"Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.

<p>In Aotearoa New Zealand, healthy women giving birth for the first time may plan to give birth in range of settings - from home to a tertiary hospital where surgical and anaesthetic services are available. Each birth location has its own culture, and the extent to which this culture influences the birth experience lies at the heart of this research. Just twenty-three percent of first-time mothers experience a normal birth with no obstetric interventions, and the chosen place of birth is implicated in this statistical outcome. Tertiary maternity settings report the highest rates of birth interventions, even for healthy women who can anticipate straightforward labour experiences. Among the most frequently used birth interventions are labour augmentation procedures - artificial rupture of membranes and administration of synthetic oxytocin infusions. My critical realist ethnography aims to explore the cultural landscape within one tertiary birthing suite and in doing so to identify the generative mechanisms that influence the likelihood of labour augmentation for well first-time mothers. I begin with a retrospective chart review to uncover the magnitude of the use of augmentation procedures for a sample of healthy women presenting in labour to the birthing suite over one calendar year. Interviews with women who experienced long labours yield insights about their decision-making with respect to augmentation. Focus groups and interviews with midwives and obstetric doctors contribute an understanding of factors associated with their use of augmentation, and a period of non-participant observation in the birthing suite illuminates the nuanced ways the unit culture contributes to the permissive use of augmentation procedures in this birthing environment. Findings reveal that sixty percent of women experienced labour augmentation procedures and for one third of them, the augmentation was not indicated according to the clinical guideline in use at the time. Pressure to be “moving things forward” characterises the birthing suite culture. The identified generative mechanisms that combine to influence the likelihood of augmentation include a lack of belief in birth, not valuing midwives, the education and socialisation of midwives and doctors, and the industrialisation of birth - all underpinned by available social discourses about being a good mother, a good midwife or a good doctor. Ironically, the very attributes that make the tertiary hospital the ideal place to be when birth is complex or the unexpected happens (‘poised-ness’ for action, being a ‘well-oiled machine’ for emergency care, surveillance and control) are the same attributes that create a dis-abling environment for physiological first birth to unfold at its own pace. The ‘perfect system’ is in place; a well-embedded midwifery-led continuity of care model incorporating seamless and integrated secondary referral processes. But despite this potentially enabling model of maternity care, once ‘nested’ within the tertiary hospital setting the impact of social, professional and industrial discourses overwhelms the salutogenic factors that should protect normal birth. A re-focussed commitment to providing continuity of care across the labour continuum, home visiting in early labour, enhancing physiological birth support in both the relational and environmental realms, averting the obstetric gaze and prioritising women’s needs over institutional needs represent the best way forward as strategies to resist the inexorable rise of obstetric intervention. Midwives are well-positioned to respond to this call. Reclaiming their expertise in support of physiological first birth by driving the practice and research agenda presents the optimal way to “move things forward” for women.</p>

"Moving things forward": Birthing Suite culture and labour augmentation for healthy first-time mothers.

<p>In Aotearoa New Zealand, healthy women giving birth for the first time may plan to give birth in range of settings - from home to a tertiary hospital where surgical and anaesthetic services are available. Each birth location has its own culture, and the extent to which this culture influences the birth experience lies at the heart of this research. Just twenty-three percent of first-time mothers experience a normal birth with no obstetric interventions, and the chosen place of birth is implicated in this statistical outcome. Tertiary maternity settings report the highest rates of birth interventions, even for healthy women who can anticipate straightforward labour experiences. Among the most frequently used birth interventions are labour augmentation procedures - artificial rupture of membranes and administration of synthetic oxytocin infusions. My critical realist ethnography aims to explore the cultural landscape within one tertiary birthing suite and in doing so to identify the generative mechanisms that influence the likelihood of labour augmentation for well first-time mothers. I begin with a retrospective chart review to uncover the magnitude of the use of augmentation procedures for a sample of healthy women presenting in labour to the birthing suite over one calendar year. Interviews with women who experienced long labours yield insights about their decision-making with respect to augmentation. Focus groups and interviews with midwives and obstetric doctors contribute an understanding of factors associated with their use of augmentation, and a period of non-participant observation in the birthing suite illuminates the nuanced ways the unit culture contributes to the permissive use of augmentation procedures in this birthing environment. Findings reveal that sixty percent of women experienced labour augmentation procedures and for one third of them, the augmentation was not indicated according to the clinical guideline in use at the time. Pressure to be “moving things forward” characterises the birthing suite culture. The identified generative mechanisms that combine to influence the likelihood of augmentation include a lack of belief in birth, not valuing midwives, the education and socialisation of midwives and doctors, and the industrialisation of birth - all underpinned by available social discourses about being a good mother, a good midwife or a good doctor. Ironically, the very attributes that make the tertiary hospital the ideal place to be when birth is complex or the unexpected happens (‘poised-ness’ for action, being a ‘well-oiled machine’ for emergency care, surveillance and control) are the same attributes that create a dis-abling environment for physiological first birth to unfold at its own pace. The ‘perfect system’ is in place; a well-embedded midwifery-led continuity of care model incorporating seamless and integrated secondary referral processes. But despite this potentially enabling model of maternity care, once ‘nested’ within the tertiary hospital setting the impact of social, professional and industrial discourses overwhelms the salutogenic factors that should protect normal birth. A re-focussed commitment to providing continuity of care across the labour continuum, home visiting in early labour, enhancing physiological birth support in both the relational and environmental realms, averting the obstetric gaze and prioritising women’s needs over institutional needs represent the best way forward as strategies to resist the inexorable rise of obstetric intervention. Midwives are well-positioned to respond to this call. Reclaiming their expertise in support of physiological first birth by driving the practice and research agenda presents the optimal way to “move things forward” for women.</p>

The Maternity Experience of New Zealand Samoan First-time Mothers

<p>Motherhood is a life-changing event. It is a significant milestone for a woman. This thesis explores the concept of motherhood from the perspectives of Samoan first-time mothers living in New Zealand. The thesis traces their experiences from conception, pregnancy and childbirth through to early motherhood. Their narratives are the focus of the research and are complemented by the viewpoints from some of their own mothers, and maternity health professionals. The overarching question, ‘What are the experiences of a group of first-time New Zealand-born Samoan mothers before and after birth?’ was framed from a strengths-based approach and draws on work which defines a strength-based approach to resilience as research that changed traditional deficit perspectives. Rather than focusing on how individuals or families have failed or struggled, emphasis is directed to how they can succeed or how they can manage (Walsh, 2006). Interviews were conducted in Wellington and Auckland with 11 first-time Samoan mothers prior to childbirth and follow-up interviews with nine of these women within 12 months of the birth of their child. Five Samoan grandmothers, i.e. mothers of these first-time mothers, five midwives and five Plunket nurses were also interviewed. Four sites of analysis were examined – the embodied experience of conception and pregnancy; the process of labour and childbirth; the new norm of early motherhood, and interpersonal relationships and encounters. Analysis was conducted through the overarching lens of the Samoan concept of the vā (Wendt, 1999), the theoretical frameworks of ‘negotiated spaces’ (Mila-Schaaf and Hudson, 2009) and sophisticated mediation (Churchward, 2011). It was found that the first-time New Zealand-born Samoan mothers engaged in a complex and, at times, contradictory process of seeking support during their transition to motherhood. They demonstrated resilience and their skill as sophisticated mediators. The women depended on relationships, some biological and some not, that were reliable and sustainable and the interaction and care that the relationship offered. Intergenerational relationships were important to these first-time New Zealand-born Samoan mothers, particularly ones they had with their own mother, or someone close to them, as it was pivotal in the way in which they constructed their maternity experience.</p>

The Maternity Experience of New Zealand Samoan First-time Mothers

<p>Motherhood is a life-changing event. It is a significant milestone for a woman. This thesis explores the concept of motherhood from the perspectives of Samoan first-time mothers living in New Zealand. The thesis traces their experiences from conception, pregnancy and childbirth through to early motherhood. Their narratives are the focus of the research and are complemented by the viewpoints from some of their own mothers, and maternity health professionals. The overarching question, ‘What are the experiences of a group of first-time New Zealand-born Samoan mothers before and after birth?’ was framed from a strengths-based approach and draws on work which defines a strength-based approach to resilience as research that changed traditional deficit perspectives. Rather than focusing on how individuals or families have failed or struggled, emphasis is directed to how they can succeed or how they can manage (Walsh, 2006). Interviews were conducted in Wellington and Auckland with 11 first-time Samoan mothers prior to childbirth and follow-up interviews with nine of these women within 12 months of the birth of their child. Five Samoan grandmothers, i.e. mothers of these first-time mothers, five midwives and five Plunket nurses were also interviewed. Four sites of analysis were examined – the embodied experience of conception and pregnancy; the process of labour and childbirth; the new norm of early motherhood, and interpersonal relationships and encounters. Analysis was conducted through the overarching lens of the Samoan concept of the vā (Wendt, 1999), the theoretical frameworks of ‘negotiated spaces’ (Mila-Schaaf and Hudson, 2009) and sophisticated mediation (Churchward, 2011). It was found that the first-time New Zealand-born Samoan mothers engaged in a complex and, at times, contradictory process of seeking support during their transition to motherhood. They demonstrated resilience and their skill as sophisticated mediators. The women depended on relationships, some biological and some not, that were reliable and sustainable and the interaction and care that the relationship offered. Intergenerational relationships were important to these first-time New Zealand-born Samoan mothers, particularly ones they had with their own mother, or someone close to them, as it was pivotal in the way in which they constructed their maternity experience.</p>

Amacompri information system for postpartum nursing monitoring

Background: First-time mothers require greater nursing accompaniment in the postpartum period due to their lack of expertise and preparation for the new challenges of motherhood. Information and communication technologies (ICTCs) allow easy access to learning habits for the transition into motherhood; however, the lack of technological appropriation for postpartum monitoring becomes evident in developing countries and in the Western world. Methods: This study developed the Amacompri postpartum nursing tracking information system, which is based on Mercer's theory of becoming a mother and discusses the vital environment: First-time mother’s family and friends. The Amacompri software was designed using the SCRUM methodology, java web technologies and PostgreSQL database. Results: This information system features a web version and a mobile App. The technical validation involved 10 experts, and the validation by population 10 first-time mothers. This first group reviewed the quality of presentation and content in the early stages of the software. Finally, the Amacompri system was used for 4 months by 33 first-time mothers, who evaluated the application for design, usability, and applicability. Amacompri software was effective for non-face-to-face nursing accompaniment to first-time mothers. Conclusions: The Amacompri software was designed based on Mercer's theory of becoming a mother, and has been technically validated (experts) and validated by population (first mothers), demonstrating its quality in both presentation and content. Its evaluation demonstrated its effectiveness in meeting the development objective. In this context, the Amacompri software meets multimedia requirements in the functional, technical-esthetic, and pedagogical aspects.

Sophisticated Mediators: New Zealand-Born Samoan First-Time Mothers and Strategies for Their Health and Wellbeing

<p>This thesis explores the experiences of four New Zealand-born Samoan first time mothers during pregnancy, childbirth and early motherhood living in Wellington. The impetus for this research arose from findings that showed a considerable variation in the prevalence of postnatal depression between Samoan women (7.6%), Tongan women (30.9%) and others (20% for all New Zealand mothers). Qualitative, face-to-face individual interviews were conducted within a qualitative feminist framework. The two interviews with each woman were conducted during the last trimester of their pregnancy (28+weeks gestation); and 12 months post-birth. The thesis drew upon the four-element model – Epistemology, Theoretical Perspective, Methodology and Methods to provide a framework to conceptualise and clarify the foundation for this research project. Thus the thesis is best described as a feminist phenomenological social constructionist approach. The findings revealed the women of this study were „Sophisticated Mediators‟ who, although faced with many challenges throughout their pregnancy, childbirth and early motherhood experiences, mediated successfully between, and within, existing cultural and belief systems i.e. Samoan traditional values and New Zealand cultural system; to acquire or maintain resilience toward depressive symptoms during early motherhood. Support structures such as family, in particular mothers, proved to be a vital source of support for the women. Recommendations arising from the research are targeted at support providers and family members and this is discussed in detail. Antenatal care was important although antenatal classes not so; conversely, the women were high adopters of technology in the form of the internet to access information. It is vital for support providers to recognise the high regard the women had for the internet as a source of valuable and easily accessible information, and utilise those avenues more to provide information that will complement or improve the existing support structures. During the antenatal period, women should be encouraged to develop or strengthen relationships with a significant female who will be with them throughout the childbirth and early motherhood process.</p>