Maternity Services

A recent report by the charitable organisation, Birth rights [1], showed that a fearful environment inhibits midwives' ability to protect women's dignity and human rights. Following that report, further research is needed into the effect that fear has on midwives' ability to advocate for women in their care. This audit seeks to address the issue by focusing on midwives' experience of assertiveness in the workplace.

Background

Communication problems between clinicians are the most common cause of preventable adverse events in hospitals. In spite of these known risks the ‘turf wars’ between midwives and doctors continue unabated.

Question

What factors affect inter-professional interactions in birthing units?

Participants

9 doctors and 10 midwives from 10 Australian maternity units.
Methods

Interpretive Interactionism was the research design. Probing in-depth interviews were conducted to elicit stories of inter-professional interactions and their perceived effects on birthing outcomes. Analysis resulted in two theoretical models of inter-professional interaction: one positive and the other negative.
Findings

Midwives and doctors agree that positive interactions are collaborative, include the woman and her partner and are associated with the best possible outcomes and experiences possible. In contrast, they agree that negative interactions involve power struggles between the professionals and these are associated with adverse outcomes. All participants are able to demonstrate emotional and social competence when interacting and applied those skills sometimes. Factors related to the organisational culture within the ‘birth territory’ of a particular maternity unit seem to be predictive of the type of interactions that are likely to occur there.

Conclusion

Interventions to enhance inter-professional collaboration should be directed first at changing organisational structures and policies to promote easy opportunities for natural dialogue between doctors and midwives.


Keywords: Inter-professional; Interactions; Midwives; Doctors; Maternity services; Collaboration; Inter-professional communication; Quality improvement

"The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals. The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted. Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel "guilty until proven innocent" within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing "spectacular transparency", driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Finally, it is suggested that a "blame business" is driving this form of transparency, in which self-interested regulators, the media, lawyers, and even some patient organisations are fuelling transparency in a wider culture of blame. A relatively small number of people were interviewed, so further research testing the findings would be useful. Transparency has some perverse effects on doctors' practice.

SOCIAL IMPLICATIONS: Rising levels of blame has perverse consequences for patient care, as doctors are practicing more defensively as a result, as well as significant financial implications for NHS funding. Transparent forms of regulation are assumed to be beneficial and yet little research has examined its effects in practice. In this paper we highlight a number of perverse effects of transparency in practice."

IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis Comment on this article Women with inflammatory bowel disease (IBD) need more advice about pregnancy in order to make informed choices about their pregnancy. A research project that documented the experiences of 22 women and found that some had decided not to have children, or restrict their family size, and many women feared the consequences of pregnancy. 'It is desperately sad that women are opting to remain childless because they are unable to get an accurate picture of the risks they face,' said Anna Madill, a supervisor of the research. 'If they have access to that information, they may make an entirely different choice. The healthcare system needs to make sure that women living with IBD have access to all the facts necessary to make a fully informed decision.' Participants were concerned that they would pass down the condition to their children as well as worried that they would be unable to cope with a small child during periods when their condition would flare-up. IBD is an overarching term that defines severe digestive disorders such as Crohn's disease and ulcerative colitis, both of which can cause severe stomach pains, weight loss, and recurring diarrhoea. There is no cure for IBD and people living with the condition will experience periods of stability, with no symptoms, and then periods of flare-ups which be debilitating and affect quality of life. In the UK, 1 in 250 people have the condition and its incidence is increasing. The researchers, from the University of Leeds, made three films featuring participants describing their experiences of living with, being pregnant with, and being a mother with IBD. 'One of the main points to emerge from the study is that learning to live with a chronic illness has helped the women prepare for motherhood,' added Ms Madill. 'These women coped well with becoming parents.'

This work examines how the no home birth policy is embedded in the professionalization and moralization of maternal health. Technological advancements have established authorities in the birthing process, and at the same time, health has been seen as a moral obligation. The “best interest” of the maternal organism, as informed by experts, is used as justification for no the home birth policy. With these developments comes the potential of the no home birth policy to distort freedom, especially when maternal health is framed as a moral issue that nitpicks on the pregnant citizens’ obligation alone. This work, however, argues that oppressive nature of birth restrictions goes beyond mere infringement of freedom. Using Berlin’s (1969) discussion on freedom, this work discusses the rather hidden oppressive nature of birth restrictions that comes when it is framed as helping pregnant people choose a moral option as per the advise of medical authorities at the expense of seeing an institutional failure to provide informed choice or options for birthing places for their so-called “best interest”. This is suggestive of double standards as this policy restricts choice based on expert advice without providing for alternatives. When the maternal organism is framed as the moral bearer of the responsibility of birth place, preferences are bound to be judged with guilt-ridden sentiments, shame and other value-laden labels related to one’s choice rather than be seen as a reflection of the quality of institutional support. The no home birth policy reflect that a pregnant person’s decision of birthplace is not isolated from the availability of one’s choice. Indeed, there is democratic interest to discussing home births as this policy could be democratic at best and discriminatory at worst.

Women with inflammatory bowel disease (IBD) should be given more advice about pregnancy so they can make informed choices about whether to have a family, say researchers. In their paper in the journal Qualitative Health Research, the scientists draw on evidence that women with the disease often decide not to have children, or to restrict the size of their family, because of fears the pregnancy would affect their health or that of their baby. Although inflammatory bowel disease can cause complications during pregnancy, research shows that one third of women with the condition will not get worse and another third will actually see an improvement in their health. The study, led by the University of Leeds, chronicled the experiences of 22 women who have had children, to plug an information gap about the realities of becoming a mother with IBD.

This video talks about how women with IBD cope with young children within the early years of motherhood. If you want to find out more about planning for a baby with IBD click here: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s

For more information on pregnancy and IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

This video talks about the challenges and considerations women with IBD face when planning for a baby. The stories end well for all the mums we interviewed as they all went on to have successful pregnancies and healthy babies.

For more information on planning for a child within the context of IBD check Crohn's and Colitis UK's website: https://www.youtube.com/watch?v=2iwLh6XCnq8&t=4s
To watch a video on pregnancy with IBD click here: https://www.youtube.com/watch?v=br0kciD8xJk&t=5s

To watch a video on the early years of motherhood with IBD click here: https://www.youtube.com/watch?v=TQjt8pnMv4I&t=10s

Background music "Where I am From" by Topher Mohr and Alex Elena (taken from YouTube audio Library, free to use)

If you wish to know more about the study "IBD and Mums-to-Be" you can follow us on Facebook or Twitter @IBDandMumstoBe

The article discusses the "Restituta Inscription," an inscription by a female physician, Restituta, dedicated to her professor Claudius Alcimus. The author examines the place of women in the medical profession in Rome during the 1st century of the Common

Cet article présente les résultats de l’observation ethnographique d’un service de Maternité, conduite du point de vue d’une sociologie de la paternité. L’auteur explique d’abord en quel sens la Maternité est une institution « matrifocalisée ». Il propose ensuite une typologie des comportements paternels dans un tel contexte. Enfin, il montre que l’enjeu de la présence paternelle dans la Maternité réside dans l’apprentissage qui y est réalisé des compétences parentales légitimes, que la matrifocalité tend à biaiser et minimiser.


This article presents the results of an ethnographic observational study carried out in a maternity service from the point of view of a sociology of paternity. The author first shows how the maternity hospital is a « matricentered » institution. He then proposes a typology of the fathers’ behaviours in such a context. Lastly, he explains that the presence of fathers in maternity hospitals is important in that they learn there their legitimate parental competence that matrifocality tends to bias or to minimize.

Background: Infections acquired during childbirth are a common cause of maternal and perinatal mortality and morbidity. Changing provider behaviour and organisational settings within the health system is key to reducing the spread of infection. Objective: To explore the opinions of health personnel on health system factors related to infection control and their perceptions of change in a sample of hospital maternity units. Design: An organisational change process called ‘appreciative inquiry ’ (AI) was introduced in three maternity units of hospitals in Gujarat, India. AI is a change process that builds on recognition of positive actions, behaviours, and attitudes. In-depth interviews were conducted with health personnel to elicit information on the environment within which they work, including physical and organisational factors, motivation, awareness, practices, perceptions of their role, and other health system factors related to infection control activities. Data were obtained f...

1 Invisible and centre stage: a disabled woman's perspective on maternity services Liz Crow Writer, filmmaker and disability equality consultant 1c Birchall Road, Bristol BS6 7TW (0117) 944 6882 (voice and fax) liz@roaring-girl.com Date of submission 15 February 2003 ...

1 Invisible and centre stage: a disabled woman's perspective on maternity services Liz Crow Writer, filmmaker and disability equality consultant 1c Birchall Road, Bristol BS6 7TW (0117) 944 6882 (voice and fax) liz@roaring-girl.com Date of submission 15 February 2003 ...

Researchers say that women with inflammatory bowel disease should be given more advice about pregnancy, so that they can make informed choices about their options and care. The study, led by the University of Leeds, chronicled the experiences of 22 women who have had children, to plug an information gap about the realities of becoming a mother with IBD. The research, published in the journal Qualitative Health Research, draws on the evidence that women with the disease often decide not to have children, or to restrict the size of their family, because of fears for their health during pregnancy and that of their baby too......

The purpose of this paper is to explore general practitioners' (GPs') and psychiatrists' views and experiences of transparent forms of medical regulation in practice, as well as those of medical regulators and those representing patients and professionals. The research included interviews with GPs, psychiatrists and others involved in medical regulation, representing patients and professionals. A qualitative narrative analysis of the interviews was then conducted. Narratives suggest rising levels of complaints, legalisation and blame within the National Health Service (NHS). Three key themes emerge. First, doctors feel "guilty until proven innocent" within increasingly legalised regulatory systems and are consequently practising more defensively. Second, regulation is described as providing "spectacular transparency", driven by political responses to high profile scandals rather than its effects in practice, which can be seen as a social defence. Fina...

Authors
Aileen Marron (University of Limerick), Gerard Burke (Perinatal Ireland Research Consortium), Eoin Devereux(University of Limerick), Michael Breen (Mary Immaculate College, Limerick)

Abstract
The mass media play a key role in informing the public about matters of public interest and, critically, in the actual shaping of public opinion about those matters. In carrying out its surveillance function for society, the mass media's central role is to connect with the public without overwhelming it with information, by effectively differentiating between that which is to be deemed important and that which is not. There is a vast body of literature that documents the influences of the mass media in both the formation and development of public perceptions on a broad range of issues. With this in mind, the purpose of this study was to examine Irish media content and the manner in which it portrays the maternity services in Ireland.

A quantitative content analysis was conducted over the five-year time period from 2007 to 2012. Using the Nexis-Lexis newspaper database, data were sampled from three broadsheet newspapers (the Irish Times, the Irish Independent and the Irish Examiner), one tabloid newspaper (the Irish Daily Mail) and the RTE website. The final sample yielded a population of 329 articles for analysis. The subsequent articles were measured according to a pre-defined coding scheme that included variables such as article placement, prominence, story length, topic, etc. and they were then compared against existing medical statistics.

The results showed that less than 1% of articles relating to the Irish maternity services received front page treatment over the five-year period. Medico-legal processes (18.8%), budgetary and staffing issues (15.8%) and specific high-profile cases of misdiagnosis or inappropriate treatment (9.7%) have predominated as the focus of coverage. The more clinical matters, such as breastfeeding (4.5%), neonatal care (3.3%) and post-natal depression (1.2%), have received relatively little examination.

The need for the public to have access to accurate information about medical matters is clearly of fundamental importance. However, in broad terms, the findings of this research suggest relatively poor coverage of certain socially or medically important issues, including outcomes (except where they involve a medical error or misconduct) and, in general, there is a discrepancy between media representations of these critical issues and the medical realities. This has the potential to undermine perceptions of these issues by the general public who, it could be argued, come to an understanding of events largely on the basis of information that is presented in the mass media. Health professionals should consider more proactive engagement with the mass media, in order to improve the quality of public discourse on matters relating to the maternity services.