A mixed method study to explore the maternal impact and outcomes of a specialist Building Attachment and Bonds Service (The BABS Study).

Our intent was to explore if maternal anxiety, depression, reflective functioning and level of attachment significantly changed after the Building Bonds and Attachment Service (BABS) Intervention. We measured outcomes for 46 at risk mothers via HADS; MAAS; MPAS and P-PRFQ. Our findings, triangulated with 32 semi structured interviews identified that BABS intervention made a significant difference to participants who were admitted during the antenatal period (Pregnant group: depression 9.63[CI:7.63-11.63; p < 0.001]; anxiety 9.40[CI: 7.56-11.24]; p < 0.001]; reflective functioning 30.78[CI:24.84-36.72; p < 0.001] and maternal attachment 8.78[CI:4.08-13.48]; p 0.001). Suicidal contemplation was prevented for two women. Our conclusions explained the service made a significant difference to the lives of mothers between baseline and post intervention for pregnant mothers with anxiety and depression who struggled to bond with their baby. Appropriate referral may help to increase accessibility to those who may benefit most. Further research needs to test if this care model would be acceptable to culturally diverse populations.

A concept analysis of women's vulnerability during pregnancy, birth and the postnatal period.

AIM: To report an analysis of the concept of vulnerability associated with pregnancy, birth and the postnatal period. BACKGROUND: The concept of vulnerability during childbirth is complex and the term, 'to be vulnerable' frequently attains a vague application. Analysis about vulnerability is needed to guide policy, practice, education and research. Clarity around the concept has the potential to improve outcomes for women. DESIGN: Concept analysis. DATA SOURCES: Searches were conducted in CINAHL, EMBASE, PubMed, Psychinfo, MEDLINE, MIDIRS and ASSIA and limited to between January 2000 - June 2014. Data were collected over 12 months during 2014. METHODS: This concept analysis drew on Morse's qualitative methods. RESULTS: Vulnerability during pregnancy, birth and the postnatal period can be defined by three main attributes: (a) Threat; (b) Barrier; and (c) Repair. Key attributes have the potential to influence outcome for women. Inseparable sub-attributes such as mother and baby attachment, the woman's free will and choice added a level of complexity about the concept. CONCLUSION: This concept analysis has clarified how the term vulnerability is currently understood and used in relation to pregnancy, birth and the postnatal period. Vulnerability should be viewed as a complex phenomenon rather than a singular concept. A 'vulnerability journey plan' has the potential to identify how reparative interventions may develop the woman's capacity for resilience and influence the degree of vulnerability experienced. Methodology based around complex theory should be explored in future work about vulnerability.

A mixed methods study to explore women and clinicians' response to pain associated with suturing second degree perineal tears and episiotomies [PRAISE].

BACKGROUND: perineal suturing is a common event which affects women across a variety of international settings. Women have expressed pain related to perineal trauma in the postnatal period but little is known about pain during suturing. In addition, there is a lack of evidence to identify how professional decisions are made about pain management during the suturing process. OBJECTIVE: to explore women and clinicians' response to pain during the suturing of second degree tears and episiotomies. DESIGN: mixed method feasibility study which included observation, questionnaires and interviews. SETTING: a Hospital Trust in Northwest England. PARTICIPANTS: 40 women and 21 clinicians participated. MEASUREMENTS AND FINDINGS: mild, moderate and severe pain was measured via the McGill Pain Questionnaire-Short Form (MCPQ-SF). Psychological distress was identified via the Hospital Anxiety and Depression Scale (HADS). Semi-structured face to face interviews identified three themes, Psychological distress and future functioning; Variation in practice and Style of communication. KEY CONCLUSIONS: women who experienced psychological distress during previous or current childbirth scored higher on HADS and MCPQ-SF, and appeared to express more concerns about future functioning and healing. Variation in practice exists and style of communication had the potential to make the difference for women. IMPLICATIONS FOR PRACTICE AND RESEARCH: the process of suturing is complex and is not a standalone event for a woman. It is crucial that health professionals consider previous and subsequent experience of perineal suturing. Future research aims to develop a decision tree to support pain management during suturing.

Becoming culturally sensitive: a painful process?

OBJECTIVE: to discuss how midwifery students develop cultural sensitivity. DESIGN: students carried out international observational elective placements and 13 matched self-assessments from before and after a Global Midwifery Module were compared. The module is based around a model of immersion and permitted measured responses and qualitative evaluation to be explored. SETTINGS: observational placements occurred in the UK, America, Canada, and Gutamala. PARTICIPANTS: seventeen year 3 midwifery students. FINDINGS: raised awareness about international midwifery was identified; the module contributed to enhancement of practice, confidence about caring for those from a different culture varied, the process of critical reflection was uncomfortable for some. KEY CONCLUSIONS: critical reflection facilitated in a safe place may support individuals to transform their way of thinking. IMPLICATIONS FOR PRACTICE: responsibility for developing cultural sensitivity should lie with the individual. However, leaders need to facilitate space for critical reflection. Critical self-assessment and reflection about cultural sensitivity should be part of a life long learning approach.

"Vanished twin": an exploration of women's experiences.

BACKGROUND: Evidence suggests that in identified twin pregnancies 30 percent become a "vanished twin," that is, when two gestation sacs are identified at early ultrasound but subsequently only one fetus is seen. This study explored the thoughts, feelings, and hospital experiences of women who have a vanished twin. METHOD: The study was conducted in a large teaching hospital in northwest England from April to June 2001. The experiences of 9 women were explored through 4 focus groups and an individual interview. Nulliparous and multiparous groups were separated for homogeneity. The study's philosophical approach was based on constructivism, and the thematic analysis used a feminist interpretation to search for patterns of meanings from the women's words. RESULTS: The women wanted to be cared for in a humanistic manner, and they felt that acknowledgement of the vanished twin by the professional was important. The findings highlighted the need for better information giving to improve communication between caregivers and women. Multiparas were more prepared than nulliparas to ask for the attention that they wanted. CONCLUSIONS: Despite the small number of study participants, results suggest that maternity caregivers should be sensitive to the feelings and individual nature of a woman who has experienced a vanished twin. Humanistic approaches to communication and improved methods of information based on the development of an information sheet are advised.