Sergio A. Silverio

King's College London | KCL · Department of Women & Children's Health

Purpose This paper aims to call the public health and mental health communities to action by making women’s mental health a public health priority. Design/methodology/approach This conceptual paper introduces a “Female Psychology” approach to framing and interpreting mental health narratives and public health discourses. It also draws upon lifecou...

Background: Global crises inevitably increase levels of anxiety in postpartum populations. Effective and efficient measurement is therefore essential. This study aimed to create a 12-item research short form of the 51-item Postpartum Specific Anxiety Scale [PSAS] and validate it for use in rapid response research at a time of global crises [PSAS-RS...

The balance between including participants in research, representing them in academic writing, and maintaining their anonymity can be in constant flux. Greater representation may mean compromising participants’ anonymity, while research that is more inclusive may lead to academic representations of data being challenged as inaccurate according to t...

Background The COVID-19 pandemic poses an unprecedented risk to the global population. Maternity care in the UK was subject to many iterations of guidance on how best to reconfigure services to keep women, their families and babies, and healthcare professionals safe. Parents who experience a pregnancy loss or perinatal death require particular care...

Objective: To explore women's experiences of maternity service reconfiguration during the first wave of the SARS-CoV-2 (COVID-19) pandemic. Design: Qualitative interview study. Setting: South London, United Kingdom. Participants: Women (N=23) who gave birth between March and August 2020 in one of the ten South London maternity hospitals. Method...

In this chapter, we draw upon the small literature-base exploring the (ab)use of illicit and prescription drugs, and alcohol amongst healthcare professionals. We present a critical review, that is, a synthesis of relevant literature, to develop a critical hypothesis about the resultant identity crisis of a population of interest (HCPs) experiencing...

The balance between including participants in research, representing them in academic writing, and maintaining their anonymity, can be in constant flux. Greater representation may mean compromising participants’ anonymity, whilst more inclusive research may lead to academic representations of data being challenged as inaccurate according to the par...

Qualitative researchers are often engaged in work addressing challenging, difficult, or sensitive topics. Consequently, qualitative researchers can be frequently exposed to the narratives of participants’ experiences which may, at times, be emotionally charged, distressing, compromising, or filled with information or details which rest heavy on a r...

Background: Lifecourse analysis has long been used to infer social interaction and (dis)organisation and is concerned with intersectionality, specifically social status and class, gender, and also race. For women who lose pregnancies, or whose babies die, the experience of the loss or bereavement can change their lifecourse trajectory. Aims and Ob...

Background: Following a call for evidence by the Department of Health & Social Care, launched in March 2021, the UK Government published their ‘Vision for the Women’s Health Strategy for England’ in December 2021. The three-month consultation and subsequent publication focused on two factors: 1) Improving the way in which the health and care system...

Objective: We examined the perceptions and experiences of decision making about service reconfiguration by maternity care staff who provided maternity care services during the pandemic in one NHS Trust in South London. Design: We employed a qualitative research design to allow expression of experiential data about how maternity healthcare profess...

The Postpartum Specific Anxiety Scale [PSAS] was developed and validated as a research tool with a four-factor structure; with predictive validity corroborated in studies examining infant-feeding and maternal bonding outcomes. The PSAS has not been examined in relation to birth experiences. We aimed to confirm the PSAS four-factor structure and exa...

Background The SARS-CoV-2 pandemic has brought racial and ethnic inequity into sharp focus, as Black, Asian, and Minority Ethnic people were reported to have greater clinical vulnerability. During the pandemic, priority was given to ongoing, reconfigured maternity and children's healthcare. This study aimed to understand the intersection between ra...

Background Approximately one in five women will experience mental health difficulties in the perinatal period. However, for a large group of women, symptoms of adverse perinatal mental health remain undetected and untreated. This is even more so for women of ethnic minority background, who face a variety of barriers which prevents them from accessi...

Problem Maternity care underwent substantial reconfiguration in the United Kingdom during the COVID-19 pandemic. Background COVID-19 posed an unprecedented public health crisis, risking population health and causing a significant health system shock. Aim To explore the psycho-social experiences of women who received maternity care and gave birth...

Objective This qualitative study examines the linguistic features associated with postpartum depression. Methods In this longitudinal online study, 53 mothers completed self-report questionnaires assessing symptoms of postpartum depression and an expressive writing exercise about their pregnancy and birth. Mothers were randomly divided into two gr...

What are the psychometric properties of scales that currently exist to measure anxiety in women in the first year postpartum?

(1) Background: Existing literature has identified associations between exclusive breastfeeding, maternal mental health, and infant sleep. This study aims to examine these relationships simultaneously and consider the mediating role of postpartum anxiety. (2) Methods: Participants completed validated measures of postpartum anxiety, infant sleep, an...

Background: Women from Black, Asian, or mixed ethnicity backgrounds in the UK experience higher rates of maternal and neonatal mortality and morbidity, and report poorer experiences of maternity care. Research is therefore required to further understand how to reduce disparities in care and outcomes, however, it is acknowledged these groups of wome...

Aims and objectives: Obstetric Fistula (OF) is a childbirth injury resulting in life altering physical and psychological morbidity, including uncontrollable leaking of urine, which may result in stigma, discrimination, or internalised feelings of shame. Engaging women affected by OF as advocates has been proposed as an effective strategy to raise a...

Mental health problems have been established as one of the leading causes of the global burden of disease. Approximately a quarter of all people worldwide will experience a mental disorder during their lifetime. With depression and anxiety becoming the leading causes of mental ill health globally, the numbers of people reporting mental health compl...

(1) Background: Approximately one in five women will experience mental health difficulties in the perinatal period. Women from ethnic minority backgrounds face a variety of barriers that can prevent or delay access to appropriate perinatal mental health care. COVID-19 pandemic restrictions created additional obstacles for this group of women. This...

Mental health is especially important as women transition into parenthood. The COVID-19 pandemic has necessitated the rapid reconfiguration of maternity services, including perinatal mental healthcare, as offered by Specialist Perinatal Mental Health Midwives, in NHS Trusts in the United Kingdom. This article represents work undertaken in rapid res...

Qualitative researchers are often engaged in work addressing challenging, difficult, or sensitive topics. Consequently, qualitative researchers can be frequently exposed to the narratives of participants’ experiences which may, at times, be emotionally charged, distressing, compromising, or filled with information or details which rest heavy on a r...

In Spite of Methods Panel. Drawing on my research conducted in antenatal clinics across London, I present a critique of rapid, multi-site, hospital ethnography. In doing so, I engage with concepts of methodological agility and research pragmatism as a social scientist engaging in ethnographic research conducted at and across the disciplinary bounda...

Background: A recent analysis showed that plasma iron concentrations decline rapidly from birth in Gambian infants, irrespective of sex or birthweight, to concentrations well below normal expected values for iron-replete children older than two months of age (typically >10 μmol/L). The development and function of neural and immune cells may thus be...

Purpose: This study aims to validate the Postpartum-Specific-Anxiety-Scale (PSAS) as a French-language instrument, which assesses maternal and infant-related anxieties during the postpartum period. Design and methods: The methodology included six stages: preliminary French translation; selection of most articulate items and back-translation; rec...

What are the risk and protective factors for neonaticide, infanticide, or filicide, as perpetrated by women?

This paper draws on two favourite characters from British reality television show, Love Island 2018: Jack Fincham, a former stationery sales manager, and Alex George, an Accident & Emergency [A&E] doctor, to explore how heterosexual norms are constructed and challenged. We study the romantic on-screen relationships these characters have with the fe...

The Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure of postpartum anxiety (PPA). However, it contains 51 items, so is limited by its length. This study aimed to reduce the number of items in the PSAS, produce a small number of high-performing short-form tools, and confirm the factor structure of the most statistically and theo...

Objective: To explore the experiences of women who had used an Early Pregnancy Assessment Unit [EPAU] service in the United Kingdom and make recommendations for their improvement. Design: Qualitative interview study. Setting: Early Pregnancy Assessment Units in the UK. Sample: A maximum variation sample of women who had consented to be inter...

Objective To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions. Design Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the “Variations in the organ...

In April 2021, the patient and public involvement and engagment (PPIE) group for the maternity and perinatal mental health theme at the NIHR Applied Research Collaboration (ARC) South London co-produced a training event to explore barriers, issues and solutions to community involvement in research. The training used participatory appraisal (PA) met...

Background Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around p...

Purpose Women with little-to-no English continue to have poor birth outcomes and low service user satisfaction. When language support services are used it enhances the relationship between the midwife and the woman, improves outcomes and ensures safer practice. However, this study has shown a reluctance to use professional interpreter services by m...

Background Black and minority ethnic women and those with social risk factors such as deprivation, refugee and asylum seeker status, homelessness, mental health issues and domestic violence are at a disproportionate risk of poor birth outcomes. Language barriers further exacerbate this risk, with women struggling to access, engage with maternity se...

Problem Disrupted access to social and healthcare professional support during the COVID-19 pandemic have had an adverse effect on maternal mental health. Background Motherhood is a key life transition which increases vulnerability to experience negative affect. Aim Explore UK women’s postnatal experiences of social and healthcare professional sup...

Background: COVID-19 has placed additional stressors on mothers during an already vulnerable lifecourse transition. Initial social distancing restrictions (Timepoint 1; T1) and initial changes to those social distancing restrictions (Timepoint 2; T2) have disrupted postpartum access to practical and emotional support. This qualitative study explore...

Objectives: To explore the pregnancy and childbearing experiences of women-survivors of childhood sexual abuse [CSA]. We aimed to generate a theory explaining those experiences for this population (women), this phenomenon (pregnancy and childbirth), and this context (those who have survived CSA). Method: Participants (N=6) were recruited to semi-s...

Infant feeding continues to be a controversial topic of research, debate, and maternity practice. Despite guidance in high resource settings changing to include ‘responsive feeding’ narratives in place of rigid ‘breast is best’ discourse, little has changed in terms of infant feeding practices in the United Kingdom, with only 1% of infants being ex...

Background: ‘Breast is best’ has been especially successful in its promotion of exclusive breastfeeding [EBF] practices to maximize health benefits for mother and infant in LMICs. However, in higher resource settings, EBF remains low (approximately 1% up to 6months of age), and women often report feelings of pressure and shame when they choose not...

Background: Contemporary parenthood is regarded as more equitable, with greater paternal involvement in routine childcare practices such as bathing, clothing, and feeding their infant. In high income settings, the breastfeeding intention-behaviour gap remains wide, highlighting the need to explore barriers to breastfeeding continuation. Many studie...

Background: Second-line feeding strategies including hand expression and syringe feeding are used as an aid to breastfeeding, however little is known about their efficacy. Aims and Objectives: This research explores the experiences of women who have used either antenatal hand expression or postnatal hand expression and syringe feeding, to identify...

Background: Bio-psycho-social barriers and facilitators of breastfeeding behaviour are well-researched among cohorts of healthy, term infants and infants born sick and/or premature. Larger birthweight [LGA] infants are a cohort for which the benefits of breastfeeding may be particularly valuable. Aims and Objectives: This study aims to explore inf...

Background: Childhood sexual abuse [CSA] is a devastating phenomenon which has wide ranging negative impacts on physical, social, and psycho-sexual health. Women-survivors of CSA can often struggle with pregnancy and childbirth, and the physical examinations which accompany maternity care. Aims and Objectives: To qualitatively explore women’s expe...

Objective Grounded Theory has previously been used to explore breastfeeding practices amongst average birthweight infants and these working hypotheses can be ‘tested’ in new contexts. A pre-existing Grounded Theory was applied to the context of women who gave birth to larger birthweight infants (≥4,000 g) to understand whether perceptions and pract...

The SRIP 40th Anniversary Masters Prize Talk: 2020 Background: The antenatal period can be a time of great joy for new mothers, but also a time of high anxiety due to the complications which may arise during pregnancy or the worry of pregnancy loss. Often in studies of pregnancy-related mental health, anxiety is overlooked and/or conflated with d...

Background: Early pregnancy can be a physically and emotionally challenging time for women, particularly if it results in pregnancy loss. Throughout the United Kingdom, women are able to access Early Pregnancy Assessment Units [EPAUs], if they experience pain or bleeding during the first 14-weeks of pregnancy. However, as the configuration of EPAUs...

Background Anxiety is one of the most prevalent mental health disorders among mothers during the postpartum period, which can lead to maternal and infant physical and psychological consequences. The Postpartum Specific Anxiety Scale (PSAS) predicts unique variance in postnatal outcomes over and above general anxiety tools. It has never been used in...

Background: Midwifery continuity of care models are the only health system intervention associated with both a reduction in preterm birth (PTB) and an improvement in perinatal survival; however, questions remain about the mechanisms by which such positive outcomes are achieved. We aimed to uncover theories of change by which we can postulate how an...

What influences women from Black, Asian, and minority ethnic groups to participate in maternity research? 1. What is known about the barriers to, and facilitators of, participating in pregnancy research if from an ethnic minority background? 2. What are women’s own perspectives on research participation in pregnancy? 3. What interventions impact re...

Shame has been often been argued as a culturally bound emotion, which can affect a country’s citizens to varying degrees. Arab societies are often regarded as being heteronormative, masculinist, and patriarchal. These cultures are themselves in turn often synonymous with shame narratives associated with the suppression of women and sexuality. Arab...

Women and girls have long been confronted with unrealistic, unattainable body image norms. Additionally, the ‘ideal feminine’ body has been subject to constant change over the last centuries and decades. With the proliferation of the Internet, women and girls are continuously exposed to advice from heteronormative discourses of womanhood. Demand fo...

Background Women with chronic disease are at increased risk of adverse pregnancy outcomes. Pregnancies which pose higher risk, often require increased medical supervision and intervention. How women perceive their pregnancy risk and its impact on health behaviour is poorly understood. The aim of this systematic review of qualitative literature is t...

Background: Throughout history, women’s bodies have been subject to more medical scrutiny and judgement than their male counterparts. As the male gaze and the medical gaze intersected, there was a resultant rise in the medicalisation of several aspects of women’s lives, including childbirth. The medicalisation of childbirth is a biological and soci...

Abstract The breastfeeding intention–behaviour gap remains wide in developed countries. Current studies have focused on maternal attitudes and behaviours concerning infant feeding in order to explore barriers to breastfeeding continuation. There has been limited consideration of the impact of paternal attitudes and behaviours, despite contemporary...

Background: Parents who experience a pregnancy loss such as a late-term miscarriage (between 14+0-23+6 weeks’ gestation) or perinatal death such as a stillbirth (a baby who is born dead on or after 24+0 weeks’ gestation) or neonatal death (a baby who is born alive, but who dies before 28 completed days after birth) require particular maternity care...

The COVID-19 pandemic has posed an unprecedented risk to the global population. Pregnant women were initially identified as having particular clinical vulnerability. The UK legislated for ‘lockdown’ across all four nations in late-March 2020; and the Royal College of Obstetricians and Gynaecologists [RCOG] quickly published guidance for pregnant an...

Background: The perinatal period is a notable life transition for women, which increases risk of experiencing emotional distress. The Coronavirus [SARS-CoV-2] or ‘COVID-19’ disease has placed additional stressors on mothers that have exacerbated these vulnerabilities. Social distancing restrictions, which were imposed due to concerns about COVID-19...

Background: When the COVID-19 pandemic was announced, many women and their partners were left uncertain about what was and was not safe for them to do whilst pregnant or just after birth. Meanwhile, maternity care in the UK was left in a state of flux. This study aimed to understand women’s experiences of pregnancy and childbirth during the early s...

Background: Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity globally. Planned delivery between 34+0 and 36+6 weeks may reduce adverse pregnancy outcomes but is yet to be evaluated in a low and middle-income setting. Prior to designing a randomised controlled trial to evaluate this in India and Zambia, we carried...

Invited Talk given at the Parent-Infant Foundation, London, UK.

Briefing Paper prepared for The Parent-Infant Foundation, London, United Kingdom.

Motherhood narratives pervade all cultures and are almost universally di-vided into the ‘good and perfect’ or the ‘bad and ugly’ mother discourses. A mother’s love is commonly thought of as an emotional investment between those who mother, and those who are mothered, and social expectations rein-force motherhood as being underpinned by an innate ps...

Data from Wave 1 of The PRegnancy And Motherhood during COVID 19 Study [The PRaM Study]. Research taken from JRIP Editorial: “ Challenges and opportunities for child health services in responses to the COVID19 pandemic”

The time-critical ‘can’t intubate, can’t oxygenate’ [CICO] emergency post-induction of anaesthesia is rare, but one which, should it occur, requires Anaesthetists to perform rapid emergency front of neck access [FONA] to the trachea, restoring oxygenation, and preventing death or brain hypoxia. The UK Difficult Airway Society [DAS] has directed all...

Background Midwifery continuity of care models for women at low and mixed risk of complications have been shown to improve women's experiences of care. However, there is limited research on care experiences among women at increased risk of preterm birth. We aimed to explore the experiences of care among women with risk factors for preterm birth par...

Published in QMiP Bulletin Upon hearing of the death of Professor Kathy Charmaz (27 July 2020), I reflected on her life’s work, bringing together Grounded Theory and constructivism, and holding a titan status among qualitative researchers revered around the world. For me, I was transported to a little over five years ago, where I was attending a s...

Background: Research examining the relationship between postpartum anxiety and maternal bonding is limited by the use of general measures of anxiety which may predict perinatal outcomes less effectively than childbearing specific tools. Objectives: This study aimed to investigate the predictive validity of the Postpartum Specific Anxiety Scale [PSA...

Background When the vulnerabilities of the postnatal period are combined with the impact of the COVID-19 pandemic, psychosocial outcomes are likely to be affected. Specifically, we aim to: a) explore the psychosocial experiences of women in the early postnatal period; b) describe prevalence rates of clinically-relevant maternal anxiety and depressi...

Through a textual analysis of four episodes comprising the 2019 ITV 1 psychological thriller Cheat, this article explores a fictional representation of the United Kingdom (UK) Higher Education (HE) setting in a television drama. We discuss our analysis in the context of growing marketisation of UK HE, where academics are increasingly viewing studen...