Search

Objectives: Explore what influenced women's decision to exclusively formula feed, and their experiences with formula feeding within a maternity hospital environment., Design: This mixed methods study used a cross-sectional exploratory survey design. Short surveys were administered by telephone in the postpartum period. Content analysis revealed common themes for responses to open-ended questions on what influenced women's choice and experience with formula feeding. Descriptive statistics were used for demographic characteristics, and frequencies conducted on some themes., Participants and Setting: English-speaking women who chose to exclusively formula feed, and attended a tertiary maternity hospital in Australia were invited to participate; 102 women were interviewed., Findings: Themes that influenced women to choose exclusive formula feeding were: 'Previous breastfeeding challenges', 'social and societal issues' including convenience, comfort, and trust in formula, and 'maternal health' including medical issues and medications, breast physiology and mental health. Themes from the formula feeding experience in hospital were: 'Supportive' elements such as midwifery care, convenience, and resources, and 'hindering' elements such as a perceived breastfeeding agenda and systemic barriers., Key Conclusions and Implications for Practice: Previous breastfeeding difficulties were a common influence on exclusive formula feeding in subsequent pregnancies, highlighting the importance of adequate support during the primary lactation/infant feeding experience. Greater comfort and confidence levels with formula feeding and a sense of trust in formula were also influential. Some maternal medications, conditions, or physiological circumstances were perceived by women as impacting breastfeeding or breastmilk, signposting the importance of antenatal screening and assessment to support women's options and decisions regarding infant feeding. A perception of professional and organisational preferences for breastfeeding over formula feeding contributed to some women feeling judged for their choice. This reminds midwives to consider the complex intersection of factors that influence infant feeding decisions and ensure all mothers are respected and fully supported., Competing Interests: Declaration of Competing Interest None declared by all authors., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Substantial public health measures occurred in Australian society during the COVID-19 pandemic to reduce the risk of community transmission. Little was known about the impact of these changes on childbearing women., Aim: To describe childbearing women's experiences of becoming a mother during the COVID-19 pandemic in Australia., Methods: A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. A total of 27 interviews were conducted with women across Australia. Data were analysed thematically., Findings: The thematic analysis resulted in four primary themes and ten sub-themes. The themes were 'going it alone - having a baby was an isolating experience' ('receiving maternity care alone', 'dealing with government restrictions', and 'desiring social support'), 'advocating for self or others' ('seeking reliable information', 'valuing peersupport', and 'having to be resourceful'), 'finding a way through' ('a changed experience for all', 'managing stress and anxiety', 'requiring constant adjustments', and 'managing fear mongering'), and 'keeping safe'., Conclusion: Becoming a mother during the COVID-19 pandemic in Australia was a profound experience for the women. Following the public health initiatives which resulted in physical distancing restrictions, isolation, and the need to provide and receive social and peer support were common experiences. Whilst public health initiatives are implemented to keep people safe, the social and emotional toll on childbearing women should be considered by healthcare professionals. Childbearing women need to be safe but also require support and reassurance., Competing Interests: Declaration of Competing Interest Not applicable., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: To explore and describe what student midwives, enrolled in one Western Australian (WA) university, had witnessed, learned and experienced regarding the concept of being 'with woman'., Design: A qualitative descriptive design was chosen., Setting: A university in Perth, Western Australia., Participants: Nineteen student midwives from an undergraduate and a post graduate midwifery course., Methods: Data were collected from audio-recorded interviews. Thematic analysis of interview transcripts was used to identify commonalities of perceptions and experiences of being 'with woman' for students. Data saturation guided when recruitment ceased and final sample size was achieved., Findings: Student interviews revealed that when considering the concept of being 'with woman' students were able to give descriptors of what they interpreted the meaning of being 'with woman' to be. They also described factors that impacted their learning of how to be 'with woman'. Included in their descriptors were that being 'with woman' enables informed choice, it creates a connection, it means the woman is at the centre of care and that it can occur in all contexts. The factors that impacted their learning of how to be 'with woman' were the importance of positive midwife role models, that providing continuity of care models accelerate learning, that the student role and workload can impact their perceived ability to be with woman and that they are aware it takes time to learn how to be 'with woman'., Conclusion and Implications: The art and skills of being 'with woman' are central to midwifery practice; students in this study were able to demonstrate understanding of the concept and also highlight factors that influence their learning of how to be 'with woman'. Findings can inform how the phenomenon of being 'with woman' can be intentionally introduced into midwifery programs, with particular emphasis on positive midwifery role models, realistic student workload and recognition of the value of the Continuity of Care Experience., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020. Published by Elsevier Ltd.)

Objective: The objective of this study was to explore midwives' experiences of being 'with woman' in the intrapartum period within the context of an unknown midwife model., Design: A descriptive phenomenological design was used with individual in-depth interviews. Transcribed interviews were analysed using thematic analysis that incorporated the data analysis framework offered by Amadeus Giorgi., Setting: Hospitals within Western Australia providing intrapartum care to women where the midwife is not usually known to them., Participants: Ten midwives were interviewed and recruitment ceased when data saturation was reached., Findings: Findings confirm the importance of building a connection to enable partnership with the woman and provide woman-centred care that is inclusive of her partner. Factors influencing midwives' ability to be 'with woman' included the 'systems' approach to childbearing as well as common birth interventions prevalent within the public hospital system. Midwives experienced both rewards and challenges associated with being 'with woman' in the unknown midwife model, adaptability and self-awareness were features that enhanced the ability to be 'with woman' within this model., Key Conclusions: Findings present new knowledge about being 'with woman', a phenomenon so central to the profession of midwifery, yet previously unexplored in the empirical domain. Insights gained reveal the intersection between the phenomenon and the unknown midwife model and highlight characteristics of the midwives that facilitate being 'with woman' such as adaptive expertise., Implications for Practice: Understanding the concept of being 'with woman' through the lived experience of midwives provides unique insight into the applied practices of the phenomenon. Characteristics of being 'with woman' as well as attributes and strengths demonstrated by the midwives provides important data for education and development of the profession. Explicating the challenges faced by midwives seeking to be 'with woman' in the unknown midwife model is useful for health leaders of service delivery and policy development to consider innovative ways to enhance this important practice advised by professional philosophy., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To determine the knowledge, attitudes and learning needs of midwives regarding antenatal vaccination., Design and Setting: A cross-sectional, paper-based survey of midwives employed at the only public tertiary maternity hospital in the Australian state of Western Australia between November 2015 and July 2016., Participants: 252 midwives providing care in antepartum, intrapartum, and/or postpartum settings., Measurements: Self-reported responses to a 41-item survey., Findings: The vast majority of midwives supported influenza and pertussis vaccination for pregnant women, with 90.0% and 71.7% reporting they would recommend pertussis and influenza vaccine, respectively, to a pregnant friend or family member, and almost all stating that midwives should administer vaccines to pregnant patients (94.8%). Seven out of ten midwives (68.1%) responded correctly to all knowledge items regarding vaccines recommended during pregnancy; 52.8% demonstrated correct knowledge regarding vaccine administration despite only 36.6% having attended an education session on antenatal vaccination in the previous two years. Nearly all midwives (97.3%) expressed a need for more education on vaccine administration. The most commonly reported barrier to administering influenza (61.3%) and pertussis (59.0%) vaccination was having staff available with the certification required to administer vaccines., Key Conclusions: Midwives view antenatal vaccination as their responsibility and are interested and receptive to education., Implications for Practice: There is an unmet need and demand among midwives for professional development that would enable them to recommend and administer vaccines to pregnant women in accordance with national immunisation guidelines and integrate vaccination into routine antenatal care., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Aim: the aim of this Western Australian study was to describe the overall labour and birth experience of partners within the context of an intrapartum transfer occurring from a low risk midwifery-led, woman-centred unit to an obstetric unit., Design: a descriptive phenomenological design was used. 15 male partners were interviewed in the first 8 weeks post partum between July and October, 2013 to explore their experience of the intrapartum transfer., Setting: a midwifery-led birth centre set on the grounds of a tertiary maternity referral hospital., Participants: partners of women who were transferred from the birth centre to the onsite tertiary hospital due to complications during the first and second stages of labour., Findings: five main themes emerged: (1) 'emotional roller coaster'; (2) 'partner׳s role in changing circumstances' with subthemes: 'acknowledgement for his inside knowledge of her' and 'challenges of being a witness'; (3) 'adapting to a changing model of care' with subthemes: 'moving from an inclusive nurturing and continuity model' and 'transferring to a medicalised model'; (4) 'adapting to environmental changes' with subthemes: 'feeling comfortable in the familiar birth centre', 'going to the place where things go wrong' and 'Back to comfortable familiarity afterwards' and (5) 'coming to terms with altered expectations around the labour and birth experience'., Key Conclusions: partners acknowledged the benefits of midwifery continuity of care, however, noted that as partners they also provided essential continuity as they felt they knew their woman better than any care provider. Partners found it difficult to witness their woman׳s difficult labour journey. They found the change of environment from birth centre to labour ward challenging but appreciated that experienced medical assistance was at hand when necessary. Being able to return to the birth centre environment was acknowledged as beneficial for the couple. Following the transfer experience partners asked for the opportunity to debrief to clarify and better understand the process., Implications for Practice: findings may be used to inform partners in childbirth education classes about what to expect when transfer takes place and offer the opportunity for them to debrief after the birth. Finally, themes can provide insight to maternity care professionals around the emotions experienced by partners during intrapartum transfer to enhance informed choice, involvement in care and empathetic support., (Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.)

Objective: this paper describes midwives' experiences of learning new counselling skills and delivering a counselling intervention entitled 'Promoting Resilience on Mothers Emotions' (PRIME)., Design: a descriptive exploratory approach was used. Data collected included semi-structured interviews (n=42), midwife diary entries (18 pages) and web based postings (169 pages). Data were analysed using manual thematic method., Setting: the intervention study was conducted in two tertiary maternity hospitals in the Australian states of Queensland (QLD) and Western Australia (WA) during a 17 month period, from August 2008 to December 2009., Participants: midwives were employed as research assistants and trained to deliver a counselling intervention to women reporting a traumatic birth experience. Eighteen of a possible 20 Australian midwives participated in this study., Intervention: PRIME is a midwife-led counselling intervention based on cognitive-behavioural principles and designed to ameliorate trauma symptoms. It is offered face-to-face within 72 hours of childbirth and by phone around six weeks post partum., Findings: participating midwives felt confronted by the level of emotional distress some women suffered as a consequence of their birth experience. Four major themes were extracted: The challenges of learning to change; Working with women in a different way; Making a difference to women and me; and A challenge not about to be overcome., Key Conclusions and Implications for Practice: the advanced counselling skills the midwives acquired improved their confidence to care for women distressed by their birthing experience and to personally manage stressful situations they encountered in practice., (© 2013 Elsevier Ltd. All rights reserved.)

Introduction: despite an exponential rise in the number of medically initiated elective caesarean sections over the last two decades, women's experiences of this birth mode remain largely unknown. The aim of this study was to address this gap by describing women's experiences of medically necessary elective caesarean section., Methods: a grounded theory approach was used to collect and analyse interview data collected from 28 Australian women who had an elective caesarean section for a medical reason, 14 of whom were also observed during their caesarean section. The analyses of the non-participant observations were used to contextualise the women's experiences., Findings: prior to having their baby, women expected to play an active part in their caesarean section and to be supported to take up their 'mother' role as soon as their baby was delivered. Postnatally however, they reported having felt invisible, superfluous and disregarded during the event. There was evidence that hospital routines and processes contributed to women feeling displaced and unimportant in their baby's birth. Three sub-categories were formed from the analysis of the data that together are represented by the in-vivo label 'off everyone's radar'. These were 'just another case on an operating list', 'striving to be included while trying to behave' and 'unable to be my baby's mum'., Discussion: our findings suggest that when women are ignored during childbirth, any fear they hold may escalate into peritraumatic disassociation, which in turn has implications for women's postnatal mental and emotional health in the short and long term. In addition, the separation of the mother-baby dyad was found to have a devastating impact on maternal-newborn attachment that lasted well into the postnatal period. To optimise women's childbirth satisfaction and foster their attachment to their baby, both of which are essential for ongoing emotional well-being, it is vital that they are located at the centre of their birth experience and that if at all possible they are not separated from their newborn., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: to explore women's experience of using a Snoezelen room during their labour., Design: a qualitative exploratory design was conducted to provide insight into the phenomenon of using a Snoezelen room for labouring women and to identify factors that could facilitate or inhibit use of this environment. The constant comparison method modified from the grounded theory methodology was used to analyse data from in-depth interviews., Setting: Osborne Park Hospital, the second largest public provider of obstetric services in Western Australia, was the study setting., Participants: sixteen women, recruited from July 2005 to June 2006, agreed to participate in an in-depth interview and share their experience of using the Snoezelen room during a recent labour., Findings: six themes were extracted from the data providing insight into what a Snoezelen environment can offer a labouring woman: distraction; relaxation; comfort; environmental control; choice of complementary therapies; and safety in a home-like atmosphere. Additional categories revealed factors that facilitated and/or detracted use of the room such as familiarity with features, being offered information and choice, timing in labour, the support person's response and working order of the room's features., Implications for Practice: when sharing their experience, women focused upon the process of their labour and how they managed this process rather than specific outcomes such as analgesic used or type of birth. Although outcomes such as type of birth may not have been their preferred choice, these women were able to achieve satisfaction with how they managed their labour while in the Snoezelen room. This midwifery-led initiative contributed to these women's labour experiences, by offering a combination of complementary therapies within the safety of a hospital environment.

Objectives: 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., Design: a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews., Setting: Perth, Western Australia., Participants: 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., Findings: 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., Implications for Practice: 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.

Objectives: 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., Design: a qualitative study using an explorative descriptive design and techniques associated with constant comparison. Data were collected from tape-recorded telephone interviews., Setting: : Perth, Western Australia., Participants: two hundred and two women who were pregnant or who had birthed within the last 12 months., Findings: 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., Implications for Practice: 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.

Objective: to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth., Design, Setting and Participants: an exploratory study was undertaken to examine the care experiences of women from three Western Australian birth centres. Data were obtained from 17 women whose interviews were audio-recorded and transcribed. The research focused upon women's perceptions of their recent birth centre care as compared to previous hospital care during childbirth., Findings: four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions' and 'care structures'. The themes of 'care interactions' and 'care structures' will be presented in this paper. Care interactions refer to women's opportunities to develop rapport with their carers. Care structures involved the organisational framework in which care was delivered. The first two themes of 'beliefs about pregnancy and birth' and the 'nature of the care relationship' were discussed in a previous paper., Key Conclusions and Implications for Practice: differences in opportunities for care interactions and care structures were revealed between birth centre and hospital settings. Ongoing, cumulative contacts with midwives in the birth-centre setting were strongly supported by women as encouraging the development of rapport and perception of 'being known' as an individual. Additionally, care structures tailored to women were advocated over the systematised, fragmented care found in hospital settings., (Copyright 2001 Harcourt Publishers Ltd.)

Objective: to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth., Design, Setting and Participants: an exploratory design was used to study the care experiences of 17 women recruited from three Western Australian birth centres. Data were obtained from in-depth interviews that explored women's perceptions of their care in both the birth centre and hospital context., Findings: four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions', and 'care structures'. The themes of 'beliefs about pregnancy and birth' and 'nature of the care relationship' are discussed in this paper. Beliefs about pregnancy and birth refer to the philosophical underpinnings of pregnancy and birth held by women and their carers. Nature of the care relationship identifies women's perceptions of their relationship with health professionals. Care interactions and care structures will be described in a subsequent paper., Key Conclusions and Implications for Practice: The women's comments suggested differences in philosophy between hospital and birth-centre settings. The philosophy and beliefs of caregivers was an important component of the care experience. Women valued the normality of the birth-centre approach and the opportunity to experience the birth of their child with collaborative support from a midwife., (Copyright 2001 Harcourt Publishers Ltd.)

Objective: To describe the experience of ten couples who have had a home birth in Western Australia., Design, Setting and Participants: Using a phenomenological approach, ten parent couples were interviewed and three home-birth videos observed. Of the ten couples, four discussed their first child's home birth. The remaining six couples had three or four children who had been born at home., Findings: The essence of these parents' experiences of home birth was gained through identifying significant statements from transcripts and field notes and clustering these into the four themes of 'constructing the environment'; 'assuming control'; 'birthing'; and 'resolving expectations'. The first two themes were presented in a previous paper (Morison et al 1998). The latter two themes are now presented. The theme 'birthing' was where parents elaborated on their birth beliefs, discussed the actual birth and shared aspects of the relationship between the couple and the midwife. 'Resolving expectations' concerned the process of parents forming expectations, experiencing the reality of birth and then evaluating whether expectations were met., Key Conclusions: The development of a supportive relationship between couples and their midwife was essential during this transition to parenthood. Resolving expectations was an essential process that the parents undertook to clarify the meaning of their birth experience, and thereby acknowledge its uniqueness., Implications for Practice: The findings are important to midwives' practice as they reveal the value clients place on a shared philosophy about birth. Midwives, in any setting, can reflect on their own birthing beliefs and determine their compatibility with their clients' beliefs.

Objective: The purpose of this qualitative study was to describe the experience of couples who have had a home birth., Design, Setting and Participants: 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., Findings: 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)., Key Conclusions: 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., Implications for Practice: 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.