Regulating migrant maternity: Nursing and midwifery’s emancipatory aims and assimilatory practices

In contemporary Western societies, birthing is framed as transformative for mothers; however, it is also a site for the regulation of women and the exercise of power relations by health professionals. Nursing scholarship often frames migrant mothers as a problem, yet nurses are imbricated within systems of scrutiny and regulation that are unevenly imposed on ‘other’ mothers. Discourses deployed by New Zealand Plunket nurses (who provide a universal ‘well child’ health service) to frame their understandings of migrant mothers were analysed using discourse analysis and concepts of power drawn from the work of French philosopher Michel Foucault, read through a postcolonial feminist perspective. This research shows how Plunket nurses draw on liberal feminist discourses, which have emancipatory aims but reflect assimilatory practices, paradoxically disempowering women who do not subscribe to ideals of individual autonomy. Consequently, the migrant mother, her family and new baby are brought into a neoliberal project of maternal improvement through surveillance. This project – enacted differentially but consistently among nurses – attempts to alter maternal and familial relationships by ‘improving’ mothering. Feminist critiques of patriarchy in maternity must be supplemented by a critique of the implicitly western subject of maternity to make empowerment a possibility for all mothers.     

Maternal and child health nurses: a vital link to the community for primiparae over the age of 35

Australia, like other developed countries, is exhibiting a trend towards later childbearing and this trend has been particularly evident in the last three decades. Social trends of declining birth rates and small nuclear families mean that the contemporary adult has far less exposure to children than adults of former generations. Increasing female trends of employment and participation in higher education have also contributed to a postponement of childbearing, and more women than ever before are having a first baby over the age of 35 years. Mothering experiences for this group of women often occur in a situation of limited family or social support, geographical distancefrom family and with few links to the community. Together these factors make new mothering an isolating experience for some women. This paper reports on findings from a longitudinal qualitative study, outlining the importance of maternal & child health nurses in providing support and in facilitating links to the community for primiparae over the age of 35 years.     

Professionals' experiences of supporting two-mother families in antenatal and child health care in Sweden

Background

In Sweden, antenatal and child health care are offered free of charge to all expectant and new parents. Professionals in antenatal and child health care play an important role in supporting parents. Previous research shows that same-sex mothers face heteronormative assumptions and insufficient support during their transition to parenthood.

Objective

To explore professionals' experiences of supporting two-mother families in antenatal and child health care.

Method

A qualitative method with focus group discussions was used. An interview guide was followed, and the discussions were held online. The data was analysed according to inductive content analysis.

Settings and participants

The participants were midwives (n = 8) and nurses (n = 5) in antenatal and child health care from different parts of Sweden. Participants were recruited through the coordinating midwives and child health care nurses in the different regions.

Findings

One main category was identified: Striving to be open-minded in supporting same-sex mothers. Health care professionals described meeting well-prepared mothers, with an equal commitment between each other, and mothers on guard against heteronormative views. Professionals provided support through empowerment by creating a safe environment and aiming at providing equal support to all parents or tailored support to same-sex mothers. Mothers described handling challenges, as a balancing act to acknowledge both mothers. Struggling with documents and communication and a lack of information were other challenges to be handled. Professionals reflected on their own professional competence and expressed that knowledge acquired through education, experience and personal interest all contributed to their competence.

Conclusions

Forms and documentation need to be updated to be gender neutral to be including to a variety of family constelleations. Health care professionals need time to reflect on norms and challenges to better support both mothers in a two-mother family.     

Attitudes of midwives and maternal child health nurses towards suicide: A cross‐sectional study

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross‐sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south–eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.     

Improving the postnatal outcomes of new mothers

BACKGROUND: Postnatal depression persists worldwide as a troubling issue for many new mothers and their families. The practice of early discharge within 72 hours after birth from maternity hospitals in Australia requires community-based care of new mothers, typically provided by community midwives initially, and then by maternal and child health nurses (MCHN). This latter workforce encounters the onset of distress/depression in vulnerable women and is expected to manage their care, but their training does not equip sufficiently them to do this. AIMS: The aim of the study was to evaluate the effectiveness of brief training for MCHN in early detection and effective management of mildly distressed new mothers. METHODS: A controlled comparative longitudinal study was carried out with a group of first-time mothers recruited through antenatal clinics at four major hospitals in a large Australian city. Forty MCHN were allocated to the intervention group. Those in the intervention group received training in the identification and management of distressed mothers. Intervention group nurses also had access to a liaison psychiatric network for consultation and referrals. Other nurses were allocated to the control group, which provided standard management services to new mothers in their catchment areas. Mothers' outcomes in psychological and psychosocial functioning were assessed; comparing those cared for by the nurses who had received the intervention with those cared for by standard practices. Mothers' satisfaction with the maternal and child health nurse services was also assessed. RESULTS: Levels of distress peaked in early pregnancy in both groups and reduced over the study period. Rates and group levels of psychological distress and psychosocial functioning did not differ over time between mothers receiving care from the enhanced trained nurses and those receiving standard care. Differential group findings were apparent in attrition, with the more distressed mothers withdrawing from the control group and the less distressed withdrawing from the intervention group. Satisfaction with maternal and child health nurse services was high in both groups. Limitations of the study included events occurring while the study was in progress, such as staffing upheaval and unrest following the introduction of compulsory competitive tendering requirements, heavy workloads and the concurrent introduction of computerized case records that required the rapid familiarization with computer usage. CONCLUSIONS: Findings indicate that the extra training of MCHN did not substantially assist in the detection and management of postnatal distress in these new mothers. Unexpected ecological conditions of workforce disruption and extra workloads may have mitigated against the success of the programme. Limitations of the study are examined and the implications for future research are discussed.     

A descriptive study on complementary and alternative medicine use in 0 to 1‐year‐old infants and nurses' awareness and recommendation for complementary and alternative medicine

This study aimed to determine complementary and alternative medicine (CAM) recommended by midwives and nurses and used by mothers on their 0 to 1‐year‐old infants. A cross‐sectional survey design was used. The sample of the study consisted of 65 midwives and mothers of 349 infants registered at these health‐care centres. The frequency of CAM use on a regular basis by mothers participating in the study on their infants was 24.6%, whereas the frequency of CAM use for a while was 41.3%. Of the mothers using CAM, 81.5–98.5% stated that the method they were employing was useful. The mothers used CAM on their infants, and the midwives and nurses recommended CAM use. However, the midwives and nurses themselves should be first trained to be able to inform individuals/mothers about CAM. Evidence‐based studies on CAM are needed.     

A holistic programme for mothers with postnatal depression: pilot study

Title.  A holistic programme for mothers with postnatal depression: pilot study.
Aim. This paper is a report of a pilot study to identify women's perceptions of participation in a holistic intervention for postnatal depression.
Background. Approximately 10–15% of women suffer from postnatal depression following childbirth. Most programmes for women with postnatal depression include pharmaceutical interventions; however, evaluation of women's perceptions of participation in holistic programmes for those suffering from postnatal depression show that non-pharmaceutical programmes can also be effective.
Method. In-depth interviews were conducted in 2004 with a self-selected sample of 10 women prior to and after an intervention to treat postnatal depression.
Findings. The intervention seemed capable of encouraging and facilitating a positive mother–infant relationship while also effectively reducing the mother's anxiety levels. Participants commented on the supportive environment of other mothers and said that they found playing with their babies difficult and needed guidance and facilitation to do this.
Conclusion. The pilot programme was well accepted and could easily be used by midwives, maternal and child health nurses and other appropriately trained allied health professionals.     

Relationships between demographic variables and family dynamics of childbearing families

Hakulinen T, Paunonen M, Laippala P. International Journal of Nursing Practice 1997; 3: 247–254
Relationships between demographic variables and family dynamics of childbearing families
In this study relationships between demographic variables and family dynamics of childbearing families in Finland were studied. The sample was 160 urban families expecting their first or second child in the third trimester of pregnancy. One-hundred and eighteen families participated in the study. The Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were used in this study. Most expectant parents reported their family was well-functioning. Mothers of higher socioeconomic status found more flexibility in their families than mothers of lower socioeconomic status. Fathers in families expecting their first baby reported more mutuality, role reciprocity and more stability than second-time fathers. The findings contribute cues for public health nurses and midwives regarding parity, socioeconomic status and family dynamics to provide more specific family guidance during the transition to parenthood. Realistic information on the changes in family dynamics after childbirth should be given to pregnant parents.     

HIV/AIDS in childbearing Hispanic/Latinas: an emerging crisis

The purpose of this article is to describe possible reasons for the increase in HIV/AIDS among childbearing Hispanic/Latinas and to discuss the implications for maternal child nurses. The median age of Hispanic/Latinas is 27 years compared to 36 years for all other races combined. Hispanic/Latinas have the highest birth rate among all women in the United States; they also have a five times greater rate of HIV/AIDS infection compared to non-Hispanic White women. Most commonly, Hispanic/Latina women first discover their HIV status when they receive prenatal care. Gender and cultural roles, poverty, lack of health insurance, poor health literacy, limited English proficiency, and low educational level all contribute to this emerging crisis. Educating Hispanic/Latina women about prevention methods, early testing/counseling, and treatment options is a first step in decreasing the suffering and devastation associated with HIV/AIDS among childbearing Hispanic/Latinas and their families.     

Advanced maternal age: delayed childbearing is rarely a conscious choice a qualitative study of women's views and experiences

BackgroundThere is a global trend, in high resource countries, for delayed childbearing beyond the age of 35. Women of advanced maternal age are considered to be at higher risk of poor maternal and neonatal outcomes. Women's views and experiences of delayed childbearing are relatively unexplored.ObjectivesTo gain an understanding of factors influencing women's decisions to delay childbearing and explore their experiences and perceptions of associated risks.DesignA qualitative phenomenological study.SettingGreater Manchester, United Kingdom.ParticipantsPurposive sample of 18 women aged 35 and over in three groups; six women with no children who were not pregnant, six women pregnant with their first child and six women with no children attending a fertility clinic.MethodsData were collected by in depth semi-structured interviews, managed manually and subjected to thematic analysis.ResultsThree main themes were identified; the chapters of life, the need to know, and childbearing being within or beyond women's control. Women focussed on the need for a stable relationship, being “ready” to have a baby, and acquisition of life experience. Their experiences reflected a lack of awareness of many of the risks associated with pregnancy over age 35 and disbelief that age alone necessarily increased the likelihood of poor outcomes. Women perceived a lack of choice in the timing of when to start a family. Women suggested that although they may have reached a juncture in their lives, at which they felt ready to have a baby, the circumstances in which they found themselves may not support this; factors such as relationship, financial stability, health and fertility, were often outside of their control.ConclusionsWomen do not perceive that they have ultimate control when it comes to the timing of childbearing. Health professionals and the media should be aware of the complex interplay of factors surrounding women's reasons for delaying childbearing. Sensitive information and support should be provided allowing for varying perceptions of risk status. Women may benefit from pre-conception education.     

Educational preparation for maternal, child and family health nurses in Australia

KRUSKE S. & GRANT J. (2012) Educational preparation for maternal, child and family health nurses in Australia. International Nursing Review 59 , 200–207 Aim: The study aims to map and critique the current postgraduate educational nursing programmes offered to nurses and midwives in maternal, child and family health in Australia. Background: Nursing specialties that focus on the early years of child health and development are based on international recognition of the developmental needs of the growing infant and of the social, health and economic consequences of failing to support families to raise their children in optimal environments. Little is known whether the educational programmes that prepare maternal, child and family health nurses (MCFHNs) for practice in Australia have kept up with new knowledge and understanding of the early years of life. Methods: A survey of all maternal, child and family health education programmes offered in Australia was undertaken. Findings: Marked variations in course titles, length, content, clinical exposure and award exist across the 12 institutions offering such programmes in Australia. Many institutions provide inadequate preparation in some of the core skills required of the workforce. Conclusion: The establishment of minimum standards for the education of MCFHNs across Australia is required. This study also highlights the need for further research around the scope of practice of MCFHNs, and the role of midwives who are not nurses, in this specialty area.     

Strategies to improve iron status in women at risk of developing anaemia

Iron deficiency is one of the most prevalent nutritional deficiency disorders worldwide, with teenage girls and women of childbearing age, especially pregnant and postpartum mothers, being most affected. Although supplements may be required in some instances, simple dietary and lifestyle changes may also help individuals to establish a healthy iron status. This article presents useful information that nurses and midwives can provide to women during particular life phases such as pregnancy, adolescence and old age to improve their iron status.     

American rural women's exercise self‐efficacy and awareness of exercise benefits and safety during pregnancy

Though the positive link between physical activity and maternal health is well documented, physical activity declines during pregnancy and, internationally, rural mothers are less likely than urban mothers to engage in physical activity. Some evidence suggests that self‐efficacy is related to sustained engagement in physical activity. The purpose of this study was to examine self‐efficacy, perceived benefits, and knowledge of safe exercise among 88 rural pregnant women in a southeastern region of the United States. Exercise self‐efficacy was significantly related to maternal age and gestation. Women over age 26 years, and those in the second and third trimesters, scored significantly higher than younger women or those in the first trimester. Fifty‐two percent (n = 46) of participants perceived that activity would decrease energy levels, 37.5% (n = 33) did not know that exercise can decrease the risk of gestational diabetes, and 47.6% (n = 41) were unaware that a mother who is overweight is more likely to have an overweight child. Results confirm a need for education to improve women's knowledge about health benefits and safety information related to physical activity during pregnancy.     

Therapeutic choices for the discomforts of labor

Health care providers including nurses and childbirth educators are crucial resources for childbearing families for accurate and current information regarding nonpharmacologic and pharmacologic interventions available for pain management in labor. All medications that are administered to laboring women have maternal and fetal effects. In order to assist women in the decision for relief of labor discomforts, health care professionals must be knowledgeable of the chemical actions and adverse effects of all medications offered to women in labor. This article discusses various types of therapeutic options used for pain management for the relief of labor discomfort.     

Children with cancer: ethical dilemmas

Ethical dilemmas have been called the "dark side of medical progress." However, ethical dilemmas can enlighten health care professionals. Nurses are examining these dilemmas to better resolve similar situations in the future. The role of the pediatric oncology nurse is important in the successful resolution of dilemmas related to the child with cancer. Pediatric oncology nurses are involved in all aspects of the process of informing the child and family about disease, and treatment, and they can encourage communication between the health care team and family. Finally, it is important that nurses keep abreast of landmark legal and ethical decisions affecting children and young adults. The controversy over parental rights v government-imposed choices will continue. "Baby Doe" and religious freedom struggles are two contemporary dilemmas. AIDS will set legal and ethical precedents. The outcome of these arguments will undoubtedly affect the care of the child with cancer.     

Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers

AIM OF THE STUDY: To gain insight into the support teenage mothers received during pregnancy, birth and their child's pre-school years and young women's perceptions of the usefulness of a support group for teenage mothers. BACKGROUND: Most qualitative studies have focused on teenage mothers around the time of the birth of their first child. For this study, women were recruited several years after the birth (median 8.5 years), so that they would have had time to reflect on the support they had received. DESIGN: The qualitative method of semi-structured interviews was chosen to obtain in-depth information and to allow teenage mothers' own views to be heard. Ten individual interviews and one paired interview were undertaken. FINDINGS: Recruitment was difficult because taking part in research was not a priority for many of the women. The study confirmed the strong link between deprivation and teenage pregnancy found in other studies, and suggested that mental health problems in teenage mothers may be more difficult to detect. Teenage women need more information on mental health and on services available to them. The fear, expressed by some of the women in this study, of becoming different from other women in their social network should be considered by health workers when establishing intervention programmes. CONCLUSIONS: Professional bodies of health workers should lobby government to provide a minimum standard of living and sufficient child-care to combat deprivation. Former teenage mothers should be involved in the recruitment, planning and implementation stages of research and interventions. Health professionals should be aware that mental health problems in teenage mothers may be particularly difficult to detect. Key community health workers or a support group may provide information on services, mental health and education facilities available that would benefit teenage mothers. A support group may also give emotional support.     

An HIV self-care symptom management intervention for African American mothers

BACKGROUND: Human immunodeficiency virus (HIV) infection has become a serious health problem for low-income African American women in their childbearing years. Interventions that help them cope with feelings about having HIV and increase their understanding of HIV as a chronic disease in which self-care practices, regular health visits, and medications can improve the quality of life can lead to better health outcomes. OBJECTIVE: This study aimed to determine the efficacy of an HIV self-care symptom management intervention for emotional distress and perceptions of health among low-income African American mothers with HIV. METHOD: Women caregivers of young children were randomly assigned to self-care symptom management intervention or usual care. The intervention, based on a conceptual model related to HIV in African American women, involved six home visits by registered nurses. A baseline pretest and two posttests were conducted with the mothers in both groups. Emotional distress was assessed as depressive symptoms, affective state, stigma, and worry about HIV. Health, self-reported by the mothers, included the number of infections and aspects of health-related quality of life (i.e., perception of health, physical function, energy, health distress, and role function). RESULTS: Regarding emotional distress, the mothers in the experimental group reported fewer feelings of stigma than the mothers in the control group. Outcome assessments of health indicated that the mothers in the experimental group reported higher physical function scores than the control mothers. Within group analysis over time showed a reduction in negative affective state (depression/dejection and tension/anxiety) and stigma as well as infections in the intervention group mothers, whereas a decline in physical and role function was found in the control group. CONCLUSIONS: The HIV symptom management intervention has potential as a case management or clinical intervention model for use by public health nurses visiting the home or by advanced practice nurses who see HIV-infected women in primary care or specialty clinics.     

Australian parents’ experiences with universal child and family health services

BackgroundAustralian governments provide free services to promote maternal and child health, and to support parenting for families with children up to age five. Services are principally provided by dedicated child and family health nurses, but also by general practitioners, practice nurses, pharmacy nurses and midwives.AimThis study aimed to examine the experiences of families with young children across Australia in accessing and receiving health care for well children, parenting support and advice from a range of providers.MethodsThe study used quantitative and qualitative data from an online survey of 719 parents and carers with children aged up to five years.FindingsOn quantitative scales, most respondents rated healthcare providers favourably for accessibility, credibility and their approach to families. However, qualitative responses revealed widely varying reactions to child and family health provision. Parents described both positive and negative experiences, highlighting elements of practice that are critical to consumer engagement.DiscussionParents require health care and support that are accessible, consistent, affordable, encouraging, trustworthy, evidence-based and non-judgemental. Parents feel more confidence in the information and care provided by health professionals who are well-informed, resourceful and who respect their knowledge and beliefs.ConclusionThe findings demonstrate ways in which child and family health providers can engage and effectively support families with young children.