the purpose of this study was to describe women׳s reasons for choosing to birth with a privately ... more the purpose of this study was to describe women׳s reasons for choosing to birth with a privately practising midwife. a modified grounded theory methodology was used. the sample comprised 14 Western Australian women who had received maternity care from a privately practising midwife within the previous five years. data analysis revealed three categories: the first was conceptualised as 'I knew what I wanted from my caregiver', which included sub-categories of: I wanted continuity of care; I wanted a relationship with my care provider; and I wanted a care provider with the same childbirth philosophy as me. The second encapsulated 'I knew what I wanted from my pregnancy and birth experience,' with two sub-categories, I wanted a natural, active, intervention free pregnancy and birth and I wanted my partner and family to be included. The final category was labelled 'I was willing to get the research to get what I wanted' and incorporated two sub-categories, I researched my care options and I researched my care provider options and the evidence around pregnancy and birth to be actively involved. findings offer insight around women׳s reasons for choosing this model of midwifery care and highlight that women know exactly what they want from their caregiver. Women valued working with their midwife towards a shared goal of an intervention-free, normal birth, researched their options and found mainstream services restrictive and focused on medical risk status rather than on the individual woman. findings will be of interest to maternity care practitioners and policy makers, as they highlight why some women prefer a social model of midwifery care that reflects a family centred, individualised and holistic approach. This insight can inform the development of maternity health care practices to recognise and accommodate the needs and values of all childbearing women.
ABSTRACT BACKGROUND: In July 2008, a new midwife-led “Next Birth After Cesarean” (NBAC) service w... more ABSTRACT BACKGROUND: In July 2008, a new midwife-led “Next Birth After Cesarean” (NBAC) service was launched at King Edward Memorial Hospital (KEMH) in Perth, Western Australia. Midwives from the NBAC service provide antenatal care, evidence-based information about birth choices, tailored birth preparation classes, and assistance with developing birth plans to pregnant women who have had a previous cesarean birth. OBJECTIVE: To determine the contributory factors that women who were cared for by the NBAC service and experienced a vaginal birth after cesarean (VBAC) perceived to be associated with achieving their desired mode of birth. METHODS: A qualitative descriptive approach was used for this study in which semistructured interviews were conducted with 13 participant women who have achieved a VBAC and were analyzed using a modified “constant comparison” technique. FINDINGS: Two key themes reflecting personal and professional factors comprising eight subthemes emerged from analysis of interview data. CONCLUSIONS: These findings offer a unique perspective on the phenomenon of achieving a VBAC and provide maternity care practitioners and policy makers around the world with valuable insights into how the care environment might be enhanced for women who would prefer a vaginal birth after their previous cesarean section.
Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia, 2002
Breastfeeding is the method of choice for infants and most women support the statement that '... more Breastfeeding is the method of choice for infants and most women support the statement that 'breast is best'. Although the majority of Australian women do initiate breastfeeding, many also encounter difficulties in what they assume to be an easy, natural process. Additionally, a number of women face difficulties significant enough to warrant additional support from resources such as the Breastfeeding Centre of Western Australia. Managing these difficulties influences mothers' perceptions of their breastfeeding experiences. However, the stories of these women have not been addressed in the literature. This phenomenological study explored the lived experiences of mothers with breastfeeding difficulties, who presented to the Breastfeeding Centre of Western Australia. In-depth interviews with ten women revealed three main themes: 'path of determination, 'staying on the path; and 'coming off the path'. The study contributes to the body of knowledge on infant f...
This paper addresses the limited sociological understanding of the phenomena of childbirth fear u... more This paper addresses the limited sociological understanding of the phenomena of childbirth fear using data from a qualitative research project conducted in Western Australia. This qualitative study used an exploratory descriptive design, with 22 women identified as being fearful of birth participating in an in-depth interview. Data analysis using the method of constant comparison revealed that social context, explored within the framework of the medicalisation of childbirth, and the intervening circumstances in which the women gave birth, impacted on how and why they experienced fear. As such, this paper argues that fear of childbirth has social as well as personal dimensions and is both a prospective and retrospective phenomena. The analysis identified prospective fear as both social and personal. The social dimensions were labelled as 'fear of the unknown', 'horror stories' and 'general fear for the well-being of the baby'. Personal dimensions included the 'fear of pain', 'losing control and disempowerment' and 'uniqueness of each birth'. Retrospective fear was exclusively personal and was clustered around the themes of 'previous horror birth' and 'speed of birth'. The analysis also revealed two central factors that mediated against childbirth fear: positive relationships formed with midwives, and the support women received from their informal network. Understanding and unpacking the dimensions of women's childbirth fear, and understanding the nature of relationships that mediate women's fear, provides health care professionals with information on which to base potential intervention strategies and support women in ways that lessen rather than heighten their fear.
a cross sectional survey was undertaken to explore midwives&a... more a cross sectional survey was undertaken to explore midwives' knowledge of, and attitudes towards, mental health disorders in childbearing women vis-à-vis their perceived mental health learning needs. a 50.1% response rate included 238 midwives employed in the only public tertiary maternity hospital in Western Australia from March to June 2013. The survey comprised a mixture of custom-designed questions and vignettes presenting various disorders. Only 37.6% of midwives felt well-equipped to support women, whilst 50.2% reported insufficient access to information. Demand was highest for education on: personality disorders (77.8%); the impact of childbearing on mental health disorders (74.2%); and skills for handling stress and aggression (57.8%). Knowledge scores were variable: on average eight out of a maximum 13 questions were answered correctly, but few (2.7%) answered more than 11 correctly, and 3.7% scored ≤4 correct. Across disorders, recognition from vignettes was highest for depression (93.9%), and lowest for schizophrenia (65.6%). Surprisingly, there were no associations between general knowledge scores and previous mental health experience, recent professional development, or access to information around mental health. The majority endorsed positive beliefs about midwives' role in mental health assessment, and belief in women's recovery (83.5%), however, cluster analysis of warmth and competence ratings revealed negative stereotyping of mental health disorders. Midwives accept it is their role to assess the mental health status of women but many feel ill-equipped to do so and express a strong desire for further knowledge and skills across a range of perinatal mental health topics. Attitudes to recovery are positive but negative stereotypes exist; therefore awareness of potential bias is important to negate their influence on care. Learning needs may change due to trends in clinical practice. Strategies are needed to recognise negative beliefs and to ensure education is responsive to local contexts.
An important part of maternity service provision is the care provided by midwives in the immediat... more An important part of maternity service provision is the care provided by midwives in the immediate postpartum period. Evidence suggests that postpartum morbidity and its impact on women's health after childbirth is an area of genuine concern. In Western Australia there is limited information on women's postpartum health needs and/or the quality of midwifery care provided in hospital and at home. This paper describes Western Australian (WA) women's perceptions of midwifery care in the early postpartum period. A cross-sectional, self report survey was used to describe the practical, emotional and informational support provided by midwives in the initial postpartum period. A questionnaire, specially designed for this population, was posted at 8 weeks postpartum to every woman with a registered live birth in WA between February and June 2006. Completed questionnaires were received from 2699 women. Data were analysed using descriptive statistics, t-tests and chi-squared. Results indicate that overall, women were happy with most aspects of midwifery care related to practical advice and assistance in relation to baby care and their immediate physical recovery. Areas that received a less positive rating were related to providing consistent advice, availability of the midwife, emotional care and information on maternal health needs, immunisation and contraception. In general, first time mothers rated both the style and quality of care more negatively than multiparous women. There was a trend by women accessing private hospital care to rank their care less favourably. There were minimal differences noted between women in metropolitan and non-metropolitan areas. Midwifery care at home was rated very positively and significantly better than hospital care (p</=0.002). Although the majority of women in this study were satisfied with the components of physical care and information and assistance with infant feeding and sleep and settling provided in the short-term, there was less satisfaction with emotional care and preparation for life at home with a new baby. This study adds to our understandings of women's experiences of the early postnatal period and provides information on which to base improvements in postnatal care and maternity services in WA and across Australia.
The purpose of this grounded theory study was to analyze the maternal process of managing the lat... more The purpose of this grounded theory study was to analyze the maternal process of managing the later stages of established breast-feeding and, ultimately, weaning the child from the breast within a Western Australian context. Data were analyzed from 33 participants' interview transcripts, field notes, 9 postal questionnaires from fathers, and individual and discussion group interviews with child health nurses. A common social problem of incompatible expectations was revealed. All participants faced a dilemma in the management of their experience when personal expectations were in opposition to others' expectations. A process of Constructing Compatibility by Adapting Focus was adopted to compensate for this incompatibility.
to explore women&... more to explore women's perceptions of conflicting advice around breast feeding from formal support networks, specifically health professionals involved in postnatal support. a qualitative exploratory design was employed using the critical incident technique. Data were obtained from 62 Western Australian women who responded to an invitation to share incidents of receiving conflicting advice. Women who had breast fed a child within the past 12 months shared their experience through a telephone interview (n = 50) or completing a brief questionnaire (n = 12) addressing the following questions: Describe a situation in detail where you felt you received conflicting advice about breast feeding from a health professional. How did this situation affect you and/or your breast feeding? a modified constant comparison method was used to analyse the critical incidents revealing commonalities under who offered conflicting advice; what contributed to advice being perceived as conflicting; topic areas more inclined to being regarded as conflicting; what protected against advice being perceived as conflicting; the consequences of receiving conflicting advice; and strategies that women used to manage these incidents. advice that was viewed as conflicting extended beyond the provision of information that was inconsistent or directly contradictory, and included issues around information overload and disparities between the mother's and health professional's expectations. The manner of presenting information or advice, the skills of using effective communication, demonstration of a caring attitude with an empathic approach and focusing upon the woman as an individual were seen to be important to minimise these incidents. Attention to women's perceptions and the consequences of conflicting advice must be addressed, otherwise the credibility and confidence in health professionals' knowledge and ability to support breast feeding is questioned, resulting in a valuable support network being selectively ignored.
to explore and describe the influence of childbirth expectations on women&amp... more to explore and describe the influence of childbirth expectations on women's perception of their birthing experience and expectations for subsequent births. This was the second phase of a study, the purpose of which its purpose was to determine the childbirth expectations of a cohort of Western Australian women and ascertain factors that influenced these expectations. a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews. Perth, Western Australia. 20 women, 11 primiparae and nine multiparae, who between them had experienced 31 births. These women had participated in phase one when they were either pregnant or had birthed within the preceding 12 months. Phase two interviews occurred 5-6 months after phase one. the themes and sub-themes revealed in phase one of the study were supported in phase two. Although women held multiple expectations for birth, specific expectations were regarded as priority. Consequently, to perceive birth as positive, a woman had to achieve her priority expectations. Multiparae reported more positive birth experiences, having altered expectations as a result of previous experiences. Unaffirming birth experiences due to unmet expectations were more common after a first birth. Women with unfulfilled expectations subsequently adapted their expectations to be more achievable thus avoiding disappointment. Supportive behaviours of maternity health-care providers assisted women to evaluate their birth experience as positive even when expectations could not be achieved. the evaluation of birth experiences as positive or negative is contingent upon achieving most, or at least the priority, childbirth expectation. Knowing a woman's expectations assists the midwife in her advocacy role. This role in assisting women to achieve their expectations is reinforced by this research. Caregivers become even more important when expectations are not able to be realised. Behaviours that encourage involvement and participation in decision-making during birth promote feelings of control, coping and feeling supported, which ultimately are needed for women to assess their birth experience as positive. Achievable expectations, such as 'being flexible' and 'only having a healthy baby' could be regarded as a lessening of ideals. The issue of whether these changing expectations are contributing to the increasing technocratic approach to birth and the resulting devaluing of the normal birth experience requires further debate.
to explore and describe the labour and birth expectations of a cohort of Western Australian women... more to explore and describe the labour and birth expectations of a cohort of Western Australian women, and to identify the factors that influence these expectations. a qualitative study using an explorative descriptive design and techniques associated with constant comparison. Data were collected from tape-recorded telephone interviews. : Perth, Western Australia. two hundred and two women who were pregnant or who had birthed within the last 12 months. five major themes were identified. Three of the five themes reflected a positive outlook on birth. These were labelled, 'owning and believing in birth as a natural event', 'satisfaction with the birth process and outcome' and 'involvement and participation in the birthing experience'. The remaining two themes 'birth is a negative event' and 'birth is a medical event' encapsulated the women's statements that described childbirth as a potential negative and unaffirming experience. Particularly influential on the formation of childbirth expectations were the public and private discourses of childbirth, especially those related to books and magazines, and the stories of mothers and sisters. Professional discourses, women's own history, and factors such as age and life-style choices also influenced decisions and contributed to how women perceived their experiences. the findings of the study challenge the anecdotal evidence that many contemporary western women willingly and knowingly choose or expect birth to be a medicalised event. Although midwives and other maternity healthcare providers need to help women develop realistic expectations, there is also a need to examine the influence of healthcare professionals in perpetuating a technical approach to birth. The findings do, however, confirm that some women are anxious, scared and frightened of the childbirth experience. It is essential that research continues to focus on developing strategies to assist women confront and deal with these fears.
The purpose of this qualitative study was to describe the experience of couples who have had a ho... more The purpose of this qualitative study was to describe the experience of couples who have had a home birth. A phenomenological approach was used to provide an understanding of the human experience of home birth in Western Australia. The research design consisted of a field study, in which 10 parent couples were interviewed and three videos of home births observed. Of the ten couples, four couples spoke of their first baby's home birth and the remaining six couples had three or four children who had been born at home. The couples' experiences of home birth were gained through identifying significant statements from transcripts and field notes, and clustering these into the following four themes: 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The themes of 'constructing the environment' and 'assuming control' are described in detail in this paper. 'Constructing the environment' describes how couples adapted the physical environment, and established support to create a positive birth environment. 'Assuming control' discusses exerting control and taking responsibility for the birth. The remaining themes of 'birthing' and 'resolving expectations' are described in a subsequent paper (Morison et al, in press). The research furnishes an insight into the couples' experience of home birth. The lived experience of birthing at home involved a process where a couple actively created an environment that enabled them to assume control and responsibility for the birth. The findings are important for midwives in any setting, as they reveal the extent to which some parents value the right to assume control and responsibility for the birth of their baby. Although the physical environment of a home birth cannot be replicated in every setting, issues specific to the birth environment are relevant to all midwives.
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2009
To explore women&... more To explore women's levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the third trimester of pregnancy. A cross-sectional descriptive survey of a community sample. Six hundred and fifty English-speaking nulliparous and multiparous women, 17 to 46 years of age and between 35 and 39 weeks gestation, with uncomplicated pregnancies. Wijma Delivery Expectancy/Experience Questionnaire, Spielberger State Anxiety Inventory, Mindell's Sleep Questionnaire, and the Multidimensional Assessment of Fatigue Questionnaire. Twenty-five percent of women reported high levels of childbirth fear and 20.6% reported sleeping less than 6 hours per night. Childbirth fear, fatigue, sleep deprivation, and anxiety were positively correlated. Fewer women attending midwives reported severe fear of childbirth than those attending obstetricians. Women with high childbirth fear were more likely to have more daily stressors, anxiety, and fatigue, as well as less help. Higher levels of anxiety predicted higher levels of childbirth fear among women. One fourth of women reported high childbirth fear. Women's fear of childbirth was related to fatigue, available help, stressors, and anxiety. Fear of childbirth appears to be part of a complex picture of women's emotional experiences during pregnancy.
A cross-sectional survey was used to determine the association among women&am... more A cross-sectional survey was used to determine the association among women's breastfeeding problems, their perceptions of support from midwives and child health nurses, and breastfeeding cessation in the first 10 weeks postbirth in a sample of Western Australian women (N = 2669). Primiparous women (75.8%) experienced significantly more problems that multiparous women (52.6%). Although 78.8% of all women agreed or strongly agreed that staff were helpful with feeding, 53.4% confirmed that different midwives offered different feeding advice; however, receiving different advice from midwives around feeding was not associated with breastfeeding cessation. Differences in breastfeeding cessation were associated with parity. Primiparous women's cessation was associated with experiencing any breastfeeding problems, unhelpful hospital midwives, and unhelpful information from child health nurses, whereas for multiparous women, this included 2 or more breastfeeding problems, not being able to choose when to feed, and unhelpful information from child health nurses.
the purpose of this study was to describe women׳s reasons for choosing to birth with a privately ... more the purpose of this study was to describe women׳s reasons for choosing to birth with a privately practising midwife. a modified grounded theory methodology was used. the sample comprised 14 Western Australian women who had received maternity care from a privately practising midwife within the previous five years. data analysis revealed three categories: the first was conceptualised as 'I knew what I wanted from my caregiver', which included sub-categories of: I wanted continuity of care; I wanted a relationship with my care provider; and I wanted a care provider with the same childbirth philosophy as me. The second encapsulated 'I knew what I wanted from my pregnancy and birth experience,' with two sub-categories, I wanted a natural, active, intervention free pregnancy and birth and I wanted my partner and family to be included. The final category was labelled 'I was willing to get the research to get what I wanted' and incorporated two sub-categories, I researched my care options and I researched my care provider options and the evidence around pregnancy and birth to be actively involved. findings offer insight around women׳s reasons for choosing this model of midwifery care and highlight that women know exactly what they want from their caregiver. Women valued working with their midwife towards a shared goal of an intervention-free, normal birth, researched their options and found mainstream services restrictive and focused on medical risk status rather than on the individual woman. findings will be of interest to maternity care practitioners and policy makers, as they highlight why some women prefer a social model of midwifery care that reflects a family centred, individualised and holistic approach. This insight can inform the development of maternity health care practices to recognise and accommodate the needs and values of all childbearing women.
ABSTRACT BACKGROUND: In July 2008, a new midwife-led “Next Birth After Cesarean” (NBAC) service w... more ABSTRACT BACKGROUND: In July 2008, a new midwife-led “Next Birth After Cesarean” (NBAC) service was launched at King Edward Memorial Hospital (KEMH) in Perth, Western Australia. Midwives from the NBAC service provide antenatal care, evidence-based information about birth choices, tailored birth preparation classes, and assistance with developing birth plans to pregnant women who have had a previous cesarean birth. OBJECTIVE: To determine the contributory factors that women who were cared for by the NBAC service and experienced a vaginal birth after cesarean (VBAC) perceived to be associated with achieving their desired mode of birth. METHODS: A qualitative descriptive approach was used for this study in which semistructured interviews were conducted with 13 participant women who have achieved a VBAC and were analyzed using a modified “constant comparison” technique. FINDINGS: Two key themes reflecting personal and professional factors comprising eight subthemes emerged from analysis of interview data. CONCLUSIONS: These findings offer a unique perspective on the phenomenon of achieving a VBAC and provide maternity care practitioners and policy makers around the world with valuable insights into how the care environment might be enhanced for women who would prefer a vaginal birth after their previous cesarean section.
Breastfeeding review : professional publication of the Nursing Mothers' Association of Australia, 2002
Breastfeeding is the method of choice for infants and most women support the statement that '... more Breastfeeding is the method of choice for infants and most women support the statement that 'breast is best'. Although the majority of Australian women do initiate breastfeeding, many also encounter difficulties in what they assume to be an easy, natural process. Additionally, a number of women face difficulties significant enough to warrant additional support from resources such as the Breastfeeding Centre of Western Australia. Managing these difficulties influences mothers' perceptions of their breastfeeding experiences. However, the stories of these women have not been addressed in the literature. This phenomenological study explored the lived experiences of mothers with breastfeeding difficulties, who presented to the Breastfeeding Centre of Western Australia. In-depth interviews with ten women revealed three main themes: 'path of determination, 'staying on the path; and 'coming off the path'. The study contributes to the body of knowledge on infant f...
This paper addresses the limited sociological understanding of the phenomena of childbirth fear u... more This paper addresses the limited sociological understanding of the phenomena of childbirth fear using data from a qualitative research project conducted in Western Australia. This qualitative study used an exploratory descriptive design, with 22 women identified as being fearful of birth participating in an in-depth interview. Data analysis using the method of constant comparison revealed that social context, explored within the framework of the medicalisation of childbirth, and the intervening circumstances in which the women gave birth, impacted on how and why they experienced fear. As such, this paper argues that fear of childbirth has social as well as personal dimensions and is both a prospective and retrospective phenomena. The analysis identified prospective fear as both social and personal. The social dimensions were labelled as 'fear of the unknown', 'horror stories' and 'general fear for the well-being of the baby'. Personal dimensions included the 'fear of pain', 'losing control and disempowerment' and 'uniqueness of each birth'. Retrospective fear was exclusively personal and was clustered around the themes of 'previous horror birth' and 'speed of birth'. The analysis also revealed two central factors that mediated against childbirth fear: positive relationships formed with midwives, and the support women received from their informal network. Understanding and unpacking the dimensions of women's childbirth fear, and understanding the nature of relationships that mediate women's fear, provides health care professionals with information on which to base potential intervention strategies and support women in ways that lessen rather than heighten their fear.
a cross sectional survey was undertaken to explore midwives&a... more a cross sectional survey was undertaken to explore midwives' knowledge of, and attitudes towards, mental health disorders in childbearing women vis-à-vis their perceived mental health learning needs. a 50.1% response rate included 238 midwives employed in the only public tertiary maternity hospital in Western Australia from March to June 2013. The survey comprised a mixture of custom-designed questions and vignettes presenting various disorders. Only 37.6% of midwives felt well-equipped to support women, whilst 50.2% reported insufficient access to information. Demand was highest for education on: personality disorders (77.8%); the impact of childbearing on mental health disorders (74.2%); and skills for handling stress and aggression (57.8%). Knowledge scores were variable: on average eight out of a maximum 13 questions were answered correctly, but few (2.7%) answered more than 11 correctly, and 3.7% scored ≤4 correct. Across disorders, recognition from vignettes was highest for depression (93.9%), and lowest for schizophrenia (65.6%). Surprisingly, there were no associations between general knowledge scores and previous mental health experience, recent professional development, or access to information around mental health. The majority endorsed positive beliefs about midwives' role in mental health assessment, and belief in women's recovery (83.5%), however, cluster analysis of warmth and competence ratings revealed negative stereotyping of mental health disorders. Midwives accept it is their role to assess the mental health status of women but many feel ill-equipped to do so and express a strong desire for further knowledge and skills across a range of perinatal mental health topics. Attitudes to recovery are positive but negative stereotypes exist; therefore awareness of potential bias is important to negate their influence on care. Learning needs may change due to trends in clinical practice. Strategies are needed to recognise negative beliefs and to ensure education is responsive to local contexts.
An important part of maternity service provision is the care provided by midwives in the immediat... more An important part of maternity service provision is the care provided by midwives in the immediate postpartum period. Evidence suggests that postpartum morbidity and its impact on women's health after childbirth is an area of genuine concern. In Western Australia there is limited information on women's postpartum health needs and/or the quality of midwifery care provided in hospital and at home. This paper describes Western Australian (WA) women's perceptions of midwifery care in the early postpartum period. A cross-sectional, self report survey was used to describe the practical, emotional and informational support provided by midwives in the initial postpartum period. A questionnaire, specially designed for this population, was posted at 8 weeks postpartum to every woman with a registered live birth in WA between February and June 2006. Completed questionnaires were received from 2699 women. Data were analysed using descriptive statistics, t-tests and chi-squared. Results indicate that overall, women were happy with most aspects of midwifery care related to practical advice and assistance in relation to baby care and their immediate physical recovery. Areas that received a less positive rating were related to providing consistent advice, availability of the midwife, emotional care and information on maternal health needs, immunisation and contraception. In general, first time mothers rated both the style and quality of care more negatively than multiparous women. There was a trend by women accessing private hospital care to rank their care less favourably. There were minimal differences noted between women in metropolitan and non-metropolitan areas. Midwifery care at home was rated very positively and significantly better than hospital care (p</=0.002). Although the majority of women in this study were satisfied with the components of physical care and information and assistance with infant feeding and sleep and settling provided in the short-term, there was less satisfaction with emotional care and preparation for life at home with a new baby. This study adds to our understandings of women's experiences of the early postnatal period and provides information on which to base improvements in postnatal care and maternity services in WA and across Australia.
The purpose of this grounded theory study was to analyze the maternal process of managing the lat... more The purpose of this grounded theory study was to analyze the maternal process of managing the later stages of established breast-feeding and, ultimately, weaning the child from the breast within a Western Australian context. Data were analyzed from 33 participants' interview transcripts, field notes, 9 postal questionnaires from fathers, and individual and discussion group interviews with child health nurses. A common social problem of incompatible expectations was revealed. All participants faced a dilemma in the management of their experience when personal expectations were in opposition to others' expectations. A process of Constructing Compatibility by Adapting Focus was adopted to compensate for this incompatibility.
to explore women&... more to explore women's perceptions of conflicting advice around breast feeding from formal support networks, specifically health professionals involved in postnatal support. a qualitative exploratory design was employed using the critical incident technique. Data were obtained from 62 Western Australian women who responded to an invitation to share incidents of receiving conflicting advice. Women who had breast fed a child within the past 12 months shared their experience through a telephone interview (n = 50) or completing a brief questionnaire (n = 12) addressing the following questions: Describe a situation in detail where you felt you received conflicting advice about breast feeding from a health professional. How did this situation affect you and/or your breast feeding? a modified constant comparison method was used to analyse the critical incidents revealing commonalities under who offered conflicting advice; what contributed to advice being perceived as conflicting; topic areas more inclined to being regarded as conflicting; what protected against advice being perceived as conflicting; the consequences of receiving conflicting advice; and strategies that women used to manage these incidents. advice that was viewed as conflicting extended beyond the provision of information that was inconsistent or directly contradictory, and included issues around information overload and disparities between the mother's and health professional's expectations. The manner of presenting information or advice, the skills of using effective communication, demonstration of a caring attitude with an empathic approach and focusing upon the woman as an individual were seen to be important to minimise these incidents. Attention to women's perceptions and the consequences of conflicting advice must be addressed, otherwise the credibility and confidence in health professionals' knowledge and ability to support breast feeding is questioned, resulting in a valuable support network being selectively ignored.
to explore and describe the influence of childbirth expectations on women&amp... more to explore and describe the influence of childbirth expectations on women's perception of their birthing experience and expectations for subsequent births. This was the second phase of a study, the purpose of which its purpose was to determine the childbirth expectations of a cohort of Western Australian women and ascertain factors that influenced these expectations. a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews. Perth, Western Australia. 20 women, 11 primiparae and nine multiparae, who between them had experienced 31 births. These women had participated in phase one when they were either pregnant or had birthed within the preceding 12 months. Phase two interviews occurred 5-6 months after phase one. the themes and sub-themes revealed in phase one of the study were supported in phase two. Although women held multiple expectations for birth, specific expectations were regarded as priority. Consequently, to perceive birth as positive, a woman had to achieve her priority expectations. Multiparae reported more positive birth experiences, having altered expectations as a result of previous experiences. Unaffirming birth experiences due to unmet expectations were more common after a first birth. Women with unfulfilled expectations subsequently adapted their expectations to be more achievable thus avoiding disappointment. Supportive behaviours of maternity health-care providers assisted women to evaluate their birth experience as positive even when expectations could not be achieved. the evaluation of birth experiences as positive or negative is contingent upon achieving most, or at least the priority, childbirth expectation. Knowing a woman's expectations assists the midwife in her advocacy role. This role in assisting women to achieve their expectations is reinforced by this research. Caregivers become even more important when expectations are not able to be realised. Behaviours that encourage involvement and participation in decision-making during birth promote feelings of control, coping and feeling supported, which ultimately are needed for women to assess their birth experience as positive. Achievable expectations, such as 'being flexible' and 'only having a healthy baby' could be regarded as a lessening of ideals. The issue of whether these changing expectations are contributing to the increasing technocratic approach to birth and the resulting devaluing of the normal birth experience requires further debate.
to explore and describe the labour and birth expectations of a cohort of Western Australian women... more to explore and describe the labour and birth expectations of a cohort of Western Australian women, and to identify the factors that influence these expectations. a qualitative study using an explorative descriptive design and techniques associated with constant comparison. Data were collected from tape-recorded telephone interviews. : Perth, Western Australia. two hundred and two women who were pregnant or who had birthed within the last 12 months. five major themes were identified. Three of the five themes reflected a positive outlook on birth. These were labelled, 'owning and believing in birth as a natural event', 'satisfaction with the birth process and outcome' and 'involvement and participation in the birthing experience'. The remaining two themes 'birth is a negative event' and 'birth is a medical event' encapsulated the women's statements that described childbirth as a potential negative and unaffirming experience. Particularly influential on the formation of childbirth expectations were the public and private discourses of childbirth, especially those related to books and magazines, and the stories of mothers and sisters. Professional discourses, women's own history, and factors such as age and life-style choices also influenced decisions and contributed to how women perceived their experiences. the findings of the study challenge the anecdotal evidence that many contemporary western women willingly and knowingly choose or expect birth to be a medicalised event. Although midwives and other maternity healthcare providers need to help women develop realistic expectations, there is also a need to examine the influence of healthcare professionals in perpetuating a technical approach to birth. The findings do, however, confirm that some women are anxious, scared and frightened of the childbirth experience. It is essential that research continues to focus on developing strategies to assist women confront and deal with these fears.
The purpose of this qualitative study was to describe the experience of couples who have had a ho... more The purpose of this qualitative study was to describe the experience of couples who have had a home birth. A phenomenological approach was used to provide an understanding of the human experience of home birth in Western Australia. The research design consisted of a field study, in which 10 parent couples were interviewed and three videos of home births observed. Of the ten couples, four couples spoke of their first baby's home birth and the remaining six couples had three or four children who had been born at home. The couples' experiences of home birth were gained through identifying significant statements from transcripts and field notes, and clustering these into the following four themes: 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The themes of 'constructing the environment' and 'assuming control' are described in detail in this paper. 'Constructing the environment' describes how couples adapted the physical environment, and established support to create a positive birth environment. 'Assuming control' discusses exerting control and taking responsibility for the birth. The remaining themes of 'birthing' and 'resolving expectations' are described in a subsequent paper (Morison et al, in press). The research furnishes an insight into the couples' experience of home birth. The lived experience of birthing at home involved a process where a couple actively created an environment that enabled them to assume control and responsibility for the birth. The findings are important for midwives in any setting, as they reveal the extent to which some parents value the right to assume control and responsibility for the birth of their baby. Although the physical environment of a home birth cannot be replicated in every setting, issues specific to the birth environment are relevant to all midwives.
Journal of Obstetric, Gynecologic, & Neonatal Nursing, 2009
To explore women&... more To explore women's levels of childbirth fear, sleep deprivation, anxiety, and fatigue and their relationships during the third trimester of pregnancy. A cross-sectional descriptive survey of a community sample. Six hundred and fifty English-speaking nulliparous and multiparous women, 17 to 46 years of age and between 35 and 39 weeks gestation, with uncomplicated pregnancies. Wijma Delivery Expectancy/Experience Questionnaire, Spielberger State Anxiety Inventory, Mindell's Sleep Questionnaire, and the Multidimensional Assessment of Fatigue Questionnaire. Twenty-five percent of women reported high levels of childbirth fear and 20.6% reported sleeping less than 6 hours per night. Childbirth fear, fatigue, sleep deprivation, and anxiety were positively correlated. Fewer women attending midwives reported severe fear of childbirth than those attending obstetricians. Women with high childbirth fear were more likely to have more daily stressors, anxiety, and fatigue, as well as less help. Higher levels of anxiety predicted higher levels of childbirth fear among women. One fourth of women reported high childbirth fear. Women's fear of childbirth was related to fatigue, available help, stressors, and anxiety. Fear of childbirth appears to be part of a complex picture of women's emotional experiences during pregnancy.
A cross-sectional survey was used to determine the association among women&am... more A cross-sectional survey was used to determine the association among women's breastfeeding problems, their perceptions of support from midwives and child health nurses, and breastfeeding cessation in the first 10 weeks postbirth in a sample of Western Australian women (N = 2669). Primiparous women (75.8%) experienced significantly more problems that multiparous women (52.6%). Although 78.8% of all women agreed or strongly agreed that staff were helpful with feeding, 53.4% confirmed that different midwives offered different feeding advice; however, receiving different advice from midwives around feeding was not associated with breastfeeding cessation. Differences in breastfeeding cessation were associated with parity. Primiparous women's cessation was associated with experiencing any breastfeeding problems, unhelpful hospital midwives, and unhelpful information from child health nurses, whereas for multiparous women, this included 2 or more breastfeeding problems, not being able to choose when to feed, and unhelpful information from child health nurses.
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Papers by Yvonne Hauck