Dr Ann Robinson

Background: Diversity exists in how storied data in narrative inquiry is analysed and represented, more so when there is a need to combine multiple data collection methods, including photographs.

Aim: This paper discuses the use of an analytical framework entitled LEARNS developed as part of a PhD study that has potential to fill this gap.

Results: The step-by-step framework presented in this paper was developed in order to analyse the data collected in this research study and gives understanding and insight into the experience of mothers whose babies are removed at birth. The LEARNS framework provides transparency and credibility; it also negates the need to restrict findings to broad themes via content/thematic analysis.

Conclusions: LEARNS could offer other researchers a reliable framework to use for future social science research.

Keywords

Analysis, Framework, Inquiry, Narrative, Photo-elicitation

Aim: To evaluate the effectiveness of prescribed postnatal exercise on postnatal depression. Prescribed exercise was defined as any physical activity that was carried out in the postnatal period with the objective of reducing postnatal depression as determined by identified scales.

Background: Research has identified that regular physical exercise interventions are beneficial to mental health conditions such as depression and anxiety.

Design: A systematic review and narrative analysis of Randomised Controlled Trials (RCT’s) reporting on the effectiveness of prescription postnatal exercise on postnatal depression.

Data Sources: Selection criteria included full text, academic articles written in English comparing exercise retrieved using MEDLINE, CINAHL, PSYCHInfo, EMBASE and SPORTSDiscus.  Published research focusing on Postnatal or Postpartum Exercise or Physical Activity; Depression or Mood Swings was included and published between 2008 and 2016. The search was refined to include females from eighteen years or more.

Review Methods:  Forty seven articles were identified as fulfilling the inclusion criteria and full text analysis was performed by two members of the research team. Twelve articles were identified as meeting the inclusion criteria, these were distributed for scrutiny and assessment amongst the 5 members of the research team. Methodological quality was assessed using a Quality Assessment Tool for Quantitative Studies published by the Effective Public Health Practice Project (EPHPP) (1998).  Finally the articles were redistributed amongst the team for a second assessment and verification. Any discrepancy of ratings of a paper between the reviewers was resolved by a third reviewer through reassessment of the paper and further discussion.

Results: Eight studies were included in the final systematic review carried out using the EPHPP assessment tool, this identified six quality RCT’s meeting the inclusion criteria.

Conclusions: The findings indicate that a tailored exercise intervention can effectively alleviate postnatal depressive symptoms, benefiting women both physically and psychologically. Social support experienced by participants in relation to the exercise intervention was seen to have a positive impact.

Keywords:

Postnatal

Depression                                                                        

Exercise                                                                                                              

Physical Activity

Systematic Review

Nursing/Midwifery                        

Background: Breastfeeding is accepted as the optimum way to nourish babies. It is established that women need informed support from midwives, but the focus of previous research has been predominantly on women’s experiences, rather than that of midwives.

Aims: The aim of this study was to explore midwives’ experiences of helping women who were struggling to breastfeed. Methods: A qualitative methodology was selected using a phenomenological approach. Five midwives were purposefully recruited and data were collected using semi-structured interviews. Following transcription, data were analysed using Colaizzi’s (1978) framework of analysis.

Findings: Three themes emerged describing midwives’ experiences: time poverty, the impact of being ‘with women’, and professional integrity.

Conclusions: The study revealed that breastfeeding has an emotional impact on midwives. Not being able to spend the time they felt the women needed affected the midwives. With reports of an increasing shortage of midwives, there is concern that time poverty may increase, leading to a greater sense of professional dissatisfaction.

Keywords: Breastfeeding, Information, Midwifery Support, Phenomenology.

Background. The last century has seen a renewed interest in the use of photographs as a means of generating data for social science research. However, despite being acknowledged as a potentially valuable tool for qualitative researchers, across a wide range of disciplines, photo-elicitation techniques have received little attention in social sciences research literature.

Aim. This paper examines the methodological dimensions and potential usefulness of photo-elicitation when combined with narrative inquiry as data generation tools for research within the health and social sciences. The context for the research was mothers’ and midwives’ experiences of babies removed at birth.

Methods. Four mothers and eight midwives took part in this research. Narrative inquiry incorporating photo-elicitation techniques was used to generate the data, with mothers being interviewed face to face and midwives taking part in focus groups. The images and audio data were collected, transcribed and analysed for emerging themes, contrasts and similarities. This research received a favourable ethical opinion by the University of Surrey ethics committee.

Results. Photo-elicitation supported the generation of contextual new knowledge and insights into individual experience that may have gone unnoticed had just conventional methods been used. It also facilitated a participatory approach to the overall research design and shifted the paradigm of power in the researcher-participant relationship, in favour of the participant. Conclusion. Photo-elicitation in face-to-face interviews was perceived by participants as non-threatening and enabled active participation in the process. It generated new knowledge that may have gone unnoticed by verbal interview methods alone.

Key words: Narrative, photography, photo-elicitation, research, evidence-based midwifery.

Abstract: Diabetes mellitus (DM), the most common of metabolic disorders, is a global public health concern. Numbers are rising with 383 million adults currently diagnosed with DM and another 175 million as yet undiagnosed. The rise in cases includes increasing numbers of women of a reproductive age whose reproductive health and contraception need careful consideration. Unintended pregnancy with poor glycemic control at the time of conception increases the chance of adverse pregnancy outcomes including stillbirth, congenital abnormalities, and perinatal mortality. In order to minimize complications, safe and effective contraception is paramount for all women with DM. This is a challenge as women have been found to be reticent to ask for advice, appear to lack understanding of risks, and are less likely to be using contraception than women without DM. The World Health Organization has developed Medical Eligibility Criteria to guide contraceptive choice. Women with DM without complications can choose from the full range of contraceptive methods including hormonal contraception as the advantages of use outweigh any risk. Women with diabetic complications may need specialist advice to assess the risk–benefit equation, particularly in respect of hormonal contraception. Women should be aware that there is no restriction to the use of oral and copper intrauterine emergency contraception methods. There is a need for an integrated approach to diabetes and reproductive health with improved communication between women with DM and their health care providers. Women need to be aware of advice and services and should make their own choice of contraception based on their needs and associated risk factors. Practitioners can offer nonjudgmental guidance working in partnership with women. This will enable discussion of risks and benefits of contraceptive methods and provision of advice dedicated to improving overall health and well-being.

Keywords: diabetes mellitus, gestational diabetes, contraception, education, preconception counseling

Refugee and asylum-seeking women in the UK are socially, physically and psychologically vulnerable, owing to their past experiences and current circumstances. They may have a range of social and sexual health needs, which may include suffering from the consequences of sexual violence, female genital mutilation or sexually transmitted infections due to inadequate contraceptive use. These women are often prevented or discouraged from accessing sexual and reproductive health services because of competing social priorities, limited health literacy and a lack of culturally sensitive services. This literature review examines barriers to sexual and reproductive health care for refugee and asylum-seeking women, exploring how issues can be addressed and ameliorated by midwives and the wider health-care team during pregnancy.

Keywords: Refugee, Asylum Seeking, Sexual Health, Maternity Care, Inequalities.

The number of babies removed from mothers at birth in the United Kingdom (UK) is on the increase (Powell 2017). This is a worrying fact, especially in light of the latest research in neuroscience and imaging which suggests that childhood neglect and trauma can significantly affect a baby's brain development (Allen 2011).  There is also a growing body of evidence to show that the environment plays a major role in shaping the behavioural, social and cognitive development of an infant's brain (Underdown and Barlow, 2012), and that the relationship infants have with their primary caregiver will have an impact upon their ability to develop and sustain trusting attachments (Schore 2003). Without positive and nurturing attachments to caregivers part of a baby's brain will fail to develop, which for some babies will be permanent (Allen 2011).

Where problems within families are so entrenched and complex, the decision to remove a baby is often made much more quickly, due to the evidence base suggesting that the longer babies remain in potentially neglected and abusive environments, the less likely they are to ever recover (van den Dries et al 2009).  It is also known that if a baby is adopted before 12 months of age they have a better chance of total recovery (Ward et al 2012). Whilst it is acknowledged that the protection of babies from abuse and neglect is of a paramount priority, the impact of removing them at birth from their mothers remains unknown.This, the first of two papers, reports on the findings from a literature review relating to the experiences of mothers who have had their baby compulsorily removed at birth.

It is evident from a review of the literature that looking after the psychological and emotional needs of women who have their baby removed at birth is a vital part of midwifery care in the childbirth continuum.  This review reports on the experiences of midwives who have provided care and emotional support to mothers who have had their baby removed at birth and the challenges they have encountered from doing so. BNI, CINAHL, EMBASE, Google Scholar, Maternity and Infant Care and PsycInfo  were searched for articles published until January 2014 and findings suggest that providing care and emotional support to women who have had their babies removed at birth remains one of the most challenging aspects of contemporary midwifery practice. It is anticipated that this study will raise awareness of the challenges associated with providing care and emotional support for women whose babies have been removed at birth and contribute to the evidence base for best practice.

Keywords: Midwives, Experiences, Removed, Birth, Babies.

Innovation in health care policy has led to the recruitment of consultant midwives in maternity units across the United Kingdom (UK). These experienced practitioners first came into post in the UK in 2000 and were expected to have a significant role in moving the midwifery profession forward in relation to practice development, effective leadership and quality care provision (DH 2007; DH 2008; DH 2009). 

  The purpose of this study was to explore the intricacies of role of the consultant midwife by observing consultant midwives in practice and by gaining perspectives of the role from consultant midwives themselves, heads of midwifery and consultant obstetricians practising in NHS Trusts across England. 

  A qualitative methodology using case study design was selected to explore the role of eight consultant midwives in eight NHS Trusts in England.   Data were collected via in-depth interviews with the consultant midwives, their heads of maternity services and consultant obstetricians.  In addition, the consultant midwives were observed in practice and documentary evidence, in the form of job descriptions, was collected to further expand upon the consultant midwife role.

    Interview recordings were transcribed verbatim and the data were analysed thematically.  Individually and collectively the consultant midwives had conveyed an enthusiasm for their role.  This is not to say that they weren’t in any way unrealistic or unaffected by the demands of their position. Their impact on practice development lay in relation to the way they used their experience, skills and understanding  to undertake complex roles in practice, juggling responsibilities to effect change and improve services for childbearing women and their families.  As anticipated, differences were noted in the way ‘practice’ was interpreted and their experiences and achievements differed. Their strength also related to the way in which they utilised their acquired knowledge and expertise, as leaders and as role models, influencing not only practice but the midwives of the future.

Aims The study examined knowledge and attitudes around Sexual Health (SH) and contraceptive use among Young People (YP) who are homelessness and resident in hostels in a large urban area and their key workers. The aim was to improve SH outcomes through building a model of SH care appropriate to the needs of YP. Less is known about SH in homeless young males’ than females’, thus the study aimed to ensure inclusion of male views.

Methods A constructivist theoretical framework was used to underpin this qualitative ethnographic case study. The case under study being homeless YP, girls, boys or transgender, aged 16–21 years resident in homeless hostel accommodation. Participants were selected by purposive sampling in order to ensure maximum variety within the case. Twenty-nine homeless YP, and five key workers were recruited from homeless hostels and a homeless day-centre in a large urban area. One to one semi-structured interviews were carried out examining knowledge and attitudes concerning SH and contraceptive use. Insider observations of resident’s meetings and the hostel and centre settings were undertaken. A reflexive approach was used in interviewing. Demographic data was collected from YP participants. Nvivo 10 QSR computer assisted software was used to analyse the data thematically, and demographic data used to stratify and identify trends between males, females and age groups.

Results Four overarching themes were identified: • Meaning of sexual health: • ○ Tended to differ between males and females • ○ Females made associations with emotions, relationships and safety • ○ Males with using protection • ○ Life experiences have overriding effect on: • ○ Attitudes • ○ Sexual well-being. • ○ Being homeless poses risks and influences priority of SH: • ○ Hygiene • ○ Dangers • ○ Survival • ○ Use of SH services: • ○ Barriers • ○ Stigma and embarrassment • ○ Staff attitudes Facilitators • Using non SH services e.g. GPs.

Conclusion Homeless YP resident in hostel accommodation require specialised delivery of SH care which is holistic and supports their needs. This could be provided within the familiar hostel or day-centre environment. It should be managed in a way that ensures facilitation of quality therapeutic relationships, with highly skilled workers, and sensitive dissemination of targeted information

Between May 2012 and May 2013, 161 people were seen in nurse-led sexual health clinics set up at three St Mungo's hostels for homeless people in North London.  Services included screening and treatment for sexually transmitted infections; access to contraception, pregnancy tests and cervical cytology; testing and treatment for HIV, hepatitis and other infections from blood-borne viruses; and vaccination.  A mixed-methods study confirmed that homeless people are at increased risk of sexual ill-health.  It also showed that their health outcomes can be improved through sexual health services provided in a convenient, familiar and friendly environment.  This article details the initiative that was undertaken.