Search

This study aimed to explore the psychosocial needs of parents whose infants required neonatal care and to identify strategies to optimise parental psychosocial wellbeing. An exploratory qualitative study, comprising semi-structured interviews was undertaken with nineteen parents (mothers=16, fathers=3). The data were analysed thematically, and three themes and associated subthemes highlight interlinking issues in terms of parents’ needs for stability during a time of uncertainty; their needs for connection with staff, other parents, and their infant; and a need for flexibility in the type, and timing of support. Social connectedness theory offers a lens for how psychosocial support can be provided during neonatal care. This requires opportunities for parents to socialise and receive information, instrumental and/or emotional forms of social support via staff and peers, and to create a sense of belonging and value as parents.

Background Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth. Aim To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth. Methods A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic. Findings Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. Discussion/Conclusion The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.

Background: Women in prison who are pregnant or recently had a baby are a highly vulnerable population due to complex histories, increased risks of poorer outcomes, and mother-infant separation. During the COVID-19 pandemic, these women faced additional challenges due to infection risks and enforced social isolation. In March 2020, the Ministry of Justice and Her Majesty’s Prisons and Probation Service prioritised the early release of pregnant women and mothers living with their babies in Mother and Baby units (compassionate release on ROTL – Release On Temporary Licence). Birth Companions, a UK-based charity that works with pregnant and post-natal women in prison, were commissioned to extend its reach to help coordinate care and post-release support to women released under ROTL, and those released as ‘business as usual’ in all English women’s prisons during the pandemic. Here we report insights from an evaluation of this work. Methods: Interviews were undertaken with nineteen participants (six women, eight Birth Companions, and five health/social care professionals) and thematic analysis was undertaken. Findings: Two themes and associated sub-themes emerged. ‘Facilitating support’ outlines how women benefitted from the support via engendering trust, promoting coping strategies, and facilitating positive change. ‘Challenges in support provision’ describes key barriers that Birth Companions faced in accessing and supporting women due to communication barriers and difficulties in coordinating wider support. Discussion: This study highlights a unique, service model that enabled woman-centred care, despite limitations. Prisons need to revisit existing policies and guidelines to ensure that equitable care is provided during future crises.

The coronavirus (COVID-19) pandemic has resulted in rapid changes in many areas of health care worldwide.1 Some organisational and governance controls on innovation have been relaxed, to enable rapid adaptation to changing circumstances. The speed of innovation raises a range of ethical, governance and organisational issues. It is important to assess what changes have been instituted, which ones should be maintained, and how to encourage effective innovations in future. Maternity care provides an exemplar case within the broader health care setting, given the imperative to provide both safe and personalised care for optimal outcomes. Some pandemic-related changes in maternity services, such as restricting women’s opportunities for companionship during ultrasound scans or throughout labour, or limiting parental visiting to neonatal units, have been associated with psychological harm.2 Other changes provide more positive impacts, including reports of more individualised and efficient care associated with the increased use of telemedicine.3 We undertook a documentary analysis of national policy and service-user organisation responses to the pandemic in the United Kingdom (UK) and the Netherlands (NL), as part of the Achieving Safe and Personalised Maternity Care In Response to Epidemics (ASPIRE COVID-19) study. The overall aim of ASPIRE COVID-19 is to identify ‘what works’ in providing maternity care during the current and future pandemics, or similar health crises. The NL was chosen as the comparator to the UK because there were known differences in the organisation of maternity services during the COVID-19 pandemic between the two countries, especially for place of birth. Here we report on activities described as new or expanded innovations in 290 documents produced by seventeen key professional and service-user organisations in the NL and the UK between February and December 2020 (see Table 1). We included strategic papers, guidelines, protocols, and updates for hea

Objectives: To explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the ASPIRE COVID-19 study. Setting: Maternity care provision in England. Participants: Interviews were held with 26 national governmental, professional, and service-user organisation leads (July-Dec 2020). Other data included public-facing outputs logged from 25 maternity Trusts (Sept/Oct 2020) and data extracted from 78 documents from eight key governmental, professional, and service-user organisations that informed national maternity care guidance and policy (Feb-Dec 2020). Results: Six themes emerged: ‘Postcode lottery of care’ highlights variations in companionship and visiting practices between trusts/locations, ‘Confusion and stress around ‘rules’’ relates to a lack of and variable information concerning companionship/visiting. ‘Unintended consequences’ concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, ‘Need for flexibility’ highlights concerns about applying companionship and visiting policies irrespective of need, ‘‘Acceptable’ time for support’ highlights variations in when and if companionship was ‘allowed’ antenatally and intrapartum; and 'Loss of human rights for gain in infection control’ emphasizes how a predominant focus on infection control was at a cost to psychological safety and human rights. Conclusions: Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations. Strengths and limitations of this study • This is the first paper to cons

Purpose: In this paper we report on insights from an evaluation of Birth Companions (a UK based charity) perinatal support in two prison settings in England. The initiative involved provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. Design/methodology/approach: A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n=9); audio recorded interviews (n=33) with prison and healthcare staff, women in prison, peer supporters and Birth Companions; analysis of existing routinely collected data by Birth Companions and notes undertaken during regular meetings (n=10) with the Birth Companions Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. Findings: Birth Companions provided instrumental/practical support, emotional support, information support, signposting to services, and advocating for women to the prison concerning their perinatal needs and rights. Key themes revealed that support had an impact on the lives of perinatal women by creating a safe place, characterised by meaningful interactions and women centred approaches that facilitated access to wider care and support. The service made a difference by empowering women and providing added value for peer supporters, prison, health care and Birth Companions staff. Key enablers and strategies for the care of perinatal women and the delivery of perinatal support are also detailed. Originality: Through longitudinal data and the involvement of a range of stakeholders, this study evidences the subtleties of support provided by Birth Companions and the potential it has to make a difference to perinatal women in prison and those volunteering or working within the prison system.

Background: The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. Aim: To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. Method: A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. Findings: Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers’ fear of contracting COVID-19; the extent to which community and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. Conclusion: We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.

• The COVId-19 pandemic is associated with an increased prevalence of depression and anxiety in the perinatal period • It is imperative to prioritise the processes for early recognition, referral, and treatment of pregnant women with mental illness • There is a need for further research to identify potential protective and risk factors for mental illness in the perinatal period, especially during the pandemic

Background Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth. Aim To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth. Methods A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic. Findings Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. Discussion/Conclusion The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.

Introduction Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research. Aim To formulate a woman-centered, inclusive definition of a traumatic childbirth experience. Methods After a rapid literature review, a five-step process was undertaken. First, a draft definition was created based on interdisciplinary experts’ views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback. Results The stepwise process confirmed that a woman-centered and inclusive definition was important. The final definition was: “A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman's health and wellbeing.” Conclusions This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women-centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care.

In many high-income countries such as the UK, inequalities in breastfeeding initiation and continuation rates exist, whereby socio-economically advantaged mothers are most likely to breastfeed. Breastfeeding peer support interventions are recommended to address this inequality, with non-profit breastfeeding organisations providing such support in areas of deprivation. As these organisations’ roots and membership are often formed of relatively highly resourced women who have different backgrounds and experiences to those living in areas of deprivation, it is important to understand their practices in this context. In order to explore how UK non-profit organisations practice breastfeeding peer support in areas of socio-economic deprivation, a systematic review and meta-ethnography of published and grey literature was undertaken. Sixteen texts were included, and three core themes constructed: (1) ‘changing communities’ reveals practices designed to generate community level change, and (2) ‘enabling one to one support’, explains how proactive working practices enabled individual mothers’ access to supportive environments. (3) ‘forging partnerships with health professionals’, describes how embedding peer support within local health services facilitated peer supporters’ access to mothers. While few breastfeeding peer support practices were directly linked to the context of socio-economic deprivation, those described sought to influence community and individual level change. They illuminate the importance of inter-professional working. Further work to consolidate the peer-professional interface to ensure needs-led care is required.

levels of unintended breastfeeding cessation. Previous research has argued that infant feeding should be perceived within a complex system whereby factors operating at different ecological levels (i.e., individual, social/community networks, cultural/institutional) interact to affect individual behaviours. However, currently, more work needs to be done to implement an ecological approach in breastfeeding programs. We adopted a complex-systems lens approach to explore how multi-level factors - individual, mother-infant dyad, health service, family and social networks, and wider community infrastructure - interacted with women's motivations and experiences of breastfeeding. We undertook a secondary analysis of 24 women's interviews: all the women had a strong antenatal intention to breastfeed and were expecting their first baby. The interviews were collected during the UK-based Assets-based feeding help Before and After birth (ABA) feasibility trial when their infant was aged between 4-21 weeks. Categorical content analysis was used to explore the interrelationships between key factors and to identify different infant feeding typologies. Two different typologies emerged: ‘disappointed’ (n=7) and ‘by hook or by crook’ (n=17). ‘Disappointed’ women had stopped breastfeeding early; women classified as ‘by hook or by crook’ continued breastfeeding despite facing challenges. Sociodemographic, social, and service level differences between the typologies were noted. ‘Disappointed’ women were more likely to be younger, White-British, to have considered mixed-feeding antenatally and experienced negative breastfeeding support from healthcare professionals and personal networks. Infants of ‘disappointed’ women were more likely to have received unexpected ‘top-ups’ and to be perceived as having infant feeding difficulties. Women classified as ‘by hook or by crook’ were just as likely as ‘disappointed’ women to experience birth-related complications, but demonstrated more proactive

This study aimed to explore the psychosocial needs of parents whose infants required neonatal care and to identify strategies to optimise parental psychosocial wellbeing. An exploratory qualitative study, comprising semi-structured interviews was undertaken with nineteen parents (mothers=16, fathers=3). The data were analysed thematically, and three themes and associated subthemes highlight interlinking issues in terms of parents’ needs for stability during a time of uncertainty; their needs for connection with staff, other parents, and their infant; and a need for flexibility in the type, and timing of support. Social connectedness theory offers a lens for how psychosocial support can be provided during neonatal care. This requires opportunities for parents to socialise and receive information, instrumental and/or emotional forms of social support via staff and peers, and to create a sense of belonging and value as parents.

Background Preterm infants often need admission to a neonatal unit causing prolonged stress for parents. Evidence has shown that neonatal early supported transfer to home interventions may reduce stress levels. This systematic review investigates effectiveness of neonatal early supported transfer to home interventions for parents and preterm infants in neonatal intensive care units. Methods Six databases and two trials registries were searched from inception to February 2022. Risk of bias was assessed using the RoB2 and ROBINS I tool. Results Ten studies were included. Neonatal early supported transfer to home interventions reduced duration of hospital stay by up to 11 days compared to usual care, without significantly increasing hospital re-admission rates (p= >0.05). Studies were judged to have moderate to serious risk of bias. Conclusions The findings indicate that early supported transfer to home interventions may reduce hospital stay with no evidence of difference in hospital admission rates, infants weight gain or breastfeeding rates (compared to standard care). However, due to the dearth of high-quality evidence it is not possible to make recommendations for implementation.

Background A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women’s relationships with maternity care providers. Aims To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women’s experiences of childbirth. Methods A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women’s experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient – provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. Findings Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. Conclusion While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants’ care practices.

Aim: To explore the content, experiences, and outcomes of interventions designed to increase early skin-to-skin contact (SSC) in high-income settings. Methods: A mixed-methods systematic review was undertaken across six bibliographic databases. References of all included studies were hand-searched. All papers were quality appraised using a mixed-method appraisal tool. A narrative synthesis was used to synthesise both quantitative and qualitative findings. Results: Database searches generated 1,221 hits, and two studies were identified via hand-searching. Ten studies were included; most (n =7) were designed to improve SSC following a caesarean section, and half were of low/poor quality. Outcomes related to SSC prevalence and/or duration (n =7), breastfeeding prevalence, (n =4) and six explored mothers’ and/or health professionals’ experiences of the intervention. While the interventions had ‘some’ impact on the prevalence of SSC, the duration was often limited and not in line with WHO recommendations. Breastfeeding rates (exclusive/any) were found to improve but generally not to a significant extent. Mother and healthcare professionals were positive about the interventions, with barriers to implementation noted. Most interventions targeted healthcare professionals, rather than mothers. Conclusion: High-quality interventions that increase SSC in line with WHO recommendations, and that target both health professionals and parents are needed.

Having a preterm birth and/or sick infant that requires neonatal care is an emotionally traumatizing event for parents. This is due to issues such as parent-infant separation, concerns for infant viability and the technological nature of the neonatal unit. It is argued that neonatal units should provide a varied and sustainable program of psychosocial support for parents both during the infant’s stay and after discharge. However, currently there is a paucity of knowledge about what types and range of support is provided within neonatal care. In this paper we report on an audit of facilities, services, and support that could address parents’ psychosocial support needs in UK neonatal units.

Background: Minoritised ethnic perinatal women can experience judgemental and stigmatising care due to systemic racism. Discriminatory care contributes to increased risks of poor maternal and infant outcomes, including higher rates of mental ill-health. This study aimed to explore minoritised ethnic women’s experiences of maternity services, including maternity care and mental health support, within a North-West England locality. Here we use an equity lens to report the findings that describe if and how women’s personal, cultural, and spiritual needs were met, their experiences of discriminatory and prejudicial care, and to identify recommendations for service provision. Methods: A mixed-methods study was undertaken comprising an online survey, interviews, and community consultations. Questions explored access to and experiences of antenatal care and education; information, communication, and choice; experiences of (dis)respect and judgement; mental health needs and support; cultural/religious needs and support; and overall experiences of maternity care. Eligibility criteria were: women, 18+ years, from self-reported minoritised ethnic backgrounds, who had given birth in the previous 2 years and received maternity care in the locality. Surveys were available in seven languages and distributed via social media, mother-baby groups, and community locations. English-speaking survey participants were invited to take part in a follow-up interview. Community leaders/staff were approached to collect data on behalf of the study team. Quantitative data were analysed descriptively (n, %) and merged with qualitative data into descriptive themes. Results: Overall, 104 women provided data; most self-identified as Asian (65.0%) or Black (10.7%) and were aged between 30-34 (32.0%) or 25-29 years (23.3%). Four descriptive themes are reported: ‘accessing care’ details variations and barriers in accessing maternity care; ‘communication needs, and resources’ describes views on adaption

Background The COVID-19 pandemic had a severe impact on women’s birth experiences. To date, there are no studies that use both quantitative and qualitative data to compare women’s birth experiences before and during the pandemic, across more than one country. Aim To examine women’s birth experiences during the COVID-19 pandemic and to compare the experiences of women who gave birth in the United Kingdom (UK) or the Netherlands (NL) either before or during the pandemic. Method This study is based on analyses of quantitative and qualitative data from the online Babies Born Better survey. Responses recorded by women giving birth in the UK and the NL between June and December 2020 have been used, encompassing women who gave birth between 2017 and 2020. Quantitative data were analysed descriptively, and chi-squared tests were performed to compare women who gave birth pre- versus during pandemic and separately by country. Qualitative data was analysed by inductive thematic analysis. Findings Respondents in both the UK and the NL who gave birth during the pandemic were as likely, or, if they had a self-reported above average standard of life, more likely to rate their labour and birth experience positively when compared to women who gave birth pre-pandemic. This was despite the fact that those labouring in the pandemic reported a lack of support and limits placed on freedom of choice. Two potential explanatory themes were identified in the qualitative data: respondents had lower expectations of care during the pandemic, and they appreciated the efforts of staff to give individualised care, despite the rules. Conclusion Our study implies that many women labouring during the COVID-19 pandemic experienced restrictions, but their experience was mitigated by staff actions. However, personalised care should not be maintained by the good will of care providers, but should be a priority in maternity care policy to benefit all service users equitably.

Objective: The aim of this systematic review was to explore the impact of the COVID-19 pandemic on breastfeeding support services and continuation rates. Methods: Electronic searches were undertaken in seven databases: Academic Search Complete, Springer Nature Journals, CINAHL Medline, Health Source: Nursing/Academic Edition, Masterfile premier, and SocINDEX. Publications following the COVID pandemic between January 2020 and March 2022 were searched for using the following keywords: impact or effect or influence and breastfeeding support and breastfeeding continuation and COVID-19 or coronavirus. Fifteen studies were included for investigation and extracted to identify seven themes related to breastfeeding support during COVID-19. Results: Factors which impacted breastfeeding support during the COVID-19 pandemic included separation, lack of skin-to-skin contact, fears of the pandemic, the impact of the pandemic on breastfeeding experiences, online breastfeeding support, insufficient support, and the need for additional support. The pandemic mostly influenced breastfeeding support negatively, with a small exception occurring where some mothers experienced lockdown as positive since it protected the mother-infant dyad from unwanted visitors. Virtual breastfeeding support was introduced in many contexts; however, practitioners and mothers reported that this could not replace the need for face-to-face support. Conclusions: Breastfeeding is a lifesaving intervention, especially in the face of a disruption such as a pandemic. This work highlights the need for clear, consistent, and evidence-based information about risks, and for key practices to be maintained including not separating mothers and infants, promoting skin-to-skin contact, and ensuring availability of high-quality breastfeeding support.