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How women can go the full nine months without knowing they’re pregnant

Helen CheyneIt is a “notorious fact”, one so commonly accepted and obvious it requires no evidence to support it in a court of law, that every woman knows when she is pregnant.

In a society that has a low tolerance for uncertainty, cases that challenge our collective notion of the possible fascinate and confuse us.  …………

Read Prof Helen Cheyne’s full article in The Conversation.

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Survey of new mothers highlights improvements

Photo of Prof Helen Cheyne

Prof Helen Cheyne

The state of maternity care in Scotland has been examined by University of Stirling researchers working with the Scottish Government.

The national report Having a baby in Scotland 2015: Listening to Mothers documents the story of more than 2000 new mothers.

Produced in partnership by the Scottish Government and Stirling’s Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) – it shows women are accessing care earlier in pregnancy with significantly more contacting a midwife first when they are pregnant.

Communication between women and maternity care staff appears to be good with most women reporting that they were listened to, spoken to in ways that they could understand and involved as much as they wanted in decisions about their care. The high level of trust women had in staff was evident, in particular during labour and birth.

Areas where care could be improved – particularly in relation to mental health – were highlighted, based on women’s responses to the survey.

Around one third of women felt that they were not given all the advice they needed about emotional changes they might experience and around one quarter were not given information about who to contact for advice about emotional changes if they needed it.

Additionally 44 percent of women said they did not get enough information to help them decide where to have their baby and 24 percent said they were not offered a choice about where to have their baby.

Report author Helen Cheyne, midwife and Professor of Midwifery Research in the NMAHP Research Unit at the University of Stirling said: “One of the most striking findings was around women’s mental health in the six weeks following birth. A recent report shows that almost a quarter of women who died between six weeks and one year following birth did so from mental health related causes. It is essential that all women and their families know the signs and symptoms of mental health problems following birth and who to contact if these occur.

“The report recommends that NHS Boards should examine whether local maternity and perinatal mental health services meet current best practice recommendations to support maternal mental health. All midwives, health visitors and medical staff caring for pregnant and postnatal women should undertake recognised training to ensure there is support for mothers who experience mental health problems.”

The report from the NMAHP Research Unit concludes with six recommendations including the appointment of post-natal care champions in every maternity hospital, ensuring one to one care of women by skilled midwives throughout labour and birth remains a priority and that all women should have choices about where their antenatal and postnatal care and place of birth happens.

Media enquiries to Corrinne Gallagher, Communications Officer, on 01786 466 687 orcorrinne.gallagher@stir.ac.uk

15 December 2015

Pregnancy diabetes is a red flashing light that we can’t ignore

Photo of Dr Josie Evans

Dr Josie Evans

Dr Josie Evans, Reader in Public Health, has been published in The Conversation:

Most people are well aware of two of the main forms of diabetes – type 1, which usually first appears in young people; and the more common type 2, which often emerges in the over 40s and is associated with obesity and sedentary lifestyles. We hear far less about the third form, gestational diabetes, which temporarily affects as many as 16% of pregnant women.

Gestational diabetes is…

Read the full article here.

How midwife Christina Mbiza’s research will help tackle maternal deaths in Malawi

Photo of Christina Mbiza

L-R: Mary Fraser, Rotary Club of Bridge of Allan and Dublane, Christina Mbiza, Prof Jayne Donaldson, University, Audrey Cooper of the Rotary Club and Prof Helen Cheyne of the University and NMAHP Research Unit

A University of Stirling Health Research student is bidding to better the lives of Malawian mothers, babies and their families.

Christina Ruth Mbiza, from Blantyre, Malawi, made the tough decision to leave her three young children at home to complete an MRes in Health Research.

Christina is a senior midwife at the busy Queen Elizabeth Hospital maternity unit in Malawi, which delivers 14,000 babies a year.

She came to Stirling to research methods to counter puerperal sepsis, a condition caused by an infection during childbirth, which accounts for 289,000 annual maternal deaths worldwide, with almost all cases occurring in low income countries.

Scotland has a strong track record of using health care methods which reduce the risk of sepsis and Christina will look to implement clean birth practices back in her homeland upon completion of her degree in September.

She said: “My children have stayed for a year without their mother for me to be here, but I had to take this opportunity as my main goal has been to come up with evidence-based solutions to improve maternal and neo-natal health in Malawi.

“I have learnt about the complexities of research and the importance of stakeholder involvement when conducting health research. I followed the framework used by the NHS in Scotland and my aim now is to use this new knowledge to come up with practices suitable for Malawi.”

Aside from her role in delivering babies, Christina mentors the young midwives and is a former Vice President of the Association of Malawian Midwives. She is also a volunteer with a number of charities supporting pregnant women in Malawi, helping to raise funds for new equipment including the renovation of a high dependency maternity unit.

“My stay at Stirling was very rewarding, added Christina. “The research at the University of Stirling is world leading and internationally recognised. The environment is very friendly, the lecturers were approachable and I have really enjoyed my time in Stirling, especially as I have met a lot of friends from different nationalities.”

Christina’s studies were supported through a scholarship from the Rotary Club of Bridge of Allan and Dunblane, partnered with the Limbe Club in Malawi.

Club President Dr Mary Fraser said: “Christina has charmed not only our Club, but also the Rotary District, made up of 88 Rotary Clubs in the North and East of Scotland, with around 3,000 Rotarian members. Christina made a presentation to the annual District conference where she spoke about her scholarship, which was warmly received. The Rotary Club will be continuing to work with Christina to support her project to minimise maternal sepsis.”

Professor Helen Cheyne, Royal College of Midwives (Scotland) Professor of Midwifery, said: “It has been a wonderful opportunity for the MRes team at the University of Stirling to work with the Rotary Club on this charitable scholarship and with a midwife from a country where there really is the potential to make a difference to the lives of mothers and babies. Christina has worked so hard to develop really practical research skills and flourished during the course of her studies. She now has the potential to become a research leader of the future.”

Media enquiries to David Christie, Senior Communications Officer, on 01786 466653 or email david.christie1@stir.ac.uk

Why women still need human support to give birth safely

Photo of Prof Helen Cheyne

Prof Helen Cheyne

Professor Helen Cheyne writes in The Conversation:

“Across the world around 390,000 women give birth each day in culturally, geographically and economically diverse settings. While pregnancy and birth is a journey of hopes, fears, and some uncertainties, the differences in birth outcomes between rich and poor are stark. Each day around 800 women die as a result of pregnancy and birth, 99% of these deaths occur in low-income countries, and the poorest women in every country fare the worst.”

Check the full article here.

An award-winning Health Visitor: How Ruth’s Clinical Doctorate research helps improve Health Visitor practice when planning interventions with parents

Photo of Dr Ashley Shepherd, Ruth Astbury and Prof Helen Cheyne at QNIS presentation

Dr Ashley Shepherd, Ruth Astbury and Prof Helen Cheyne

At first, in my career, I wanted to find ways of improving my own nursing practice. That’s only natural in the work setting isn’t it? – wanting to be the best that you can be to provide excellent care for your patients. Over time I began to learn that it was also really important to find ways to influence colleagues’ practice too, in order to collectively have a positive impact on patients, clients, babies, children, young people and families served by the NHS.

So at the beginning of my research career, when I was completing a taught MSc in Nursing (RCN Institute) I explored what it feels like to be a breastfeeding mother working outside the home – because I wanted to be able to support breastfeeding mothers effectively in my Health Visitor practice. And when I completed this piece of work my research supervisor Dr Marilyn Kirshbaum, working at the University of Sheffield, suggested applying for funding for a PhD. ‘But how will that work?’  I asked ‘How will that help me to improve my practice?’ ‘How can I be a health visitor and study at the same time?’

So it was with great delight that I discovered, after a bit of searching, that the University of Stirling – which was right on my doorstep – had just started to provide a Professional Doctorate programme for Nurses and Midwives (and subsequently Allied Health Professionals) and that I could continue to nurse at the same time as pursuing an academic career.

And what was the Clinical Doctorate Programme like? Well it’s been everything that I could have hoped for.

I’ve had the opportunity to discuss, debate and write assignments on a range of provoking subjects related to practice; I’ve been examined on my practice, and I have been given the opportunity to try out quality improvement skills in practice.

I have also been given opportunities, through the wider University community, to improve my IT skills, including managing and using spreadsheets and using research software. I’ve been immersed in the theory and practice of project management and I’ve met some incredibly inspirational people over the years.

I have received amazing support from my peers – both at work, and on the Programme. Who would have thought that a Health Visitor and School Nurse could learn so much from a colleague whose speciality is cancer care, reducing healthcare acquired infections, working with young people with mental health issues or a speech and language therapist? But it happened. And in addition there has been a real respect for each other’s roles and responsibilities in practice as we have tried to understand the healthcare context within which each of us works.

And what gradually dawned on me – as I progressed through the ‘Clin. Doc’ Programme – was that this was just as much about ensuring that I was in a position where I could put my learning into practice and influence the practice of colleagues in my workplace, as it was working through the various assignments and the research study. Basically I needed to ensure that my world of practice ‘kept up’, because (apart from everything else) on the Programme we were constantly being challenged about the need to improve the quality of the service that our organisation provided, and we were also encouraged to have the confidence to move out of our comfort zones to do this if required.

So an opportunity arose and I moved to work in Glasgow City as a Practice Development Nurse supporting Health Visitor and School Nurse teams who are working with some of the most vulnerable and disadvantaged children and families in Scotland. Since my arrival I have been continually impressed by the knowledge, skills, compassion and resilience that the team leaders and team members show in their practice – and I am continually learning from them too.

A few ‘thank-you’s – thank you so much to Jane Walker from the Queen’s Nursing Institute Scotland for the Community Nursing Award presented to me and to Professor Jayne Donaldson and Dr Ashley Shepherd for their nomination.

The Award, for ‘promoting excellence in community nursing’, means a great deal to me, because it implies that the research that I’ve carried out to complete the Clinical Doctorate Programme at Stirling University, School of Health Sciences, is recognised as ‘valuable’ to Health Visitor and School Nurse practice – which became one of my key ambitions during the Programme.

Professor Kate Niven and Dr Kath Stoddart, Directors of the Programme, have been incredibly supportive and helpful in very practical ways, and Dr Ashley Shepherd and Professor Helen Cheyne, my research supervisors, have provided me with guidance through their wisdom and knowledge.

And last, but not least, I am indebted to my husband Tom, and the rest of my family for their patience and support as I have completed the Clinical Doctorate Programme; but they know it’s not ‘the end’ of hard work as they know me well enough to understand that I am still as ambitious as ever to work with Health Visitors and School Nurses so that together we can continue to find ways to improve the lives of babies, children and young people.

If you are interested in my research study I have already presented the findings at the RCN International Research Conference 2015 in Nottingham and a PDF copy of the presentation is available here.

Ruth Astbury, 26 June 2015
Winner of University of Stirling’s QNIS Postgraduate Academic Award in recognition of promoting excellence in community nursing.

Being the First to Breastfeed in a Family: Challenges and opportunities for change

Photo of mother breastfeeding her babyBreastfeeding is widely accepted as having health and wellbeing benefits for mothers and babies.  Consequently national policies have been developed and significant investment made, to encourage more women to breastfeed. Despite this, breastfeeding rates in Scotland have increased very little in the last ten years.

My curiosity about why this might be led me to undertake my PhD with the University of Stirling.  While there are many factors which affect breastfeeding decision making, having a family history of breastfeeding appears to be one of the most important.  Women who were not breastfed themselves are nearly 30% less likely to start breastfeeding than those who were breastfeeding themselves as babies. There are, however, few studies which have investigated this area.

My study begins to fill this gap by investigating the experience of being the first to breastfeed in a family and making a different feeding choice from that of one’s own mother and sisters. This was though the analysis of conversations with fourteen mothers who had breastfed, using semi structured interviews and a new research tool which I developed, the Infant Feeding Genogram, which shares similarities with ‘family tree’ diagrams. Participants were selected through local toddler groups and via social media and a qualitative method, Interpretative Phenomenological Analysis, was used to analyse the data.

The analysis found four high level themes:

  • Breaching family and social norms;
  • Volitions and imperatives;
  • Unprepared for the challenge; and
  • A sacrifice but worth it.

These themes were integrated and demonstrated that breastfeeding was not the straightforward process women were expecting from antenatal classes, rather it could be isolating, painful, distressing and conflictual.

Women found that formula feeding was the default position and that their immediate community and family culture was unsupportive of breastfeeding, involving both overt criticism and more subtle undermining. To avoid this and to maintain relationships, many women adapted their behaviour, for example not breastfeeding in public or in front of family members or avoiding asking for parenting help. There were also, however, powerful moments of joy and connection from the exclusive relationship they formed with their baby. This raised their self-esteem and helped them feel like ‘complete mothers’. This fitted with their understanding of some of society’s positive representation of breastfeeding as being the ‘best and most natural’ way to feed a baby.

Photo of Dr Kirsty Darwent

Dr Kirsty Darwent

Undertaking this research has led me to make some recommendations about how to improve women’s breastfeeding experience. Firstly, breastfeeding needs to be represented in a more realistic way in antenatal classes which acknowledges the physical and emotional difficulties that women often experience. Added to this, policy-makers need to consider the implications of the ‘Breast is Best’ and breastfeeding as ‘natural’ messages that are often used in public health messages, as although they appear to influence some women’s decision making and raise their self esteem, they have implications for women who make formula feed their babies, who were judged by breastfeeding mothers for making a less acceptable decision.

Finally, the health service needs to take a mother and family focussed approach to breastfeeding, recognising the importance of infant feeding history and family members’ limited ability to provide support to their daughters when they breastfeed. This means health professionals need the skills to actively involve women and their families in looking at their family stories which support or undermine women’s breastfeeding and the Infant Feeding Genogram appears to be a useful tool to assist with this.

Having satisfied some of my own curiosity, my next steps involve sharing my ideas and testing them with practitioners and policy makers to see if they also find them interesting and useful. This feedback will shape the next stages, which I hope will involve developing and testing this new focus with women and their families. Please don’t hesitate to get in touch, if you would like to be involved in this process.

Dr Kirsty Darwent, The Family Therapy Training Network
email : Kirsty.darwent@btinternet.com

First published 22 June 2015
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