30 results on '"Mills, Tracey A."'
Search Results
2. An exploration of women’s lived experiences of care and support following perinatal death in South-Western Nigeria: A hermeneutic phenomenological study
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Kuforiji, Omotewa, Mills, Tracey A., and Lovell, Karina
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- 2024
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3. Locating what comes to mind in empirically derived representational spaces
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Mills, Tracey and Phillips, Jonathan
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- 2023
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4. Better maternity care pathways in pregnancies after stillbirth or neonatal death: a feasibility study
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Mills, Tracey A., Roberts, Stephen A., Camacho, Elizabeth, Heazell, Alexander E. P., Massey, Rachael N., Melvin, Cathie, Newport, Rachel, Smith, Debbie M., Storey, Claire O., Taylor, Wendy, and Lavender, Tina
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- 2022
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5. Measures of anxiety, depression and stress in the antenatal and perinatal period following a stillbirth or neonatal death: a multicentre cohort study
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Thomas, Suzanne, Stephens, Louise, Mills, Tracey A., Hughes, Christine, Kerby, Alan, Smith, Debbie M., and Heazell, Alexander E. P.
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- 2021
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6. The impact of cultural beliefs and practices on parents’ experiences of bereavement following stillbirth: a qualitative study in Uganda and Kenya
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Ayebare, Elizabeth, Lavender, Tina, Mweteise, Jonan, Nabisere, Allen, Nendela, Anne, Mukhwana, Raheli, Wood, Rebecca, Wakasiaka, Sabina, Omoni, Grace, Kagoda, Birungi Susan, and Mills, Tracey A.
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- 2021
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7. Women's experiences of care after stillbirth and obstetric fistula: A phenomenological study in Kenya.
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Nendela, Anne, Farrell, Sarah, Wakasiaka, Sabina, Mills, Tracey, Khisa, Weston, Omoni, Grace, and Lavender, Tina
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MATERNAL health services ,ATTITUDES of mothers ,MIDDLE-income countries ,PREGNANT women ,INTERVIEWING ,SOCIAL stigma ,WORLD health ,PERINATAL death ,EXPERIENCE ,PHENOMENOLOGY ,QUALITATIVE research ,LOW-income countries ,RESEARCH funding ,VAGINAL fistula ,JUDGMENT sampling ,THEMATIC analysis ,WOMEN'S health - Abstract
Background: Stillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low‐ and middle‐income countries with limited access to maternity care. Few studies have explored women's experiences of the combined trauma of stillbirth and fistula. Aim: To explore the lived experiences of women following stillbirth and fistula. Methods: Qualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen's reflexive approach. Results: Three main themes summarised participants' experiences: 'Treated like an alien' reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in 'Shattered dreams'. The impact of beliefs and practices of women and those around them were encapsulated in 'It was not written on my forehead'. Conclusion: The distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked an understanding of the pathophysiology and identification of fistula and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow‐up care meant that women suffered for long periods while living with a constant reminder of their baby's death. Cultural beliefs, faith and family support affected women's resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women's experiences. Patient or Public Contribution: A Community Engagement and Involvement group of bereaved mothers with lived experience of stillbirth and neonatal death assisted with the review of the study protocol, participant‐facing materials and confirmation of findings. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Managing Madness
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Erika Dyck, Alex Deighton, Hugh Lafave, John Elias, Gary Gerber, Alexander Dyck, John Mills, Tracey Mitchell and Erika Dyck, Alex Deighton, Hugh Lafave, John Elias, Gary Gerber, Alexander Dyck, John Mills, Tracey Mitchell
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- 2017
9. “Nature makes you blind to the risks”: An exploration of womens' views surrounding decisions on the timing of childbearing in contemporary society
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Lavender, Tina, Logan, Janette, Cooke, Alison, Lavender, Rebecca, and Mills, Tracey A.
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- 2015
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10. “Forty is the new twenty”: An analysis of British media portrayals of older mothers
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Mills, Tracey A., Lavender, Rebecca, and Lavender, Tina
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- 2015
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11. Women's experiences of care and support following perinatal death in high burden countries: A metasynthesis.
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Kuforiji, Omotewa, Mills, Tracey A., and Lovell, Karina
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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]
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- 2023
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12. 'There is trauma all round': A qualitative study of health workers' experiences of caring for parents after stillbirth in Kenya and Uganda.
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Mills, Tracey A., Ayebare, Elizabeth, Mweteise, Jonan, Nabisere, Allen, Mukhwana, Raheli, Nendela, Anne, Omoni, Grace, Wakasiaka, Sabina, and Lavender, Tina
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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]
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- 2023
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13. Women's experiences of a pregnancy whilst attending a specialist antenatal service for pregnancies after stillbirth or neonatal death: a qualitative interview study.
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Smith, Debbie M., Thomas, Suzanne, Stephens, Louise, Mills, Tracey A., Hughes, Christine, Beaumont, Joanna, and Heazell, Alexander E. P.
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PRENATAL care ,NEONATAL death ,STILLBIRTH ,MATERNITY nursing ,PREGNANCY complications ,PREGNANCY - Abstract
Aim: Pregnancy after the death of a baby is associated with numerous, varied psychological challenges for pregnant women. This study aimed to explore women's experiences of pregnancy whilst attending a specialist antenatal service for pregnancies after a perinatal death.Methods: Semi-structured interviews with twenty women in a subsequent pregnancy after a perinatal death were conducted and analyzed taking an inductive thematic analysis approach.Results: All women expressed a heightened "awareness of risk". Two subthemes demonstrated how increased awareness of risk affected their experience and their desire regarding antenatal and postnatal support. Women talked about stillbirth being a "quiet, unspoken subject" causing them internal conflict as they had an awareness of pregnancy complications that other people did not. Navigating subsequent pregnancies relied on them "expecting the worst and hoping for the best" in terms of pregnancy outcomes. Women viewed specialist antenatal care in pregnancy after perinatal loss favorably, as it enabled them to receive tailored care that met their needs stemming from their increased awareness of and personal expectations of risk.Conclusion: Women's experiences can be used to develop models of care but further studies are required to determine to identify which components are most valued. [ABSTRACT FROM AUTHOR]
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- 2022
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14. “Forty is the new twenty”: an analysis of British media portrayals of older mothers
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Mills, Tracey A, Lavender, Rebecca, and Lavender, Tina
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- 2015
15. Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study.
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Watson, Kylie, Mills, Tracey A., and Lavender, Tina
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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]
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- 2022
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16. The RESPECT Study for consensus on global bereavement care after stillbirth
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Shakespeare, Clare, Merriel, Abi, Bakhbakhi, Danya, Blencowe, Hannah, Boyle, Frances M, Flenady, Vicki, Gold, Katherine, Horey, Dell, Lynch, Mary, Mills, Tracey A, Murphy, Margaret M, Storey, Claire, Toolan, Miriam, Siassakos, Dimitrios, and RESPECT (Research of Evidence based Stillbirth care Principles t
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Adult ,Postnatal Care ,Consensus ,Delphi Technique ,Health Personnel ,media_common.quotation_subject ,Acknowledgement ,Global health ,Respect ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Pregnancy ,Bereavement care ,Surveys and Questionnaires ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Quality of Health Care ,Reproductive health ,media_common ,030219 obstetrics & reproductive medicine ,business.industry ,Stakeholder ,Obstetrics and Gynecology ,Professional-Patient Relations ,General Medicine ,Stillbirth ,Systematic review ,Female ,Grief ,The Internet ,Empathy ,business ,Bereavement - Abstract
OBJECTIVE: To develop global consensus on a set of evidence-based core principles for bereavement care after stillbirth.METHODS: A modified policy-Delphi methodology was used to consult international stakeholders and healthcare workers with experience in stillbirth between September 2017 and October 2018 Five sequential rounds involved two expert stakeholder meetings and three internet-based surveys, including a global internet-based survey targeted at healthcare workers in a wide range of settings.RESULTS: Initially, 23 expert stakeholders considered 43 evidence-based themes derived from systematic reviews, identifying 10 core principles. The global survey received 236 responses from participants in 26 countries, after which nine principles met a priori criteria for inclusion. The final stakeholder meeting and internet-based survey of all participants confirmed consensus on eight core principles. Highest quality bereavement care should be enabled through training of healthcare staff to reduce stigma and establish respectful care, including acknowledgement and support for grief responses, and provision for physical and psychologic needs. Women and families should be supported to make informed choices, including those concerning their future reproductive health.CONCLUSION: Consensus was established for eight principles for stillbirth bereavement care. Further work should explore implementation and involve the voices of women and families globally.
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- 2020
17. Placental Dysfunction Underlies Increased Risk of Fetal Growth Restriction and Stillbirth in Advanced Maternal Age Women
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Lean, Samantha, Heazell, Alexander, Dilworth, Mark, Mills, Tracey, and Jones, Rebecca
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embryonic structures ,parasitic diseases - Abstract
Pregnancies in women of advanced maternal age (AMA) are susceptible to fetal growth restriction (FGR) and stillbirth. We hypothesised that maternal ageing is associated with utero-placental dysfunction, predisposing to adverse fetal outcomes. Women of AMA (≥35 years) and young controls (20-30 years) with uncomplicated pregnancies were studied. Placentas from AMA women exhibited increased syncytial nuclear aggregates and decreased proliferation, and had increased amino acid transporter activity. Chorionic plate and myometrial artery relaxation was increased compared to controls. AMA was associated with lowermaternal serum PAPP-A and sFlt and a higher PlGF:sFlt ratio. AMA mice (38-41 weeks) at E17.5 had fewer pups, more late fetal deaths, reduced fetal weight, increased placental weight and reduced fetal:placental weight ratio compared to 8-12 weeks controls. Maternofetal clearance of 14C-MeAIB and 3H-taurine was reduced and uterine arteries showed increased relaxation. These studies identify reduced placental efficiency and altered placental function with AMA in women, with evidence of placental adaptations in normal pregnancies. The AMA mouse model complements the human studies, demonstrating high rates of adverse fetal outcomes and commonalities in placental phenotype. These findings highlight placental dysfunction as a potential mechanism for susceptibility to FGR and stillbirth with AMA.
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- 2017
18. 'Nature makes you blind to the risks': An exploration of womens' views and experiences surrounding decisions on the timing of childbearing in contemporary society
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Lavender , Tina, Logan, Janette A, Cooke, Alison, Lavender, Rebecca, and Mills, Tracey A
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- 2015
19. PARENTS 2 study: consensus report for parental engagement in the perinatal mortality review process.
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Bakhbakhi, D., Siassakos, D., Lynch, M., Timlin, L., Storey, C., Heazell, A., Burden, C., Luyt, Karen, Lee‐Davey, Caroline, Sheppherd, Inge, Redshaw, Maggie, Scott, Jane, Titherly, Cheryl, Evans, Kath, Scott, Janet, Molloy, Mary, Mills, Tracey, Kingdom, Carol, Sleap, Vicky, and Kennedy, Nathalya
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Objective: The PARENTS 1 study (Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death) found that parents would endorse the opportunity to give feedback into the perinatal mortality review (PNMR) process. In subsequent focus groups, healthcare professionals were positive about parental engagement, although they considered that there may be significant challenges. The objective of this study was to develop core principles and recommendations for parental engagement in PNMR in the UK.Methods: A two-round Delphi technique was followed to reach consensus on core principles for parental engagement in the PNMR process; Round 1 included a national consensus workshop and Round 2 an online questionnaire. The consensus meeting was attended by a national panel of stakeholders (clinical and academic experts, parent advocates, managers and commissioners) in stillbirth and neonatal and bereavement care. To develop recommendations for parental engagement, participants discussed four key areas comprising: communication with parents, including receiving feedback; the format of the PNMR meeting; the parental engagement pathway; and challenging aspects of engaging with parents in reviews. Content analysis was conducted to generate recommendations from the meeting for a subsequent anonymous web-based survey. Attendees of the consensus workshop and members of the PARENTS 2 Project Advisory Board were asked to rank recommendations using a 9-point Likert scale from 1 (not important) to 9 (critically important). It had been agreed a priori, in compliance with established Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria, that 'consensus' would be achieved if over 70% of participants scored the principle as 'critical' (score of 7-9) and fewer than 15% scored the principle as 'not important' (score of 1-3). Principles for which consensus was achieved were included in the core recommendations.Results: Of the 29 invited stakeholders, 22 participated in the consensus meeting and 25 (86% response rate) in the subsequent online questionnaire in June 2017. Consensus was agreed on 12 core principles. Of the 25 participants, 96% agreed that a face-to-face explanation of the PNMR process was of critical importance, 72% considered that parents should be offered the opportunity to nominate a suitable advocate, 92% believed that responses to parents' comments should be formally documented, 96% indicated that it was vital for action plans to be translated into lessons learnt and that this process should be monitored, and 100% of stakeholders voted that a plain-English summary should be produced for the parents following the meeting. There was good agreement on a further seven principles.Conclusions: Key national stakeholders were unanimously supportive of parental engagement in the PNMR process and agreed on core principles to make this process feasible, meaningful and robust. A 6-month pilot of parental engagement in the PNMR process (PARENTS 2 study) in two UK units took place after the consensus on core principles. In collaboration with the National Perinatal Epidemiology Unit, the findings will inform the national standardized PNMR tool. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]- Published
- 2019
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20. The use of telemetry in labour: Results of a national online survey of UK maternity units.
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Watson, Kylie, Mills, Tracey A, and Lavender, Dame Tina
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BIOTELEMETRY , *FETAL monitoring , *LABOR (Obstetrics) , *INTRAPARTUM care - Abstract
Background Guidelines from the National Institute for Health and Care Excellence recommend that telemetry is offered to any woman who needs continuous cardiotocography in labour. Methods An online survey of 168 maternity units in the UK was undertaken between November 2013 and February 2014 to determine how many units in the UK offered telemetry to women in labour and in what circumstances it was used. Findings The response rate was 62% (n=104). Some 63% (n=65) of responding units had at least one cardiotocography machine that could monitor the fetal heart via telemetry. Telemetry was used most often for women who had experienced a previous caesarean section and respondents felt that mobility and satisfaction with labour experience were most likely to be positively influenced by telemetry. Conclusion The survey gives an indication of how often and for whom telemetry is being used in the UK and describes the benefits that maternity units see for women using telemetry, such as increased choice and control. [ABSTRACT FROM AUTHOR]
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- 2018
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21. Exploring the lived experience of women, families and health care professionals of care and support following perinatal death in south-western Nigeria : a hermeneutic phenomenological study
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Kuforiji, Omotewa, Lovell, Karina, and Mills, Tracey
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perinatal death ,mothers ,support ,sub-Saharan Africa ,bereavement care ,high burden settings ,care and support ,metasynthesis ,health care professionals - Abstract
Introduction: Perinatal death has a significant impact on the physical, emotional and mental health of women. This requires adequate bereavement care to limit the impact in the short and long term and on the quality of life. Women and families in sub-Saharan Africa and South Asian countries are most affected as they carry the highest burden of perinatal death. The experience of care and support in these countries has not been explored. Thus, there is a lack of understanding of the care and support received by women, and provided by healthcare professionals in South-Western Nigeria, one of the regions with the highest rate of perinatal death globally. Aim: The aims of this thesis were (i) to identify, synthesise and critically reinterpret the findings of existing literature on the care and support following perinatal death in high burden settings, and to reveal gaps and new understanding, (ii) to explore the lived-experience of women and families of care and support following perinatal death in South-Western Nigeria and (iii) to explore the lived experience of health care professionals who provide care and support following perinatal death in South-Western Nigeria. Methods: A metaethnographic metasynthesis was undertaken in synthesising and critically reinterpreting existing studies on womens care and support following perinatal death in high burden settings. Qualitative hermeneutic phenomenological studies using semi-structured interviews were conducted in exploring the lived experience of women, families and health care professionals of care and support following perinatal death. Results: Perinatal death is not appropriately acknowledged, thus care and support in high burden settings is inadequate. Women are not adequately supported whilst in hospital and receive no follow-up care from health care professionals in the community following discharge. Nurses endeavour to provide support as far as is possible within the hospital but this is determined by their practice as there is no recognised guideline for bereavement care following perinatal death in South-Western Nigeria. Thus, there is a lack of consistency in care and support. Nonetheless, nurses recognise the need for post-discharge follow-up and provide this within their own leisure time, outside of their role. Conclusion: Overall, bereavement care following perinatal death is limited in South-Western Nigeria; rather nurses provide care and support based on their own practice. There is a need for further research into and a development of sufficient bereavement care in Nigeria for women who experience perinatal death. In addition, the experience of other health care professionals and family members including partners of care and support also requires further research.
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- 2023
22. Does altered placental morphology and function explain increased incidence of poor pregnancy outcome in advanced maternal age.
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Lean, Samantha, Heazell, Alex, Boscolo-Ryan, Jane, Peacock, Linda, Mills, Tracey, and Jones, Rebecca
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- 2014
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23. The use of telemetry to monitor the fetal heart during labour : a mixed methods study
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Watson, Kylie, Mills, Tracey, and Lavender, Tina
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Midwife ,Birth ,Fetal heart ,Telemetry ,Labour - Abstract
Background: Wireless fetal heart rate monitoring (telemetry) is increasingly being used by maternity units in the UK. Guidelines from the National Institute for Health and Care and Excellence recommend that telemetry is offered to any woman who needs continuous monitoring of the fetal heart in labour. There is no contemporary evidence on the use of telemetry in the UK. Aims: To gather in-depth knowledge about the experiences of women and midwives using telemetry to monitor the fetal heart in labour and to assess any impact that the use of telemetry may have on clinical outcomes, mobility in labour or control and satisfaction. Study design: A convergent parallel mixed methods design was chosen. Methods: Qualitative methods included in-depth interviews with 10 women, 2 partners, 12 midwives and one student midwife from two NHS Trusts in the Northwest of England. A constructivist grounded theory methodology was employed for this phase and used both purposive and theoretical sampling. All interviews were audio-recorded and transcribed verbatim. The quantitative phase recruited 161 women from both sites and compared clinical outcome and mobility data from 74 women who used telemetry during labour and 87 women who had conventional wired monitoring. Women also were asked to complete a questionnaire in the postnatal period on control and satisfaction during labour and birth. Questionnaire data was analysed from 128 women, 64 who used telemetry and 64 who had conventional wired monitoring. Both sets of data were integrated to give an overall broad understanding of telemetry use. Findings: The grounded theory core category was 'Telemetry: A Sense of Normality' and was described by three sub-categories. 'Being Free' described women being more mobile when using telemetry in labour and experiencing greater feelings of control, normality, and support. Telemetry also increased dignity for women as they were able to use the bathroom independently and with ease. 'Enabling and facilitating' described midwives facilitating the use of telemetry, encouraging mobility and using midwifery skills including caring for women in a birth pool. 'Culture and Change' described the different maternity unit cultures and how this impacted on the use of telemetry. Telemetry was viewed as increasing choice and equity for women with more complex pregnancies. Within the quantitative phase there was no difference in the aggregate scores for either the Perceived Control in Childbirth (PCCh) scale or the Satisfaction with Childbirth (SWCh) scale. Sub-group analysis found that women who used telemetry for the majority of the time the fetus was continuously monitored in labour scored a higher aggregate score for perceived control during labour (mean ± SD; 5.3 ±0.8 telemetry vs. 4.9 ± 0.9 wired, p = 0.047). Mobility data found that women using telemetry spent more time off the bed in labour and adopted more upright positions for birth. Conclusions: Both qualitative and quantitative findings confirmed that women were more mobile in labour when using telemetry to monitor the fetal heart and integrated findings also found that telemetry increased feelings of control in labour. The use of telemetry had a positive impact on women who required continuous monitoring in labour and engendered a sense of normality for both women and midwives. The use of telemetry contributes to humanising birth for women requiring more complex care in labour and birth.
- Published
- 2020
24. Navigating antenatal care in Oman : a grounded theory of women's and healthcare professionals' experiences
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Al Maqbali, Fatma, Furber, Christine, and Mills, Tracey
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362.1982 ,views ,perceptions ,knowledge ,opinions ,pregnant women ,experiences ,low-risk pregnancy ,antenatal care ,prenatal care ,normal pregnancy ,anepartum care - Abstract
Background: In Oman, 33.3% of women attended late for publicly funded antenatal care in 2015 and 24% did not attend for the recommended 4-6 visits during their pregnancy. This low attendance suggests a need to explore attendance for antenatal care for low-risk pregnant women in Oman. Methodology: An exploratory qualitative design informed by constructivist grounded theory methodology was used in this research. Methods: In-depth semi-structured interviews were conducted with an initial purposive sample of nine pregnant women. The initial analysis enabled theoretical sampling of thirteen non-participant observations during women's appointments, interviews with ten care providers, and six women who booked late after 12 weeks of gestation. A constructivist grounded theory analytical framework of initial, focused and theoretical coding was followed to analyse all the data collected. Findings: The core category consists of five interrelated sub-categories: perceived benefits and value of antenatal care; timing of the first antenatal visit; woman-carer interactions during antenatal care; experiences with antenatal care delivery; and supplementary use of private healthcare. The integral categories explain the social processes and issues surrounding antenatal care. The emergent core category, Navigating antenatal care, reflects the views of the women and their care providers. The women were unhappy with the organisation and physical environment of care but attended their appointments to ensure optimal pregnancy outcome and to alleviate their fears of developing complications. Thus, they used both private and public healthcare and sourced online information in response to their feelings of obligation to protect their fetus. Conclusion: The women appeared disempowered and to lack control over the care they received. Thus, they accepted conditions such as long waiting times in an uncomfortable environment and the disrespect they encountered during their visits. There was a discrepancy between what the women expected and needed from their antenatal care and the actual care and information they received, which did not satisfy their needs. This could be due to a lack of woman-centred care and limited involvement in the plan of care. Thus, women sought further reassurance by accessing private clinics, using online information, and networking with others, which also resulted in a late booking for public antenatal care.
- Published
- 2018
25. Advanced Maternal Age: Identifying Mechanisms Underlying Vulnerability to Stillbirth
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Lean, Samantha, MILLS, TRACEY TA, HEAZELL, ALEXANDER AEP, Jones, Rebecca, Mills, Tracey, and Heazell, Alexander
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Pregnancy ,Placenta ,parasitic diseases ,Advanced Maternal Age ,Stillbirth ,Fetal Growth Restriction - Abstract
Advanced maternal age (AMA) is defined as childbearing in mothers ≥35 years of age and is becoming increasingly prevalent in high income countries. AMA has been associated with increased risk of adverse pregnancy outcomes, particularly stillbirth. Although AMA mothers have higher rates of chromosomal abnormalities and maternal co-morbidities, AMA remains an independent risk factor for stillbirth. Despite these findings, the etiology behind this increased risk is unknown. We hypothesise that an altered maternal environment, including increased oxidative stress and inflammation, due to ageing causes placental dysfunction which increases AMA mothers’ vulnerability to stillbirth.A holistic approach was applied to investigate placental dysfunction in AMA. Firstly, a systematic review and meta-analysis comprehensively reviewed existing data on AMA and associated adverse pregnancy outcomes. Secondly, Manchester Advanced Maternal Age Study (MAMAS), a multi-centre prospective observational cohort study, was conducted to investigate risk factors for composite adverse pregnancy outcome (CAPO) in AMA. MAMAS utilised both uni- and multivariate analysis on demographic and clinical data, and measuring biomarkers of ageing and placental dysfunction by ELISA in maternal circulation during the third trimester of pregnancy. Utero-placental dysfunction was directly investigated in uncomplicated AMA pregnancies by quantifying placental morphology, placental nutrient transport capabilities and both placental and maternal uterine vascular responses. Finally, a C57BL/6J murine model of AMA was developed and characterised to further investigate maternal age on pregnancy outcome and the role of the placenta. In the meta-analysis, maternal age was linearly associated with increased risk of stillbirth and other adverse outcomes strongly associated with placental dysfunction (fetal growth restriction, preeclampsia and placental abruption). In MAMAS, smoking status and primiparity were predictive of CAPO. After adjustment, AMA mothers had an odd ratio of 2.05-3.43 of CAPO compared to 20-30 year old mothers. AMA mothers showed evidence of increased oxidative stress and pro-inflammatory bias. AMA mothers who suffered CAPO showed reduced placental endocrine capacity seen in placental dysfunction. Placentas from uneventful AMA pregnancies showed evidence of accelerated ageing and placental adaptation with increased nutrient transport, increased placental weight but reduced efficiency, and altered vascular function. AMA mice showed many similar aspects to human AMA with increased fetal loss, fetal growth restriction and increased placental size. These studies provide robust evidence for increased incidence of adverse pregnancy outcome due to placental dysfunction in pregnancies of women of AMA. This finding requires the appropriate recognition in a clinical context, with a greater focus on personalised obstetric care in an attempt to reduce stillbirth rates in this high risk population. By optimising antenatal and obstetric care for AMA mothers, we could reduce stillbirth rates by 4.7% - the population attributable risk due to AMA. These studies highlight key areas of future research that will further understanding into stillbirth risk in AMA pregnancy, test predictive models and test therapies and clinical care interventions an ultimately improve pregnancy outcome in mothers of AMA. Pregnant mothers over the age of 35 years old are classified as advanced maternal age (AMA). AMA is known to be associated with increased risks in pregnancy, including the baby being born too small or dying before birth (stillbirth). This risk of stillbirth in AMA is even true independently of the genetic defects in the eggs and maternal diseases that are more often seen in these women due to their age. However, it is not know why this increased risk of stillbirth occurs in AMA mothers. The placenta is a vital organ in pregnancy that regulates blood and nutrient supply to the baby and is known to not work properly (known a placental dysfunction) in pregnancies where the baby doesn’t grow properly or is stillborn. We propose that changes in the mother due to her age will affect the way that her placenta works and this is the reason why more babies are born small or are stillborn in AMA mothers compared to younger mothers. Firstly, we reviewed existing studies to see how many have found evidence of pregnancy diseases known to be caused by placental dysfunction in AMA pregnancies. We set up a clinical study called Manchester Advanced Maternal Age Study (MAMAS) and recruited pregnant mothers to investigate lifestyle risk factors for having poor outcomes (with placental links) in AMA. We collected mothers’ blood to see if higher levels of markers of ageing were detectable in AMA and if they were related to increased risk of poor outcome. The placentas from these mothers were used to measure their size, whether the cells were dividing or dying and how well they could transport nutrients from mother to baby. Placental and uterine vessels were tested to see how well they can control blood flow to the baby during pregnancy. Finally, a mouse model of AMA was developed and characterised to further investigate maternal age on pregnancy outcome and the role of the placenta.Previous studies showed that AMA was more strongly linked to increased risk of pregnancy outcomes that are associated with placental dysfunction than those that are not. In MAMAS, smoking and carrying a first pregnancy made mothers and being AMA increased risk of suffering a poor outcome. AMA mothers who had normal outcomes showed evidence of increased ageing markers but also increased mechanisms to counteract ageing related damage in their blood. AMA mothers who had poor outcome had higher levels of age related damage and inflammatory responses to that damage. They had lower levels of placental hormones indicating placental dysfunction. Placentas from AMA pregnancies had to work harder to keep the baby healthy by increasing their size, nutrient transport and altering placental and maternal vascular function. However, they still functioned less efficiently than placentas from younger mothers. Our mouse model of AMA showed many similar aspects to human AMA with small pups, high rates of stillbirth and larger placentas. These studies provide robust evidence for placental dysfunction can explain why mothers over the age of 35 years are more at risk of having small babies or stillborn babies. This finding should be recognised by doctors and midwives when deciding how to manage their pregnancies. If so, we could reduce national stillbirth rates by 4.7%. The mouse model offers a way for us to test interventions in AMA pregnancies to improve their outcome.
- Published
- 2016
26. Going viral - capacity strengthening in the context of pandemic(s).
- Author
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Mills TA, Wakasiaka S, Ayebare E, Danna VA, Lavender T, and Bedwell C
- Subjects
- Female, Humans, Infant, Newborn, Kenya, Pandemics prevention & control, Pregnancy, Uganda, COVID-19 epidemiology, Midwifery
- Abstract
Strengthening the capacity of midwives and nurses in low- and middle-income countries to lead research is an urgent priority in embedding and sustaining evidence-based practice and better outcomes for women and newborns during childbearing. International and local travel restrictions, and physical distancing resulting from the COVID-19 pandemic have compromised the delivery of many existing programmes and challenged international partnerships working in maternal and newborn health to adapt rapidly. In this paper, we share the experiences of a midwife-led research partnership between Kenya, Malawi, Tanzania, Uganda, the UK, Zambia and Zimbabwe in sustaining and enhancing capacity strengthening activities remotely in this period. Whilst considerable challenges arose, and not all were overcome, collectively, we gained new insights and important learning which have shifted perspectives and will impact future design and delivery of learning programmes., Competing Interests: Declaration of competing interest None., (Copyright © 2021. Published by Elsevier Ltd.)
- Published
- 2022
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27. Lay and healthcare providers' experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: an Appreciative Inquiry.
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Mdoe P, Mills TA, Chasweka R, Nsemwa L, Petross C, Laisser R, Chimwaza A, and Lavender T
- Subjects
- Attitude of Health Personnel, Empathy, Family, Female, Health Personnel, Humans, Infant, Newborn, Malawi, Pregnancy, Quality of Health Care, Tanzania, Communication, Maternal Health Services
- Abstract
Objectives: Disrespectful care, which remains prevalent in low and middle-income countries (LMICs), acts as a barrier to women accessing skilled birth attendance, compromising care when services are available. Building on what was positive in facilities, we aimed to explore lay and healthcare providers' experience of respectful care to inform future interventions., Setting: Five maternity facilities in Mwanza Tanzania and Lilongwe Malawi., Participants: 94 participants in Malawi (N=46) and Tanzania (N=48) including 24 women birthing live baby within the previous 12 months; 22 family members and 48 healthcare providers who regularly provided maternity care in the included facilities DESIGN: The study was guided by Appreciative Inquiry (AI). Semistructured, one-to-one interviews were conducted between January and December 2019. Interviews were audio-recorded, translated where necessary, transcribed verbatim, and analysed using the framework approach., Results: Four main themes describing participants positive experience and their vision of respectful care were identified: (1) empathic healthcare provider-woman interactions including friendly welcome and courteous language, well-timed appropriate care and information sharing, (2) an enabling environment, characterised by improvement of physical environment, the use of screens, curtains and wall partitions for privacy, availability of equipment and provision of incentives to staff, (3) supportive leadership demonstrated by the commitment of the government and facility leaders to provision of respectful care, ensuring availability of guidelines and policies, supportive supervision, reflective discussion and paying staff salaries timely, (4) providers' attitudes and behaviours characterised by professional values through readiness, compassionate communication and commitment., Conclusion: The positive experiences of service users, families and healthcare providers provided insight into key drivers of respectful care in facilities in Tanzania and Malawi. Interventions targeting improved environment and privacy, healthcare provider communication and developing positive leadership structures in facilities could provide the basis for sustained improvement in respectful and dignified maternal and newborn care in LMICs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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28. Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania.
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Lavender T, Bedwell C, Kasengele CT, Kimaro D, Kuzenza F, Lyangenda K, Mills TA, Nsemwa L, Shayo H, Tuwele K, Wakasiaka S, and Laisser R
- Subjects
- Attitude of Health Personnel, Female, Grounded Theory, Humans, Infant, Newborn, Pregnancy, Qualitative Research, Tanzania, Zambia, Maternal Health Services
- Abstract
Background: Quality of maternal and newborn care is integral to positive clinical, social and psychological outcomes. Respectful care is an important component of this but is suboptimum in many low-income settings. A renewed energy among health professionals and academics is driving an international agenda to eradicate disrespectful health facility care around the globe. However, few studies have explored respectful care from different vantage points., Methods: We used Strauss and Corbin's grounded theory methodology to explore intrapartum experiences in Tanzania and Zambia. In-depth interviews were conducted with 98 participants (48 women, 18 partners, 21 health-providers and 11 key stakeholders), resulting in data saturation. Analysis involved constant comparison, comprising three stages of coding: open, axial and selective. The process involved application of memos, reflexivity and positionality., Results: Findings demonstrated that direct and indirect social discrimination led to inequity of care. Health-providers were believed to display manipulative behaviours to orchestrate situations for their own or the woman's benefit, and were often caring against the odds , in challenging environments. Emergent categories were related to the core category: respectful care, an added extra , which reflects the notion that women did not always expect or receive respectful care, and tolerated poor experiences to obtain services believed to benefit them or their babies. Respectful care was not seen as a component of good quality care, but a luxury that only some receive., Conclusion: Both quality of care and respectful care were valued but were not viewed as mutually inclusive. Good quality treatment (transactional care) was often juxtaposed with disrespectful care; with relational care having a lower status among women and healthcare providers. To readdress the balance, respectful care should be a predominant theme in training programmes, policies and audits. Women's and health-provider voices are pivotal to the development of such interventions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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29. The RESPECT Study for consensus on global bereavement care after stillbirth.
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Shakespeare C, Merriel A, Bakhbakhi D, Blencowe H, Boyle FM, Flenady V, Gold K, Horey D, Lynch M, Mills TA, Murphy MM, Storey C, Toolan M, and Siassakos D
- Subjects
- Adult, Consensus, Delphi Technique, Empathy, Female, Health Personnel education, Humans, Postnatal Care methods, Postnatal Care psychology, Pregnancy, Professional-Patient Relations, Respect, Surveys and Questionnaires, Bereavement, Quality of Health Care standards, Stillbirth psychology
- Abstract
Objective: To develop global consensus on a set of evidence-based core principles for bereavement care after stillbirth., Methods: A modified policy-Delphi methodology was used to consult international stakeholders and healthcare workers with experience in stillbirth between September 2017 and October 2018. Five sequential rounds involved two expert stakeholder meetings and three internet-based surveys, including a global internet-based survey targeted at healthcare workers in a wide range of settings., Results: Initially, 23 expert stakeholders considered 43 evidence-based themes derived from systematic reviews, identifying 10 core principles. The global survey received 236 responses from participants in 26 countries, after which nine principles met a priori criteria for inclusion. The final stakeholder meeting and internet-based survey of all participants confirmed consensus on eight core principles. Highest quality bereavement care should be enabled through training of healthcare staff to reduce stigma and establish respectful care, including acknowledgement and support for grief responses, and provision for physical and psychologic needs. Women and families should be supported to make informed choices, including those concerning their future reproductive health., Conclusion: Consensus was established for eight principles for stillbirth bereavement care. Further work should explore implementation and involve the voices of women and families globally., (© 2020 International Federation of Gynecology and Obstetrics.)
- Published
- 2020
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30. Placental Dysfunction Underlies Increased Risk of Fetal Growth Restriction and Stillbirth in Advanced Maternal Age Women.
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Lean SC, Heazell AEP, Dilworth MR, Mills TA, and Jones RL
- Subjects
- Adult, Animals, Female, Humans, Mice, Middle Aged, Models, Animal, Pregnancy, Young Adult, Fetal Growth Retardation epidemiology, Fetal Growth Retardation physiopathology, Maternal Age, Placenta pathology, Stillbirth epidemiology
- Abstract
Pregnancies in women of advanced maternal age (AMA) are susceptible to fetal growth restriction (FGR) and stillbirth. We hypothesised that maternal ageing is associated with utero-placental dysfunction, predisposing to adverse fetal outcomes. Women of AMA (≥35 years) and young controls (20-30 years) with uncomplicated pregnancies were studied. Placentas from AMA women exhibited increased syncytial nuclear aggregates and decreased proliferation, and had increased amino acid transporter activity. Chorionic plate and myometrial artery relaxation was increased compared to controls. AMA was associated with lower maternal serum PAPP-A and sFlt and a higher PlGF:sFlt ratio. AMA mice (38-41 weeks) at E17.5 had fewer pups, more late fetal deaths, reduced fetal weight, increased placental weight and reduced fetal:placental weight ratio compared to 8-12 week controls. Maternofetal clearance of
14 C-MeAIB and3 H-taurine was reduced and uterine arteries showed increased relaxation. These studies identify reduced placental efficiency and altered placental function with AMA in women, with evidence of placental adaptations in normal pregnancies. The AMA mouse model complements the human studies, demonstrating high rates of adverse fetal outcomes and commonalities in placental phenotype. These findings highlight placental dysfunction as a potential mechanism for susceptibility to FGR and stillbirth with AMA.- Published
- 2017
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