This is the first study to specifically explore fathers' experiences of newborn resuscitation. The findings should inform healthcare education, policy development and the provision of support to fathers.
BackgroundWe tested the hypothesis that routine MRI would improve the care and well-being of preterm infants and their families.DesignParallel-group randomised trial (1.1 allocation; intention-to-treat) with nested diagnostic and cost evaluations (EudraCT 2009-011602-42).SettingParticipants from 14 London hospitals, imaged at a single centre.Patients511 infants born before 33 weeks gestation underwent both MRI and ultrasound around term. 255 were randomly allocated (siblings together) to receive only MRI results and 255 only ultrasound from a paediatrician unaware of unallocated results; one withdrew before allocation.Main outcome measuresMaternal anxiety, measured by the State-Trait Anxiety inventory (STAI) assessed in 206/214 mothers receiving MRI and 217/220 receiving ultrasound. Secondary outcomes included: prediction of neurodevelopment, health-related costs and quality of life.ResultsAfter MRI, STAI fell from 36.81 (95% CI 35.18 to 38.44) to 32.77 (95% CI 31.54 to 34.01), 31.87 (95% CI 30.63 to 33.12) and 31.82 (95% CI 30.65 to 33.00) at 14 days, 12 and 20 months, respectively. STAI fell less after ultrasound: from 37.59 (95% CI 36.00 to 39.18) to 33.97 (95% CI 32.78 to 35.17), 33.43 (95% CI 32.22 to 34.63) and 33.63 (95% CI 32.49 to 34.77), p=0.02. There were no differences in health-related quality of life. MRI predicted moderate or severe functional motor impairment at 20 months slightly better than ultrasound (area under the receiver operator characteristic curve (CI) 0.74; 0.66 to 0.83 vs 0.64; 0.56 to 0.72, p=0.01) but cost £315 (CI £295–£336) more per infant.ConclusionsMRI increased costs and provided only modest benefits.Trial registrationClinicalTrials.gov NCT01049594 https://clinicaltrials.gov/ct2/show/NCT01049594. EudraCT: EudraCT: 2009-011602-42 (https://www.clinicaltrialsregister.eu/).
Problem Many women experience the transition to motherhood as stressful and find it challenging to cope, contributing to poor emotional wellbeing. Background Postnatal social support from health professionals can support new mothers in coping with this transition, but their social support role during the postnatal period is poorly defined. Aim To explore how first time mothers in England experienced social support from health professionals involved in their postnatal care. Methods A qualitative descriptive study, theoretically informed by phenomenological social psychology, based on semi-structured, in-depth interviews with 32 mothers from diverse backgrounds. These were analysed using inductive thematic analysis, with themes subsequently mapped on to the four dimensional model of social support (emotional, appraisal, informational, practical). Findings There were nine themes connected to social support, with the strongest mapping to appraisal and informational support: for appraisal support, ‘Praise and validation’, ‘Criticism and undermining’, and ‘Made to feel powerless’; for informational support, ‘Is this normal?’, ‘Need for proactive information’, and ‘Confusion about postnatal care’; for emotional support, ‘Treated as an individual and heard’ and ‘Impersonal care and being ignored’; for practical support, ‘Enabling partners to provide practical support’. Conclusions Health professionals can play an important role postnatally in helping first time mothers to cope, develop confidence and to thrive, by taking every opportunity to give appropriate and personalised appraisal, informational and emotional social support alongside clinical care. Training and professional leadership may help to ensure that all health professionals are able and expected to offer the positive social support already offered by some.
ObjectiveTo explore healthcare professionals’ experiences around the time of newborn resuscitation in the delivery room, when the baby's father was present.DesignA qualitative descriptive, retrospective design using the critical incident approach. Tape-recorded semistructured interviews were undertaken with healthcare professionals involved in newborn resuscitation. Participants recalled resuscitation events when the baby's father was present. They described what happened and how those present, including the father, responded. They also reflected upon the impact of the resuscitation and the father's presence on themselves. Participant responses were analysed using thematic analysis.SettingA large teaching hospital in the UK.ParticipantsPurposive sampling was utilised. It was anticipated that 35–40 participants would be recruited. Forty-nine potential participants were invited to take part. The final sample consisted of 37 participants including midwives, obstetricians, anaesthetists, neonatal nurse practitioners, neonatal nurses and paediatricians.ResultsFour themes were identified: ‘whose role?’ ‘saying and doing’ ‘teamwork’ and ‘impact on me’. While no-one was delegated to support the father during the resuscitation, midwives and anaesthetists most commonly took on this role. Participants felt the midwife was the most appropriate person to support fathers. All healthcare professional groups said they often did not know what to say to fathers during prolonged resuscitation. Teamwork was felt to be of benefit to all concerned, including the father. Some paediatricians described their discomfort when fathers came to the resuscitaire. None of the participants had received education and training specifically on supporting fathers during newborn resuscitation.ConclusionsThis is the first known study to specifically explore the experiences of healthcare professionals of the father's presence during newborn resuscitation. The findings suggest the need for more focused training about supporting fathers. There is also scope for service providers to consider ways in which fathers can be supported more readily during newborn resuscitation.
Objective To explore what first time mothers in England expect from postnatal care while they are pregnant, what they would ideally like, where they get their information on postnatal care, and their views on the sufficiency of this information. Design A qualitative descriptive interview-based study. Setting England Participants A maximum variation sample of 40 women who were currently in the third trimester of pregnancy; aged 16 or over; planning to give birth in England and had not given birth previously. Methods Semi structured interviews were carried out between October 2017 and March 2018, by telephone ( n = 32) and face to face ( n = 8). Interviews were analysed using thematic analysis. Results There were six themes and twelve subthemes. The themes were: (1) ‘Piecing together snippets of information’ containing subthemes ‘Incomplete official sources’ and ‘Other mothers’ stories’; (2) ‘Planning ahead or going with the flow’ containing subthemes ‘Wanting more information’ and ‘Postnatal care not a priority’; (3) ‘Judgement or reassurance’ containing subthemes ‘Real: Being judged’, ‘Ideal: Reassurance and non-judgmental advice’; (4) ‘Focus of care’ containing subthemes ‘Real: A focus on checks and feeding’, ‘Ideal: More focus on mother's wellbeing’; (5) ‘A system under pressure’ containing subthemes ‘Real: Busy midwives, reactive care’, ‘Ideal: Reliable, proactive information’; (6) ‘Deciding about discharge’, containing subthemes ‘Real: Confusion about decision-making’, ‘Ideal: More control over length of hospital stay’. Key conclusions Fi r st time mothers’ experience of the transition to parenthood could be improved by antenatal access to comprehensive information about the timing, location, content and purpose of postnatal care. Information should take a woman-centred perspective and cover all settings (hospitals, birth centres, home, community), including the roles and responsibilities of all the professionals who may be involved. Implications for practice Clear and comprehensive information about postnatal care should be provided to all women in ways that are accessible at any stage of pregnancy or the postnatal period. As women pregnant for the first time worry about being judged if they seek professional advice and reassurance postnatally, information about postnatal care should aim to address this.
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