Biomedical subjects

Jennifer Fenwick

Publications and source records attributed to Jennifer Fenwick.

6 recordsLinked to original sources

PubMed2006

The influence of childbirth expectations on Western Australian women's perceptions of their birth experience.

OBJECTIVES: to explore and describe the influence of childbirth expectations on women's perception of their birthing experience and expectations for subsequent births. This was the second phase of a study, the purpose of which its purpose was to determine the childbirth expectations of a cohort of Western Australian women and ascertain factors that influenced these expectations. DESIGN: a qualitative study which used an exploratory descriptive design. Data were collected from in-depth individual interviews. SETTING: Perth, Western Australia. PARTICIPANTS: 20 women, 11 primiparae and nine multiparae, who between them had experienced 31 births. These women had participated in phase one when they were either pregnant or had birthed within the preceding 12 months. Phase two interviews occurred 5-6 months after phase one. FINDINGS: the themes and sub-themes revealed in phase one of the study were supported in phase two. Although women held multiple expectations for birth, specific expectations were regarded as priority. Consequently, to perceive birth as positive, a woman had to achieve her priority expectations. Multiparae reported more positive birth experiences, having altered expectations as a result of previous experiences. Unaffirming birth experiences due to unmet expectations were more common after a first birth. Women with unfulfilled expectations subsequently adapted their expectations to be more achievable thus avoiding disappointment. Supportive behaviours of maternity health-care providers assisted women to evaluate their birth experience as positive even when expectations could not be achieved. IMPLICATIONS FOR PRACTICE: the evaluation of birth experiences as positive or negative is contingent upon achieving most, or at least the priority, childbirth expectation. Knowing a woman's expectations assists the midwife in her advocacy role. This role in assisting women to achieve their expectations is reinforced by this research. Caregivers become even more important when expectations are not able to be realised. Behaviours that encourage involvement and participation in decision-making during birth promote feelings of control, coping and feeling supported, which ultimately are needed for women to assess their birth experience as positive. Achievable expectations, such as 'being flexible' and 'only having a healthy baby' could be regarded as a lessening of ideals. The issue of whether these changing expectations are contributing to the increasing technocratic approach to birth and the resulting devaluing of the normal birth experience requires further debate.

Adult↗

PubMed2006

Reframing birth: a consequence of cesarean section.

AIM: This paper is a report of a study to describe the childbirth expectations, influences and knowledge of a group of Western Australian women who experienced a cesarean section (CS) and would prefer a CS in a subsequent pregnancy. BACKGROUND: Evidence suggests that a previous CS is not an indication for an elective CS in a subsequent pregnancy, but western world data indicate high probability of repeat CS. METHODS: Community advertisements invited women who had experienced a CS to participate in a telephone interview. The thematic analysis presented in this paper is derived from data collected during 2003/2004 from 49 participants who had initially expected to birth vaginal but had a CS and who had planned a CS in a subsequent pregnancy or stated that they would choose this option in a future pregnancy. FINDINGS: Before the first CS most women expected and wanted to give birth normally. After having a CS, however, many reframed vaginal birth as uncertain, unsafe and unachievable. For this group of women, the medical discourse that promoted CS as the safest option was a major influence on their decisions. As a result, they reconstructed CS as an acceptable alternative that was safer for them and their babies, allowed them to be better prepared, and was convenient. CONCLUSION: In the present climate, enabling women to keep birth 'fear' in perspective may be an important strategy if we are to improve the uptake of vaginal birth after CS and the quality of care offered to women during the normal, but major, life event of childbirth.

Attitude of Health Personnel↗

PubMed2006

Priorities for midwifery research in Perth, Western Australia: a Delphi study.

This paper reports a two-round Delphi study undertaken to identify the research priorities of midwives at five public maternity hospitals in Western Australia's metropolitan area of Perth. In round one, 117 midwives identified 64 different problems or issues for research. Using thematic content analysis, these problems were grouped together and then collapsed to develop 17 specific research topics within four major categories. In round two, 152 midwives were asked to rank how important each of the topic statements were to women, their families and midwives. Research focusing on 'the postnatal experience' was ranked by midwives as the most important to the care of women and their families. From a midwife's perspective, the highest ranked topic was 'examining the professional issues that impact on midwives' clinical practice' (e.g. midwifery and medical collaboration, potential litigation and horizontal violence in the workplace). The results of the study show that Western Australian midwives, like their national and international colleagues, are concerned about the delivery and organization of maternity services, the invisibility of the postnatal experience and how to operationalize evidence-based care in the clinical area.

Adult↗

PubMed2005

The childbirth expectations of a self-selected cohort of Western Australian women.

OBJECTIVES: to explore and describe the labour and birth expectations of a cohort of Western Australian women, and to identify the factors that influence these expectations. DESIGN: a qualitative study using an explorative descriptive design and techniques associated with constant comparison. Data were collected from tape-recorded telephone interviews. SETTING: : Perth, Western Australia. PARTICIPANTS: two hundred and two women who were pregnant or who had birthed within the last 12 months. FINDINGS: five major themes were identified. Three of the five themes reflected a positive outlook on birth. These were labelled, 'owning and believing in birth as a natural event', 'satisfaction with the birth process and outcome' and 'involvement and participation in the birthing experience'. The remaining two themes 'birth is a negative event' and 'birth is a medical event' encapsulated the women's statements that described childbirth as a potential negative and unaffirming experience. Particularly influential on the formation of childbirth expectations were the public and private discourses of childbirth, especially those related to books and magazines, and the stories of mothers and sisters. Professional discourses, women's own history, and factors such as age and life-style choices also influenced decisions and contributed to how women perceived their experiences. IMPLICATIONS FOR PRACTICE: the findings of the study challenge the anecdotal evidence that many contemporary western women willingly and knowingly choose or expect birth to be a medicalised event. Although midwives and other maternity healthcare providers need to help women develop realistic expectations, there is also a need to examine the influence of healthcare professionals in perpetuating a technical approach to birth. The findings do, however, confirm that some women are anxious, scared and frightened of the childbirth experience. It is essential that research continues to focus on developing strategies to assist women confront and deal with these fears.

Attitude to Health↗

PubMed2005

Speculum 'self-insertion': a pilot study.

AIM: This paper reports phase II of a pilot study that aimed to determine whether self-insertion of a speculum by women undergoing a pap smear would be more comfortable and lead to an improvement in satisfaction and a decrease in anxiety associated with this procedure. BACKGROUND: Research demonstrates that pelvic examinations are considered by most women to be unpleasant and are routinely associated with embarrassment, apprehension, fear and often some level of discomfort and/or pain. DESIGN: The study used quantitative and qualitative data collection techniques. Phase I (described elsewhere) tested the newly developed Speculum Self-Insertion Satisfaction Questionnaire for content validity, internal consistency and clarity. Phase II pilot study tested the technique of speculum self-insertion. Women's general level of anxiety was measured using the State Trait Anxiety Inventory, both before and after they performed the self-insertion procedure. Women's satisfaction and acceptance of the procedure was measured using the Speculum Self-Insertion Satisfaction Questionnaire and explored through the use of qualitative research techniques. PARTICIPANTS: A total of 198 women attending family planning clinics in Perth, Western Australia, between September and December 2003 were invited to participate in the study. One hundred and thirty-three women agreed to self-insert their own speculum. RESULTS: The study demonstrated that speculum self-insertion was acceptable to most women, especially younger women. Nearly 91% of women either agreed or strongly agreed that they were satisfied with the experience of self-insertion and would choose to self-insert the speculum again. This included the women who had not previously had a speculum examination. The quality of specimen collected was not detrimentally affected by speculum self-insertion. CONCLUSIONS: The results of this pilot research, while needing to be replicated in a larger study, demonstrate that offering women the opportunity to self-insert a speculum during a routine pelvic examination is an acceptable, innovative, simple and cost-neutral change in clinical practice that increases women's comfort and satisfaction and potentially makes sexual health screening less threatening to women of all ages. RELEVANCE TO CLINICAL PRACTICE: Speculum self-insertion may encourage women's attendance at clinics for regular screening. Early diagnosis and treatment will result in better health outcomes for women, families and the community at large.

Adolescent↗

PubMed2003

Women's experiences of Caesarean section and vaginal birth after Caesarian: a Birthrites initiative.

This paper reports the findings of a small pilot study undertaken to identify women's perceptions of their Caesarean section and/or their experience of attempting to achieve a vaginal birth after Caesarean. Fifty-nine women replied to a survey designed and distributed by the consumer organisation Birthrites. The survey consisted of 22 closed and open-ended questions. Descriptive statistics and content analysis were used to analyse the data. Six major factors that impacted on women's perceptions of their birthing experience were identified: (i) 'being supported'; (ii) 'violated expectations'; (iii) 'loss of control'; (iv) 'health professionals' language, attitudes and care practices'; (v) 'the labour experience and the cascade of intervention'; and (vi) 'surgical birth and the separation from the baby'. The results support previous work in this area and demonstrate that some women suffer from psychological trauma following an emergency Caesarean section. The experiences of the women in this small study indicate a need for health professionals to not only better understand the distress that may occur but to also develop a greater understanding of the impact of their interactions with women. The study also provides a consumer 'voice' on current routine hospital policies surrounding vaginal birth after Caesarean and confirms the importance of choice, control and continuity of care for all women regardless of their 'risk' status.

Attitude to Health↗