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Perinatal death results in long-lasting intense grief for bereaved mothers with a potential to negatively impact on their short- and long-term outcomes and quality of life if inadequately supported in coping with and managing their experience. This study aimed at exploring the lived experience of women, of care and support following perinatal death in South-Western, Nigeria. A qualitative methodology using Heideggerian phenomenology was used. Fourteen women who had experienced perinatal death in South-Western Nigeria within the last (5) five years were interviewed, and Van Manen's approach to hermeneutic phenomenology was used in data analysis. Four main themes were identified: "they did not tell me the baby died", "response of health care professionals after the baby died", "moving on from hospital", and "support from family". The physical health status of mothers determined how they were informed of perinatal death. Health care professionals were distant, rude, nonempathetic and did not offer emotional support, in some cases. Mothers were given opportunity to see and hold their babies. There was no routine follow-up support in the community, besides a postnatal check-up appointment offered to all mothers regardless of their birth outcome. Family provided emotional support for mothers on discharge. This study was the first to explore the lived experience of women of the care and support following perinatal death in South-Western, Nigeria. There is a need for healthcare systems to review bereavement care and support provisions for women who experience perinatal death. [ABSTRACT FROM AUTHOR]

The experiences of women in low and middle-income countries following perinatal death remains difficult and challenging, thereby increasing their susceptibility to negative psychological impact particularly with insufficient bereavement care and support. Perinatal death invariably brings intense grief which significantly impacts women, and requires adequate bereavement care to limit negative outcomes in the short and long-term. To develop deeper understanding of women's experience of care and support following perinatal death in high burden settings. Six electronic databases were searched with relevant terms established using the SPIDER tool, supplemented by hand search of reference lists. Studies were independently screened for inclusion by all authors. Meta-ethnography (Noblit and Hare,1988) was used to synthesise existing qualitative studies. Eight studies conducted in Sub-Saharan African and South Asian countries namely South Africa, Uganda, Ghana, Kenya, India and Malawi were included, and three main themes were identified; mothers' reaction to their baby's death, care and support after perinatal death, and coping strategies in the absence of care and support. Perinatal death was not appropriately acknowledged therefore care and support was inadequate and, in some cases, non-existent. Consequently, mothers resorted to adopting coping strategies as they were unable to express their grief. There is insufficient care and support for women following perinatal death in high burden settings. Further research is required into the care and support being given by healthcare professionals and families in high burden settings, thereby ultimately aiding the development of guidance on perinatal bereavement care. [ABSTRACT FROM AUTHOR]

Stillbirth is a traumatic life-event for parents. Compassionate care from health workers supports grief and adjustment, alleviating psychological distress and minimising serious adverse health and social consequences. Bereavement support in facilities in LMICs, including in sub-Saharan Africa, often fails to meet parents' needs. However, very few studies have explored health worker's experiences in these settings. To explore the lived experiences of midwives, doctors and others, caring for women after stillbirth in Kenya and Uganda. Qualitative, guided by Heideggerian phenomenology. Sixty-one health workers, including nurse-midwives (N = 37), midwives (N = 12) and doctors (N = 10), working in five facilities in Kenya and Uganda, were interviewed. Data were analysed following Van Manen's reflexive approach. Three main themes summarised participants' experiences: ' In the mud and you learn to swim in it ' reflected a perceived of lack of preparation; skills were gained through experience and often without adequate support. The emotional and psychological impacts including sadness, frustration, guilt and shame were summarised in 'It's bad, it's a sad experience'. Deficiencies in organisational culture and support, which entrenched blame, fear and negative behaviours were encapsulated in Nobody asks 'how are you doing?'. Health workers in Kenya and Uganda were deeply sensitive to the impacts of stillbirth for women and families, and often profoundly and personally affected. Care and psychological support were acknowledged as often inadequate. Interventions to support improved bereavement care in sub-Saharan Africa need to target increasing health worker knowledge and awareness and also embed supportive organisational cultures and processes. [ABSTRACT FROM AUTHOR]

Wireless continuous electronic fetal monitoring (CEFM) using telemetry offers potential for increased mobility during labour. United Kingdom national recommendations are that telemetry should be offered to all women having CEFM during labour. There is limited contemporary evidence on experiences of telemetry use or impacts it may have. To gather in-depth knowledge about the experiences of women and midwives using telemetry, and to assess any impact that its use may have on clinical outcomes, mobility in labour, control or satisfaction. A convergent parallel mixed-methods study was employed. Grounded theory was adopted for interviews and analysis of 13 midwives, 10 women and 2 partners. Satisfaction, positions during labour and clinical outcome data was analysed from a cohort comparing telemetry (n = 64) with wired CEFM (n = 64). Qualitative and quantitative data were synthesised to give deeper understanding. Women using telemetry were more mobile and adopted more upright positions during labour. The core category A Sense of Normality encompassed themes of 'Being Free, Being in Control', 'Enabling and Facilitating' and 'Maternity Unit Culture'. Greater mobility resulted in increased feelings of internal and external control and increased perceptions of autonomy, normality and dignity. There was no difference in control or satisfaction between cohort groups. When CEFM is used during labour, telemetry provides an opportunity to improve experience and support physiological capability. The use of telemetry during labour contributes to humanising birth for women who have CEFM and its use places them at the centre and in control of their birth experience. [ABSTRACT FROM AUTHOR]

• Culturally sensitive maternity care helps women from minority ethnic groups feel safe. • Information provision helps women from minority ethnic groups make informed choices. • Midwives' workload compromises care provision, especially for non-English speakers. • Midwives need support to provide fully equitable information for non-English speakers. • Innovative ways of ensuring representative maternity services feedback are needed. To understand the maternity experiences of women from minority ethnic groups who had given birth in an NHS trust in the North-West of England, and experiences of midwives caring for them. Women from minority ethnic groups have poorer maternity outcomes compared with other women. Research about maternity experiences of women from minority ethnic groups is limited but suggests that they have poorer experiences. Constructivist grounded theory was used as the framework for the study. Thirteen women and sixteen midwives were interviewed to elicit views and maternity experiences of women from minority ethnic groups. Interviews were transcribed, analysed, and focused codes developed into theoretical codes resulting in an emergent grounded theory. Four sub-categories emerged: 'I was feeling protected', 'it is just literally empowering them, 'it will affect them more', and 'if people speak out it will help other people'. These sub-categories generated a substantive theory: 'striving towards equity and women centred care'. Culturally sensitive, relational care made women feel safe and trust their care providers. Information provision led to reassurance and enabled women to make choices about their care. Midwives' workload compromised care provision and disproportionally affected women from minority ethnic groups, especially those who do not speak English. Women from minority groups are less likely to complain and be represented in feedback. Culturally sensitive care is meeting the individual needs of many women; however, non– English speakers are disproportionally and negatively affected by midwives' workload, attitudes, or service challenges, reducing their reassurance and choice. [ABSTRACT FROM AUTHOR]

Objective To gain an understanding of womens' views surrounding decisions on the timing of childbearing. Study Design This study was based on interviews with 18 childless women, from North-West England, in three age groups: Six women aged between 18 and 24; Six women aged between 25 and 34; and six women aged 35 or more. Data were analysed using a hermeneutic phenomenological approach with thematic analysis. Results Three main themes were identified. Women perceived themselves as living within boundaries , defined internally and externally; they aspired to being a great mother or no mother ; and had a desire to contribute to family and society, at multiple levels. Risks associated with delaying childbearing had little or no influence on decision-making. The overarching phenomenon was social comparability; decisions were made in the context of women's knowledge and perceptions of others and a high degree of critical self-evaluation. Conclusion We conclude that social reality dominates womens' reproductive decisions. Whilst the biological reality is that fertility reduces and medical complications increase with maternal age, social discourses deter women from acknowledging this. Medical risks associated with advanced maternal age are undermined by the notion that women can choose when to start a family. [ABSTRACT FROM AUTHOR]

Objectives Despite increased risks of infertility and poor outcomes, women in high-income countries are increasingly deferring pregnancy beyond age 35.The underlying causes are incompletely understood. The mass media is recognised as a powerful influence on health-related behaviour; therefore media representations warrant critical examination. Study design Qualitative thematic analysis of portrayals of pregnancy and birth in women over 35 in UK national newspapers, popular magazines and television programmes Results Extensive media interest in childbearing and a preponderance of coverage related to celebrities was confirmed. Three main themes were identified; delayed childbearing was portrayed positively, as part of a life plan allowing women have the “best of both worlds”. The media did not acknowledge age per sé as an obstacle to pregnancy and endorsed reproductive technologies suggesting ‘it's never too late’. Images and descriptions of ideal post-pregnancy bodies in women over 35 reinforced the message that “you can regain your beautiful body”. Conclusion Delayed childbearing was represented positively, as it facilitated conformity with dominant ideologies surrounding motherhood. Within these boundaries, the effects of age were disregarded. This study provides evidence of restrictive framing of the issues surrounding delayed childbearing in the UK media which militate against communication of important public health messages. [ABSTRACT FROM AUTHOR]

Abstract: Delayed childbearing is a growing trend in developed countries. Between 1982 and 2012, the number of live births to UK women over 40 more than quadrupled. This accelerating demographic shift is of major clinical and public health concern, because advanced maternal age has consistently been associated with adverse pregnancy outcomes. Current evidence suggests increased risk of miscarriage, ectopic pregnancy and stillbirth. Most studies also report elevated maternal morbidity resulting from hypertensive disorders and gestational diabetes. Many questions remain unanswered regarding the underlying mechanisms. The contribution of age per sé versus co-morbidities is unclear, as is the age threshold at which increased risks become significant. Despite the increased risks, there are potential psychological and social advantages to delaying childbirth and absolute numbers of complications are small. Further studies are required to develop effective strategies to reduce poor outcomes and provide optimal care for pregnant women of advanced age. [Copyright &y& Elsevier]

Abstract: Delayed childbearing is a growing trend in developed countries. Between 1989 and 2009, the number of live births to UK women over 40 almost trebled. This accelerating demographic shift is of major clinical and public health concern, because advanced maternal age has consistently been associated with adverse pregnancy outcomes. Current evidence suggests a strong association with increased risk of miscarriage, ectopic pregnancy and stillbirth. Most studies also report elevated maternal morbidity resulting from hypertensive disorders and gestational diabetes. Many questions remain unanswered regarding the underlying mechanisms. The contribution of age per sé versus co-morbidities is unclear, as is the age threshold at which increased risks become significant. Despite the increased risks, there are potential psychological and social advantages to delaying childbirth and absolute numbers of complications are small. Further studies are required to develop effective strategies to reduce poor outcomes and provide optimal care for pregnant women of advanced age. [Copyright &y& Elsevier]