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ABSTRACT: An earlier matched cohort study in the United Kingdom found a significantly higher perinatal mortality rate for births booked under an independent midwife compared with births in National Health Service units (1.7% [25/1,508] vs 0.6% [45/7,366]). This study examined independent midwives' management and decision making in the 15 instances of perinatal death that occurred at term.
Thematic analysis of independent midwives' case notes was performed in instances of perinatal mortality. Semi-structured interviews were conducted with the midwives concerned.
Home birth was attempted in 13 of the 15 cases. Significant (often multiple) antenatal risk factors were identified in 13 cases, including twin pregnancy, planned vaginal births after cesarean section, breech presentations, and maternal illness. Several women had declined some or all routine antenatal screening. Three deaths occurred before labor onset. Postmortem results were known in only four cases; many causes of death remained unexplained. Professional consensus was that seven deaths were unpreventable; elective cesarean section may have changed the outcome in eight cases. However, the pregnant women had declined this option; some were reported to be avoiding National Health Service care because of previous bad experiences. Transfer to hospital care, when it occurred, was often problematic. Care management was judged to be clinically acceptable within the parameters set by the mothers' choices.
Information about clinical processes (and outcomes) is essential if informed decisions are to be made. The women in this review had reportedly accepted the potential consequences of their high-risk situations. If reality is to match rhetoric about "patient" autonomy, such decision making in high-risk situations must be accepted.
Birth 12/2010; 37(4):280-7. · 2.18 Impact Factor
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Mavis Kirkham
The practising midwife 03/2010; 13(3):14.
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Mavis Kirkham
The practising midwife 01/2010; 13(1):13-5.
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ABSTRACT: This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices.
Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood.
The study employed an inductive qualitative approach.
A purposive sample of childbearing women (n = 16), who self-defined as living with an eating disorder, were recruited. Data were generated from one-to-one interviews; a thematic analysis identified key issues.
Participants were primarily responsible for ensuring child/ren's socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to 'healthy' eating as protective against their children acquiring an eating disorder and in this respect commercial child-care facilities provided alternative environments for children to explore food-related activities.
Participants employed a variety of strategies to ensure children's exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants.
Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women's future health and well-being and that of their children.
Journal of Clinical Nursing 04/2009; 18(6):874-83. · 1.12 Impact Factor
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Midwifery 07/2008; 24(2):132-7. · 1.78 Impact Factor
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ABSTRACT: Debates about infant-feeding methods have intensified in recent years with increasing pressures on women living in industrialized nations to breastfeed their infants. This paper, based on a qualitative study of 16 childbearing women with a pre-existing eating disorder living in the north of England, examines participants' motivations for, and understandings of, infant-feeding decisions and practices. In this study, a small number of participants reported being 'desperate' to formula feed in order to resume practices underpinning their eating disorder and thereby to shed the weight accumulated during pregnancy. These participants anticipated an early return to restrictive eating, heavy exercise regimes and/or bingeing/purging behaviours. Most participants, however, reported being 'desperate' to breastfeed because this implied 'good' mothering and prolonged the time during which they could consume 'naughty' treats. Women who opted to breastfeed generally believed this would accelerate weight loss. This study contributes to research on the subjective experiences of a particular group of women living with chronic illnesses and problematic relationships with their bodies. Negotiating individual transitions to motherhood required participants to confront their own, often longstanding, disrupted eating patterns and to make important decisions about infant-feeding methods. Findings from this study raise questions about some of the assumptions underpinning infant-feeding activities and articulate some of the complexities surrounding these issues. By highlighting ways in which women may compromise their own well-being by prioritizing their baby's needs, for example by persisting with breastfeeding when they were 'desperate' to re-engage with their disordered eating practices, an individualized cost-benefit framing is outlined.
Maternal and Child Nutrition 05/2008; 4(2):106-20. · 1.61 Impact Factor
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Mavis Kirkham
RCM midwives: the official journal of the Royal College of Midwives 06/2007; 10(5):224-6.
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RCM midwives: the official journal of the Royal College of Midwives 04/2006; 9(3):113.
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Mavis Kirkham
The practising midwife 05/2004; 7(4):18-20.
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Mavis Kirkham
The practising midwife 01/2004; 6(11):12-5.
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ABSTRACT: to describe the extent to which women using maternity services perceive that they have exercised informed choice.
twelve maternity units in Wales.
postal survey of women using maternity services, covering women's views of the extent to which they exercised informed choice overall, and at eight decision points during their care.
1386 women at approximately 28 weeks gestation (antenatal sample) and 1741 women at approximately 8 weeks post delivery (postnatal sample).
54% of women perceived that they exercised informed choice overall in the antenatal sample (95% CI: 51-57%) and 54% overall in the postnatal sample (95% CI: 52-56%). Perceptions of informed choice differed by decision point, varying between 31% for fetal heart monitoring during labour and 73% for the screening test for Down's syndrome and spina bifida in the baby. There were differences by maternity unit, even when the characteristics of women attending these units were taken into account. Multiparous women, women from manual occupations and women with lower educational status were more likely to feel that they exercised informed choice during antenatal care. These sub-groups of women were also more likely to report a preference for not sharing decision-making with health professionals.
a large minority of women felt that they had not exercised informed choice overall in their maternity care. The perception of informed choice differed by decision point, maternity unit and characteristics of the woman.
attaining informed choice is more of a challenge for some decision points in maternity care than others, particularly fetal monitoring. The difference in levels of informed choice between maternity units highlights the importance of maternity unit policy in the promotion of informed choice.
Midwifery 07/2002; 18(2):136-44. · 1.78 Impact Factor
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ABSTRACT: To examine the use of evidence based leaflets on informed choice in maternity services.
Non-participant observation of 886 antenatal consultations. 383 in depth interviews with women using maternity services and health professionals providing antenatal care.
Women's homes; antenatal and ultrasound clinics in 13 maternity units in Wales.
Childbearing women and health professionals who provide antenatal care. Intervention: Provision of 10 pairs of Informed Choice leaflets for service users and staff and a training session in their use.
Participants' views and commonly observed responses during consultations and interviews.
Health professionals were positive about the leaflets and their potential to assist women in making informed choices, but competing demands within the clinical environment undermined their effective use. Time pressures limited discussion, and choice was often not available in practice. A widespread belief that technological intervention would be viewed positively in the event of litigation reinforced notions of "right" and "wrong" choices rather than "informed" choices. Hierarchical power structures resulted in obstetricians defining the norms of clinical practice and hence which choices were possible. Women's trust in health professionals ensured their compliance with professionally defined choices, and only rarely were they observed asking questions or making alternative requests. Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy. The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced.
The way in which the leaflets were disseminated affected promotion of informed choice in maternity care. The culture into which the leaflets were introduced supported existing normative patterns of care and this ensured informed compliance rather than informed choice.
BMJ (Clinical research ed.). 04/2002; 324(7338):639.
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