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Mary J Renfrew

Publications and source records attributed to Mary J Renfrew.

14 recordsLinked to original sources
PubMed2006

The conduct of ethical research collaboration across international and culturally diverse communities.

OBJECTIVE: to present recently developed guidelines by the International Confederation of Midwives (ICM) to guide the ethical conduct of research by midwives across international and culturally diverse communities. To illustrate the complexities of conducting collaborative research across diverse communities, a case study is provided highlighting unequal power balances, legal, ethical and cultural constraints. BACKGROUND: the research guidelines are structured using a human rights framework. The document was developed with input and consideration by the ICM Research Standing Committee and comments of 35 delegates who participated in a workshop to evaluate the guidelines from the perspectives of frontline midwifery clinicians, leaders and researchers. It is intended to serve as a blueprint for midwives aiming to enter into a collaborative research partnership with ethnic and culturally diverse groups. CONCLUSIONS: although the document was developed with the international midwifery community in mind, it will guide any researcher seeking to conduct research in the best interest of women, their newborn babies, their families, and their wider communities.

Cooperative Behavior↗
PubMed2006

Turning policy into practice: more difficult than it seems. The case of breastfeeding education.

Breastfeeding is increasingly recognized as a health policy priority. To achieve real change in breastfeeding rates, those who advise and support childbearing women need to be appropriately educated and trained so that they do not disrupt breastfeeding. The aim of this study was to conduct a needs analysis about breastfeeding training among a range of people who advise and support breastfeeding women, including breastfeeding women themselves, to contribute to future provision of education. A qualitative, interview-based study was conducted in one northern UK city with practitioners who support breastfeeding, and breastfeeding women, selected using purposive sampling. Individual (n = 73) and group (n = 9) interviews were conducted. Detailed notes were returned to each respondent for checking. Information was organized into themes. Coding was charted to enable comparison by theme and case. Four main themes emerged: perspectives of breastfeeding women; feeling (un)prepared to support breastfeeding; fragmentation of knowledge; and provision of education about breastfeeding. A deficit in education and training for all professional groups was identified. There was little evidence of informal shared learning among professional groups, and no evidence of usual mechanisms to ensure education and practice standards. Doctors received very little formal education; most relied on other health professionals to provide this expertise. Students encountered a chaotic learning environment where it was not possible to observe sound, consistent practice. Voluntary breastfeeding supporters felt well-prepared. The results call into question the potential for health services to respond to policy recommendations that support increased rates of breastfeeding.

Breast Feeding↗
PubMed2006

Developing practice in breastfeeding.

This paper reports on an approach to practice development in breastfeeding as part of a national programme of work to address inequalities in maternal and child nutrition. The production and dissemination of evidence and guidelines is necessary but not sufficient on its own to effect change in practice, particularly when dealing with complex public health issues. In the case of breastfeeding, review evidence and national guidance have shown that multifaceted changes are essential if policy aspirations are to be realized. The objectives of the programme described here were to (1) inform and enable practice development in breastfeeding in low-income areas; (2) evaluate the impact of approaches used; and (3) develop robust approaches and appropriate material for use nationally. A conceptual framework was established, and a six-stage process is outlined. The recruitment of four sentinel sites across whole health economies, involving professionals and the voluntary sector, was an essential component of the programme. The strength of the model is that it provides a structured, cross-sectoral approach to practice development in public health. A key challenge is to identify whose responsibility it is to resource practice development when a number of disciplines and sectors are involved. This question needs to be addressed if public health guidance is to be of sustained benefit.

Breast Feeding↗
PubMed2006

Addressing the learning deficit in breastfeeding: strategies for change.

This paper summarizes the findings of the learning needs assessment described in this issue. Limitations and strengths are discussed. The paper describes a national, multi-sectoral, multidisciplinary picture. Our respondents may over-represent those with an interest in breastfeeding; if so, the true picture may be even more problematic than described here. Major deficits were identified in the knowledge and skills of practitioners from all backgrounds and all sectors. Many professionals report poor knowledge about breastfeeding and have low levels of confidence and clinical competence. Organizational constraints and barriers to effective education and practice include fragmentation of care and education, lack of facilities, and a low priority being given to breastfeeding. There is a range of current educational provision, although not all is fit for purpose. Voluntary organizations seem to have higher standards than do some current professional learning opportunities. Preferred methods of training include practical observation and mentorship, volunteer counsellor involvement in training programmes, as well as self-study and online opportunities. Recommendations include: a funded, mandatory, interagency and multidisciplinary approach; appropriate content; support at local and national levels; breastfeeding education to be included in clinical governance and audit mechanisms; and further research and evaluation to examine optimum ways of providing education and training. Organizational barriers could be addressed through a public health policy and evidence-based approach.

Breast Feeding↗
PubMed2006

'Informal' learning to support breastfeeding: local problems and opportunities.

This study explored 'informal' learning opportunities in three health economies, both for National Health Service (NHS) staff and lay people wishing to promote and support breastfeeding and for new mothers wishing to breastfeed. The word 'informal' indicates local learning opportunities that are not part of recognized academic or professional training courses. Semi-structured telephone interviews were conducted with 31 key informants, including health visitors, midwives, infant feeding advisers, Sure Start personnel, voluntary organization representatives, Strategic Health Authority representatives, senior nurses and trainers. The results were analysed thematically. In each site, there were regular training events for NHS staff to acquire or update knowledge and skills. Training was provided by a small number of enthusiasts. Midwives and health visitors were the groups who attend most frequently, although many find it difficult to make time. Although many training events were multidisciplinary, few doctors appeared to attend. Individual staff also used additional learning opportunities, e.g. other courses, conferences, web-based learning, and training by voluntary organizations. Services offered to lay people by the NHS, Sure Start and voluntary organizations included parentcraft, antenatal and post-natal classes, breastfeeding support groups, 'baby cafés' and telephone counselling. Interviewees' organizations did not have a specific breastfeeding strategy, although action groups were trying to take the agenda forward. Local opportunities were over-dependent on individual champions working in relative isolation, and support is needed from local health economies for the facilitation of coordination and networking.

Breast Feeding↗
PubMed2006

Assessing learning needs for breastfeeding: setting the scene.

Breastfeeding has a major contribution to make to public health, yet the UK, like many other developed countries, has low rates of breastfeeding. A contributing factor is that practitioners are ill-prepared to support breastfeeding women. There is a mismatch between the care professionals provide and the support women desire. A national breastfeeding learning needs assessment (LNA) was carried out in England to provide a comprehensive picture of professional and practitioner learning needs and existing training opportunities and resources. The LNA comprised five elements, and sought the views of service users through consumer organizations and voluntary breastfeeding supporters. Two elements of the LNA are reported here. A search of RDLearning, a web-based national resource, provided details of existing accredited courses in the UK for practitioners. Ten short courses provided by higher education institutions were identified, along with a range of courses offered by voluntary and other organizations, such as the National Childbirth Trust and UNICEF Baby Friendly Initiative. Second, an e-mail survey of 28 key stakeholder organizations was undertaken, with a response rate of 68% (n = 18). All but one acknowledged that their members could benefit from further breastfeeding knowledge and expertise and were supportive of a national breastfeeding education initiative. The most popular forms of education provision were workshops and seminars, online and written information. The topic considered most important for all practitioners was the health outcomes of breastfeeding. Other contributions which stakeholder organizations felt they could make were the provision of information resources and setting up specialist interest groups.

Breast Feeding↗
PubMed2004

A prospective randomised trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia.

OBJECTIVE: To determine whether the rate of instrumental birth in nulliparous women using epidural analgesia is affected by maternal position in the passive second stage of labour. DESIGN: A pragmatic prospective randomised trial. SETTING: Consultant maternity unit in the Midlands. PARTICIPANTS: One hundred and seven nulliparous women using epidural analgesia and reaching the second stage of labour with no contraindications to spontaneous birth. INTERVENTIONS: The lateral versus the supported sitting position during the passive second stage of labour. MEASUREMENTS: Mode of birth, incidence of episiotomy, and perineal suturing. FINDINGS: Recruitment was lower than anticipated (107 vs. 220 planned). Lateral position was associated with lower rates of instrumental birth rate (lateral group 33%; sitting group 52%; p=0.05, RR 0.64, CI for RR: 0.40-1.01; Number-needed-to-treat (NNT)=5), of episiotomy (45% vs. 64%; p=0.05, RR 0.66, CI for RR: 0.44-1.00, NNT=5), and of perineal suturing (78% vs. 86%; p=0.243, RR 0.75, CI for RR 0.47-1.17). The odds ratio for instrumental birth in the sitting group was 2.2 (CI 1.00-4.6). Logistic regression of potential confounder variables was undertaken, due to a large variation in maternal weight between the randomised groups. Of the nine possible confounders tested, only position of the baby's head at full dilation affected the risk of instrumental birth significantly (p=0.4, OR 2.7 where the fetal head was in the lateral or posterior position). Maternal weight did not appear to have any effect. The odds ratio for instrumental delivery for women randomised to the sitting position was slightly higher within the logistic regression model (adjusted OR 2.3). KEY CONCLUSIONS: Women randomised to the lateral position had a better chance of a spontaneous vaginal birth than those randomised to the supported sitting position. Position of the babies head at full dilation had an additional effect on mode of birth. These effects are not conclusively generalizable. RECOMMENDATIONS FOR PRACTICE: The lateral position is likely to be at best beneficial, and at the worst no less harmful than the sitting position for most women and their babies who meet the criteria set for this study. Conclusive evidence for or against the technique should be established using larger trials.

Adult↗
PubMed2003

Conducting international research in midwifery: a workshop held at the ICM Congress, Vienna, April 2002.

A workshop on international research in midwifery was held at the triennial International Confederation of Midwives (ICM) Congress in Vienna, April 2002. Thirty-five participants from 12 countries took part. The participants themselves defined the agenda, and subsequent discussion addressed the following issues: international research relationships and collaboration; ethical conduct in international research in midwifery; the role of the ICM in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were: that guidelines and a code of ethics for the conduct of international research in midwifery be developed; that the ICM and national midwifery organisations continue to actively support research, and further develop that support; that the ICM support education and capacity building for research at basic and continuing education levels; and that the priorities identified for collaborative international studies be updated on a regular basis.

Education↗
PubMed2003

Support for breastfeeding mothers: a systematic review.

Although the benefits of breastfeeding are widely accepted, the effectiveness of different strategies to promote the continuation of breastfeeding once initiated are less clear. The objective of this systematic review was to describe studies comparing standard care with the provision of extra breastfeeding support and to measure its effectiveness. Outcome measures used were rates of cessation of any breastfeeding or exclusive breastfeeding at chosen points in time. Measures of child morbidity and maternal satisfaction were also used when these were reported. Twenty eligible randomised or quasi-randomised controlled trials were identified, involving 23 712 mother-infant pairs. Extra support had a beneficial effect on the duration of any breastfeeding (RR [95% confidence intervals] for stopping any breastfeeding before the last study assessment up to 6 months 0.88 [0.81, 0.95]; 15 trials, 21 910 women). The effect was greater for exclusive breastfeeding (RR for stopping exclusive breastfeeding before the last study assessment 0.78 [0.69, 0.89]; 11 trials, 20 788 women). Although the point estimates of relative risk were very similar, benefit derived from professional support achieved statistical significance for any breastfeeding (RR 0.89 [0.81, 0.97]; 10 trials, 19 696 women) but not for exclusive breastfeeding (RR 0.90 [0.81, 1.01]; six trials, 18 258 women). Lay support was effective in reducing the cessation of exclusive breastfeeding (RR 0.66 [0.49, 0.89]; five trials, 2530 women) while the strength of its effect on any breastfeeding was less clear (RR 0.84 [0.69, 1.02]; five trials, 2224 women). Professional support in the largest trial to assess health outcomes produced a significant reduction in the risk of gastrointestinal infections and atopic eczema. In two trials with children suffering from diarrhoeal illness, extra support was highly effective in increasing short-term exclusive breastfeeding rates and reducing recurrence of diarrhoea. This review supports the conclusion that supplementary breastfeeding support should be provided as part of routine health service provision. There is clear evidence for the effectiveness of professional support on the duration of any breastfeeding although the strength of its effect on the rate of exclusive breastfeeding is uncertain. Lay support is effective in promoting exclusive breastfeeding although the strength of its effect on the duration of any breastfeeding is uncertain. Evidence supports the promotion of exclusive breastfeeding as central to the management of diarrhoeal illness in partially breast-fed infants.

Breast Feeding↗
PubMedDate not supplied

A systematic approach for midwifery students: how to consider evidence-based research findings.

The midwifery profession is increasingly applying the results of evidence-based research findings. Several researchers were asked if they would answer questions regarding the essential research skills necessary for midwives, the relevance of applying valid evidence to practice, and concerns regarding evidence-based practice overall. The objectives were to share expert researchers' responses that could be used by educators to help introductory midwifery students understand the importance of developing skills in assessing "the best evidence" and to stimulate interactive discussion in the classroom. Consideration of the expert opinions stimulated student thinking on the relation of evidence-based findings to practice in an exciting approach characterized by inquiry and debate, which got favorable responses and evaluations from the students.

Clinical Competence↗
PubMedDate not supplied

Conducting international research in midwifery: a workshop held at the ICM Congress, Vienna, April 2002.

A workshop on international research in midwifery was held at the International Confederation of Midwives (ICM) Triennial Congress in Vienna, April 2002. Thirty-five participants from 12 countries took part. The participants themselves defined the agenda, and subsequent discussion addressed the following issues: international research relationships and collaboration; ethical conduct in international research in midwifery; the role of the International Confederation of Midwives in international research; and identifying topics for an international midwifery research agenda. Recommendations arising from this workshop were as follows: develop guidelines and a code of ethics for the conduct of international research in midwifery; continue to actively support research and further develop that support; support education and capacity building for research at basic and continuing education levels; and update on a regular basis the priorities identified for collaborative international studies.

Austria↗