scholarly journals A weighty issue: The implications of an ultrasound prediction of a large baby in pregnancy

2021 ◽  
Vol 57 ◽  
Author(s):  
Cara Baddington ◽  
George Parker
Keyword(s):  
Medical Model ◽  
Decision Makers ◽  
Large For Gestational Age ◽  
Model Of Care ◽  
Normal Birth ◽  
Search Terms ◽  
Aotearoa New Zealand ◽  
Sonographic Assessment ◽  
Fetal Size ◽  
Experiences Of Women

Introduction: The assessment of fetal growth in Aotearoa New Zealand is governed by a largely medical model of care which highly values the purported objectivity of sonographic assessment. Ultrasound scans are an increasingly normalised part of pregnancy care, and expectant parents may advocate strongly for access to them. It could be questioned whether the increasing number of scans is aligned with clinical need. This paper presents a literature review that explores the implications of an ultrasound diagnosis of a large baby during pregnancy. Method: Databases searched were CINAHL, PubMed, Proquest, and Google Scholar. Search terms used were “macrosomia”, “large for dates” and “large for gestational age”. This search was first undertaken in May 2019, and then repeated in November 2020. Findings: Sonographic assessment of fetal size can be inaccurate and the existence of a predicted fetal weight on scan increases the likelihood of birth interventions, regardless of the baby’s actual size. While there are potentially negative outcomes associated with a larger baby, it is unclear whether birth interventions will significantly reduce the occurrence of these outcomes. There is limited research that focuses on the parents’ experience of having a predicted large baby, offering contradictory insights, which suggests the influence of conflicting meanings applied to large babies and ignoring the experiences of women whose babies were predicted to be large but were born “normal” sized. Discussion: Midwives are encouraged to openly discuss with women the limitations in available evidence in this area. Midwives can consider the context of the woman and whānau (wider family), and how they may assess risk uniquely. Finally, midwives can honour the woman and whānau as the decision-makers in their own experience. There are further opportunities for research to provide a counter-narrative to medicalising discourses about large babies, grounded in a midwifery belief in normal birth. Conclusion: Midwives and women are drawn into a risk-centric paradigm that pathologises large babies for questionable benefit. To support informed decision-making within the midwifery partnership, midwives need to critically evaluate existing research and communicate its limitations and risk-centric orientation.

The Medical Model of Care

1986 ◽  
pp. 11-15
Author(s):  
Peter Aggleton ◽  
Helen Chalmers
Keyword(s):  
Medical Model ◽  
Model Of Care

scholarly journals Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e023127 ◽  
Author(s):  
Sonya Osborne ◽  
Gai Harrison ◽  
Angela O’Malia ◽  
Adrian Gerard Barnett ◽  
Hannah E Carter ◽  
...  
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Willingness To Pay ◽  
Social Worker ◽  
Decision Makers ◽  
Psychosocial Needs ◽  
Model Of Care ◽  
Hospital Resources ◽  
Bed Days ◽  
The Cost

BackgroundLong-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources.ObjectiveTo determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of long stay, and to determine the economic value of this model relative to the decision makers’ willingness to pay for bed days released.DesignA prospective, matched cohort study with historical controls.SettingA large, tertiary teaching and referral hospital in metropolitan Southeast Queensland, Australia.MethodsLength of hospital stay for a cohort of patients seen under the specialist social worker-led model of care was compared with a matched control group of patients admitted to the hospital prior to the introduction of the new model of care using a multistate model with the social worker model of care as an intermediate event. Costs associated with the model of care were calculated and an estimate of the ‘cost per bed day’ was produced.ResultsThe model of care reduced mean length of stay by 33 days. This translated to 9999 bed days released over 12 months. The cost to achieve this was estimated to be $A229 000 over 12 months. The cost per bed day released was $23, which is below estimates of hospital decision makers’ willingness to pay for a bed day to be released for an alternate use.ConclusionsThe specialist social worker-led model of care was associated with a reduced length of stay at a relatively low cost. This is likely to represent a cost-effective use of hospital resources. The limitations of our historic control cohort selection mean that results should be interpreted with caution. Further research is needed to confirm these findings.

Sense of Coherence and Childbearing: A Scoping Review of the Literature

2014 ◽  
Vol 4 (3) ◽  
pp. 134-150 ◽  
Author(s):  
Sally Ferguson ◽  
Deborah Davis ◽  
Jenny Browne ◽  
Jan Taylor
Keyword(s):  
Sense Of Coherence ◽  
Scoping Review ◽  
Emotional Health ◽  
Review Of The Literature ◽  
Normal Birth ◽  
Ovid Medline ◽  
Search Terms ◽  
Critical Appraisal Skills ◽  
Meta Analyses ◽  
Childbearing Women

OBJECTIVE: To undertake a scoping review of the literature to understand how a woman’s sense of coherence (SOC) score affects her childbearing.METHOD: Ovid MEDLINE, CINAHL, Cochrane, and Web of Science databases were searched to identify articles published in English from 2000 to 2014 using combinations of specified search terms. Included articles were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Critical Appraisal Skills Programme.FINDINGS: This scoping review identified 15 studies focusing on SOC scores and childbearing. Childbearing women with strong SOC were less likely to smoke and more likely to seek out useful support compared to women with low SOC. Women with strong SOC demonstrated increased emotional health, experiencing less depression, anxiety, stress, and posttraumatic stress disorder. Women with strong SOC were more likely to experience uncomplicated birth and birth at home, identify normal birth as their preferred birth option in pregnancy and identify a desire to avoid epidural anesthesia in labor compared to women with low SOC.CONCLUSION: This scoping review of the literature identified significant associations between strong SOC and positive childbearing, including increased emotional health, improved health behaviors, and increased normal birth choices and outcomes.

Physical Activity Experiences of Women Aging with Disabilities

2004 ◽  
Vol 21 (2) ◽  
pp. 122-138 ◽  
Author(s):  
Donna L. Goodwin ◽  
Scott G. Compton
Keyword(s):  
Physical Activity ◽  
Phenomenological Study ◽  
Physical Disabilities ◽  
Medical Model ◽  
Acquired Brain Injury ◽  
Structured Interviews ◽  
Hermeneutic Phenomenological ◽  
Cord Injury ◽  
Experiences Of Women ◽  
Hermeneutic Phenomenological Study

This hermeneutic phenomenological study sought to understand the experiences of physical activity and aging with a disability. Six women with physical disabilities, including cerebral palsy (n = 2), acquired brain injury (n = 1), and spinal cord injury (n = 3), and between the ages of 22-37 years (mean age = 28 years) participated in the study. Their experiences were captured by way of semi-structured interviews. Each participant completed two interviews that were audiotaped and transcribed verbatim. The thematic analysis revealed three themes: experiencing something normal, loss of physical freedom, and maintaining function through physical activity. Implications of the findings were discussed within the context of health promotion and Verbrugge and Jette’s (1994) socio-medical model of disablement.

scholarly journals Climate Change Adaptation in the Environment Court: Revisiting the 2010 Holt Case

2019 ◽  
Vol 50 (4) ◽  
pp. 609
Author(s):  
CJ Iorns Magallanes ◽  
MJ Dicken
Keyword(s):  
Climate Change ◽  
New Zealand ◽  
Climate Change Adaptation ◽  
Coastal Area ◽  
Common Law ◽  
Decision Makers ◽  
Court Case ◽  
Aotearoa New Zealand

Common law precedents for some resource consent approvals in Aotearoa New Zealand are out of date due to the rapid increase in the science and understanding of the effects of climate change. This article considers one 2010 Environment Court case on a resource consent for building in the coastal area. It examines how the case would be decided if it arose today, with the benefit of the relevant law, policies and guidance now available to decision-makers. It suggests that the option taken by the Court in 2010, whereby the owners assumed the relevant inundation risks, would not be so available to a court today. This case is thus no longer good law.

scholarly journals ‘Strengthening community from the inside out’: Transformative possibility for climate change resilience and adaptation in Te Awa Kairangi-Hutt City

2021 ◽  
Author(s):  
◽  
Kaitlyn Simon
Keyword(s):  
Climate Change ◽  
Natural Environment ◽  
Participant Observation ◽  
Decision Makers ◽  
Critical Geography ◽  
Community Members ◽  
Human Relationships ◽  
Aotearoa New Zealand ◽  
Alternate Possibility ◽  
Political Act

<p>How do we organise society and adjust our human relationships with the natural environment to adapt to a changing climate? How do we decide to make these adjustments? These questions shape Aotearoa-New Zealand climate change discourse across adaptation research and central and local government policy. A resilience approach to adaptation is one conceptual response that has gained popularity over the past decade. However, some critical geographers argue that the dominant typologies of resilience have been normalised as neoliberal capitalist strategies and positioned as ‘neutral processes’, and that these strategies can perpetuate inequity and unsustainability. Critical geographers therefore suggest focusing on addressing the root causes of inequity and unsustainability through transformative resilience and adaptation.  This research builds on critical geography work by exploring how Common Unity Project Aotearoa (CUPA), a charitable trust located in Te Awa Kairangi-Hutt City, is fostering a community that understands and performs transformative possibilities for resilience and adaptation. For community members of CUPA, ethical actions of a community economy, a process of collective learning and an ability to make sustainability accessible contribute to transformative adaptation and resilience. Exploration of these themes provides a grounded example of how communities can adapt to climate change in ways that also seek to transform inequitable and unsustainable capitalist relations with one another and with the natural environment. CUPA’s transformative work poses implications for councils and decision-makers seeking to build resilience and the capacity to adapt in community, offering alternate possibility for discourse, decision-making, participation and engagement.  I approach this project as a scholar-activist in recognition that research is a performative, political act. Through a scholar-activist methodology I use participant observation and interviews to gather insight and information. I ground my critical geography lens in care in order to contribute to a knowledge-making around climate change based in possibility and multiplicity, rather than of authority and judgement.</p>

scholarly journals Forestland management and empowerment: A phenomenological inquiry into the experiences of women forestland managers in the state of Georgia, USA

2020 ◽  
Vol 1 (2) ◽  
pp. 24-38
Author(s):  
Hallie C. Harriman ◽  
Nicholas E. Fuhrman ◽  
Kathleen D. Kelsey ◽  
Kyle Maurice Woosnam
Keyword(s):  
Land Management ◽  
The United States ◽  
Decision Makers ◽  
Educational Outreach ◽  
Structured Interviews ◽  
Phenomenological Inquiry ◽  
Phenomenological Research Design ◽  
Qualitative Phenomenological ◽  
Professional Resources ◽  
Experiences Of Women

Women are increasingly becoming the primary decision-makers of forested properties throughout the United States. The purpose of this study was to understand the experiences of women forestland owners in Georgia. A qualitative phenomenological research design was used to interview nine female forestland owners. Three themes emerged from the semi-structured interviews. Participants stated that land management involved: (a) initial feelings of inadequacy (an imposter syndrome), (b) personal and professional resources, and (c) genuine relationships. The theory of empowerment provided a basis for interpreting the findings and aided in the development of recommendations for future practice and research.  We found that  women experienced a temporary imposter stage early in land management that gave way to feeling empowered as their experiences with managing land increased. Access to trustworthy information, as well as genuine relationships with forestry professionals and other landowners, played key roles in such advancement. We recommend  strategies for natural resource professionals to consider, including encouraging formal and informal networking opportunities when working with female audiences, including at educational outreach events like those hosted by Extension.

A comparison of the prescriptions received by the elderly in long-term care in New York and London

1984 ◽  
Vol 14 (4) ◽  
pp. 891-897 ◽  
Author(s):  
Anthony H. Mann ◽  
Rachel Jenkins ◽  
Peter S. Cross ◽  
Barry J. Gurland
Keyword(s):  
New York ◽  
Long Term Care ◽  
Medical Model ◽  
The Elderly ◽  
Model Of Care ◽  
Term Care ◽  
Neuroleptic Medication ◽  
To Receive

SynopsisA comparison of medication prescribed for elderly residents in long-term care institutions in London and New York shows that New York residents are prescribed more drugs. The contrast is sharpest for those suffering from dementia who are much more likely to receive neuroleptic medication than their counterparts in London. Analysis indicates that the differences may reflect the greater emphasis in New York on the nursing-medical model of care, rather than any differences between the residents themselves.

New Views on a ‘Stuck’ Issue: Communicating about Childhood Immunisation in Aotearoa New Zealand

2014 ◽  
Vol 152 (1) ◽  
pp. 40-56 ◽  
Author(s):  
Elspeth Tilley ◽  
Niki Murray ◽  
Bronwyn Watson ◽  
Margie Comrie
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Focus Group ◽  
Research Process ◽  
Decision Makers ◽  
Communication Process ◽  
Qualitative Investigation ◽  
Childhood Immunisation ◽  
Aotearoa New Zealand ◽  
Depth Interviews

This article explores attitudes towards immunisation and immunisation communication materials among parents and caregivers currently facing immunisation decisions in Aotearoa New Zealand. The research aimed to discover, from an open-ended qualitative investigation, new ways to conceptualise and explain immunisation decision-making, and identify participants' own views on approaches worth trialling as ways to increase immunisation rates. The research used communication artefacts as talking points, and an action research process to modify these to reflect participants' design suggestions, but was primarily exploratory. It started a broad conversation with participants about their decision-making influences rather than being designed to test any particular attributes of the immunisation communication process. From a qualitative analysis of transcripts of focus-group and in-depth interviews with 107 immunisation decision-makers, themes were drawn. Applying an emic process enabled identification of participants' own ideas that have now broadened the range of possible approaches currently being considered for immunisation communication in Aotearoa New Zealand. Given that immunisation decline is a problem internationally, these participant-driven ideas may also be worth testing in other contexts.

Fear of Home Birth in Doctors and Obstetric Iatrogenesis

2011 ◽  
Vol 1 (4) ◽  
pp. 263-272 ◽  
Author(s):  
Amali Lokugamage
Keyword(s):  
Public Health ◽  
Physiological Function ◽  
Medical Model ◽  
Home Birth ◽  
Social Model ◽  
Birth Experience ◽  
Normal Birth ◽  
The Social ◽  
Form Part ◽  
Breastfeeding Rates

Home births are physiological births and form part of the social model of birth. Doctors, traditionally, have been very fearful of out-of-hospital birth, and physiological births happen less frequently in obstetric units. Normal/physiological birth contributes to improving public health, and doctors are often not aware of the extent of this benefit. Normal birth leads to adaptive physiological function in the baby (endocrine, immune system, thyroid function, respiration, neurology, temperature regulation), more mother and baby bonding, and promotes higher breastfeeding rates, which in turn lead to better lifelong emotional and physical health in babies. Normal birth affirms health, promotes empowerment in mothers, and is a societal event that has been linked to promoting positive emotional qualities in society via the birthing hormone, oxytocin. Training within the medical model constrains doctors’ appreciation of normal birth. Experience of complications, a lack of awareness of the evidence surrounding home birth, compounded by failure to understand the concept of iatrogenesis, perpetuates fear of home birth among doctors.

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