alone and unsupported. The busyness of the hospital units precluded women centred care both in early labour and in the period following the birth. Some women would not have another baby due to their childbirth experiences. KEY CONCLUSIONS: The context within which women give birth in the Republic of Ireland is important to their birth experiences. Although positive experiences were reported many women felt anxious and isolated. Busy environments added to women's fears and participants appeared to accept the lack of support as inevitable. Midwives play a pivotal role in helping women achieve a positive birth experience. IMPLICATIONS FOR PRACTICE: Excluding women's views from service evaluation renders an incomplete and somewhat distorted depiction of childbirth in Ireland. Although women appear to be satisfied with a live healthy baby, the process of 'getting there' has an emotional and psychological dimension that is important to the experience. Measuring the quality of maternity services must encompass recognition of psychological and emotional well-being alongside physical safety.

Women's experiences of labour and birth: an evolutionary concept analysis.

AIM: the aim of this paper is to identify the core attributes of the experience of labour and birth. METHODS: a literature search was conducted using a variety of online databases for the years 1990-2005. A thematic analysis of a random sample of 62 of these papers identified the main characteristics of the experience of childbirth. There are multiple methodological challenges in researching the experience of labour and birth, and in developing the existing complexity of evidence. RESULTS: despite agreement across disciplines regarding the significance of the childbirth experience, there is little consensus on a conceptual definition. Four main attributes of the experience were described as individual, complex, process and life event. Through this concept analysis, the experiences of labour and birth is defined as an individual life event, incorporating interrelated subjective psychological and physiological processes, influenced by social, environmental, organisational and policy contexts. CONCLUSIONS: identification of the core attributes of the labour and birth experience may provide a framework for future consideration and investigation including further analysis of related concepts such as 'support' and 'control'. IMPLICATIONS FOR PRACTICE: practitioners and researchers have already identified the diversity and complexity of women's experiences during labour and birth. The importance of the identified attributes also requires organisational and policy development within the context of a cultural environment that acknowledges this diversity.

The complexities of documenting clinical information in long-term care settings in Australia.

Clinical nursing documentation, written, verbal or supported by technology, is being affected by both the worldwide "information explosion" and budgetary constraints. In Australia, the necessity of documenting complex care needs and treatment plans in older adult care settings has become more imperative because funding levels and sources are frequently tied to these documents. As a consequence, the statutory requirements for documentation have become a significant driving force in shaping nursing practice. Although the value of quality documentation is or should be recognized, the seemingly vast amounts of time required inevitably distracts nurses from what they see as their primary purpose-the provision of direct patient care. Older adults who are frail are among the most complex clients requiring services in what is traditionally a poorly resourced sector. Under-funding frequently impacts on the staff skill mix, resulting in low levels of senior, highly qualified, and skilled staff. These factors impact the quality of the documentation and possibly the usage of the information itself. This article will provide an overview of the issues related to documentation of clinical information in older adult care settings with particular reference to some of the "unique" inefficiencies inherent in the Australian system.