Striving for excellence in maternity care: The Maternity Stream of the City of Sanctuary.
KeywordPregnant women, Asylum seekers, Women, Refugee women, Voluntary sector, Maternity services, Maternity care, Maternity Stream of the City of Sanctuary
Rights© 2015 Mark Allen Healthcare. Reproduced in accordance with the publisher's self-archiving policy.
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AbstractAsylum-seeking and refugee (AS&R) women living in the UK often have complex health and social care needs, with poor underlying mental and physical health and an increased risk of negative pregnancy outcomes. Despite this, AS&R women are less likely to attend for timely maternity care and when they do, care may be poor, with staff not understanding their specific needs and displaying poor attitudes. This article discusses the Maternity Stream of the City of Sanctuary and how this charity aims to work with statutory and voluntary sector maternity-related services and groups to develop services that are inclusive for AS&R women and meet their specific needs. Volunteer AS&R women are central to the activities of the Maternity Stream and this article discusses how they engage with midwives and other maternity workers to facilitate the development of services that may ultimately improve pregnancy outcomes for AS&R women.
CitationHaith-Cooper M and McCarthy R (2015) Striving for excellence in maternity care: The Maternity Stream of the City of Sanctuary. British Journal of Midwifery, 23(9) 648-652.
Link to publisher’s versionhttp://dx.doi.org/10.12968/bjom.2015.23.9.648
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Early environments and neurobehavioural programming: Therapeutic actions of antidepressants. Neurobehavioural programming during development.Smythe, James W.; Fraser, Josie; Alrumaih, Ali M.S. (University of BradfordDepartment of pharmacy, 2014-05-07)Following decades of research on stress and its impact on behaviour, it is now widely accepted that selective psycho-pathologies, in particular clinical depression are more prevalent in humans with prior history of life-stress events. Interest in stress has led to questions about how it might affect the physiology and behaviour of animals exposed indirectly during gestational development. Not unexpectedly gestational stress has been shown to affect the offspring in several ways: endocrine responses to stress are elevated, fear, arousal and affective disturbances are all subject to vary if the pregnant animal is subjected to periods of aversive stimulation. Beginning in 1997, Michael Meaney of McGill University produced a series of publications suggesting that peri-natal events influence offspring and infant development, not via physical discomfort or physiological disturbance, but does so through modifications of maternal behaviour. Highly nurturant mothers (those who engage in active arched-back nursing (ABN), and spend more time licking and grooming (L/G) their pups), programme their offspring with improved cognitive abilities, decreased anxiety and fear, and reduced HPA axis hormone secretion. Low-nurturant mothers, who engage in less ABN and less L/G, tend to programme the opposite responses in their offspring. Our initial foray into this field was to investigate if gestational stress might also produce responses in the offspring via changes in maternal behaviour, and indeed ABN and L/G were reduced in dams which were subjected to gestational stress. We queried why stressed Dams would be less maternal towards their infants, and tested gestationally-stressed Dams in the Porsolt test for depressive-like behaviour. Our results suggested that these stressed Dams were actually depressed and this resulted in less maternal behaviour. Human mothers with depression are also less maternal and have been shown to divest themselves of infant care much like our prenatally-stressed Dams. On this basis we have proposed that gestational stress induced decrements in maternal behaviour represent a novel rat model for postnatal depression with face and construct validities. In the present work we have attempted to replicate the findings of Smythe¿s group (Smith et al., 2004), and have investigated the potential for antidepressants to alter the influence of gestational stress on maternal behaviours and depressive-like response, and whether or not the offspring¿ are modified by maternal treatment with ant-depressants. Approximately 140 time-mated, lister hooded rats were generated in house, and subjected to gestational stress on days 10-20 (1hr restraint/day) or remained undisturbed in their home cages. Following birth, cohorts of control and stressed Dams were administered vehicle or an antidepressant (imipramine 15mg/kg; or sertraline 10mg/kg) once daily until postnatal day 10. We assessed maternal Porsolt activity, nurturance (ABN, L/G, nest building) and anxiety-like behaviour in the elevated plus maze (EPM). Representative offspring of each Dam¿s treatment conditions were maintained post weaning and assessed in the Porsolt and EPM to determine if any changes in maternal behaviour elicited by the antidepressants altered their behavioural programming. Our findings confirm that Dams show depressive-like symptoms following gestational stress, and that administration of antidepressants to the Dams reduces depressive-like behaviour and increased maternal care. We propose that rat gestational stress is a putative model for human postnatal depression. Prenatal stress effects on maternal behaviour in the rat Dam represent a novel, and innovative model for human postnatal depression.
Vaginal birth after caesarean section (VBAC): exploring women's perceptionsMeddings, Fiona S.; MacVane Phipps, Fiona E.; Haith-Cooper, Melanie; Haigh, Jacquelyn (2007)Aims and objectives. This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background. The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites’ choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology. Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results. This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions. Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice. This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.
Qualitative study exploring Maternity Ward Attendants’ perceptions of occupational (work related) stress and the coping methods they adopted within maternity care settings (hospital) in NigeriaBradshaw, Gwendolen; Prowse, Julie M.; Kuforiji, Oluwatoyosi A. (University of BradfordFaculty of Health Studies, 2017)Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.