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Objective: to explore the views and experiences of women with mental health difficulties, in the Republic of Ireland, accessing and receiving care from publicly-funded maternity care services during pregnancy, childbirth and immediate postnatal period in hospital., Participants: in total 20 women with a range of mental health problems were recruited. The women had given birth within maternity services with and without specialist perinatal mental health services., Design: a qualitative descriptive design using in-depth face to face interviews was used to explore women׳s experience. Data were analysed using an inductive thematic process., Findings: the study offers valuable insights into the maternity care experiences of women with mental health problems, and highlights the deficits and fragmentation of care in maternity units that do not have a specialist mental health service. Even when the women voluntarily disclosed their difficulties, midwives appeared to lack the knowledge and skills to respond sensitively and responsively., Key Conclusions and Implications for Practice: there is a need to expand perinatal mental health services in the Republic of Ireland, so that quality service provision is not dependent on geography. In addition, there is a need for education to address the lack of knowledge and understanding of perinatal mental health problems amongst maternity care practitioners., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study is to explore first-time mothers' experiences of early labour in Italian maternity care services when admitted to hospital or advised to return home after maternity triage assessment., Setting: The study was conducted in a second-level maternity hospital in northern Italy with an obstetric unit for both low- and high-risk women., Participants: The participants included 15 first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy who accessed maternity triage during early labour, and were either admitted to hospital or advised to return home., Design: A qualitative interpretive phenomenological study was conducted. A face-to-face recorded semi-structured interview was conducted with each participant 48-72h after birth., Findings: Four key themes emerged from the interviews: (a) recognising signs of early labour; (b) coping with pain at home; (c) seeking reassurance from healthcare professionals; and (d) being admitted to hospital versus returning home. Uncertainty about the progression of labour and the need for reassurance were cited by women as the main reasons for hospital visit in early labour. An ambivalent feeling was reported by the participants when admitted to hospital in early labour. In fact, while the women felt reassured in the first instance, some women subsequently felt dissatisfied due to the absence of one-to-one dedicated care during early labour. When advised to return home, a number of women reported feelings of disappointment, anger, fear, discouragement and anxiety about not being admitted to hospital; however, some of these women reported a subsequent feeling of comfort due to being at home and putting in place the suggestions made by the midwives during the maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women׳s satisfaction when advised either to return home or to stay at the hospital during early labour., Conclusions and Implications for Practice: During antenatal classes and clinics, midwives should provide clear information and advice about early labour in order to increase women׳s confidence and self-efficacy, and decrease their anxiety and fear. During early labour, appropriate maternity care services should be offered according to individual needs. When home visits are not provided by midwives, a telephone triage run by midwives should be considered as a routine service for the first point of contact with women during early labour., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: to integrate findings of individual studies in order to broaden the understanding of first-time mothers' experiences of early labour., Design: the methodology was metasynthesis which is based on the interpretive meta-ethnography described by Noblit and Hare (1988). Metasynthesis is research on research which synthesises the findings of previous qualitative studies, and the focus is on interpretation and the creation of new knowledge., Setting: all included studies originated from high resource countries (USA 2, UK 4, and Scandinavia 5) and all were carried out in a context of hospital based maternity care., Participants: a total of 231 women participated in the studies., Findings: 11 articles were included. The main results are presented with the metaphor a balancing act in an unknown territory. The 'unknown territory' has a double meaning: as the personal experience of going into labour for the first time and as encountering the maternity care system. On both levels women have to make significant decisions: whether labour really has started and subsequently when to go to the hospital. A key challenge is to balance the arrival on the labour ward at the 'right' time, not too early and not too late. Arriving at the 'right' time leads to a positive path, while arriving 'too soon' might lead to a cascade of negative experiences. The results are further presented with five central themes: 'Finding out if labour has started is absorbing'; 'Dealing with labour at home'; 'Trying to arrive at the labour ward at the right time'; 'There is always a risk of being sent home'; 'Encountering health professionals arouses strong emotions'., Conclusions: the metasynthesis broadens the understanding of first-time mothers' experiences of early labour, and suggests that women's needs when planning a hospital birth are not being adequately met at this stage in the labour process. Three areas of future research are suggested: how to support and strengthen women during pregnancy in order to cope with early labour; women's experiences of early labour when planning a birth in contexts other than hospital; and to continue to investigate new ways of giving care during early labour., (Copyright © 2014 Elsevier Ltd. All rights reserved.)