• The abused perineum

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (Mark Allen Publishers, 1998-07-02)
      This article discusses whether too many second degree tears are being left to heal themselves, when in fact they should be sutured. There is a need for more research based evidence by randomised controlled trial to help with decisions as to the best treatment
    • Alleviating perineal trauma - the APT study

      Steen, Mary; Marchant, Paul; Leeds Teaching Hospitals NHS Trust/Leeds Metropolitan University (Royal College of Midwives, 2001-08)
      The objectives of this study were to evaluate the effectiveness of a new cooling device (gel pad) and compare it with a standard regimen (ice pack) and a no localised treatment regimen (control). The study was a randomised controlled trial, initially based in a hospital midwifery unit in the North of England and then continued in the community. Participants were 450 women who had undergone either a normal or an instrumental delivery that required suturing of an episiotomy or second degree tear. The measurements and findings were as follows: 316 (71%) of completed questionnaires were returned. A significant reduction in the levels of oedema was observed in favour of using cooling treatments at day two and day five, p=0.016. p=0.018, and there was a significant reduction in bruising at day ten, p=0.01 (using the Kruskal-Wallis test). Self-reported pain was less in the cooling gel pad group. A significant reduction in pain was demonstrated at day five, day ten and day 14, p=0.023, p=0.007, p=0.058, (Kruskal-Wallis test). A reduction in pain was reported earlier on day two, day three and day five when making a binary comparison of moderate or severe pain, with none or mild, p=0.0038, p=0.037, p=0.017 (chi-squared test). Maternal satisfaction With the cooling gel pad was high and differed statistically significantly compared to the other regimens, p=0.0005, (Kruskal-Wallis test). There were no clinical significant differences monitored between groups when assessing healing. The key conclusions were that this clinical trial confirms earlier findings in a previous study and provides evidence that the use of a specifically designed cooling gel pad is a safe and effective localised method to alleviate perineal trauma, without any adverse effects on healing.
    • Alleviating perineal trauma: The APT study

      Steen, Mary (2000)
      This poster presentation aims to evaluate the effectiveness of a new cooling device (gel pad) with a standard regimen (ice pack) and compare these with no localised treatment regimen (control). 450 women partipcated in this study at St James's University Hospital and their own homes. The trial confirmed earlier findings to support the use of a specially designed cooling gel pad (Feme pad)to alleviate perineal trauma.
    • Alleviating postnatal perineal trauma: To cool or not to cool?

      Steen, Mary; Briggs, Michelle; King, David; UCLan/University of Leeds/Royal College of Midwives (Mark Allen Publishing, 2006-05-01)
      This article discusses the evidence reported from quasi randomised trials and randomised controlled trials on the efficacy and acceptability of localised cooling methods in alleviating perineal trauma. Two types of cooling methods were identified: iced sitz baths and cooling devices. The review suggests that cooling may lower the levels of reported perineal pain after childbirth and reduce the inflammatory response associated with perineal trauma. However, women's preferences as well as the efficacy of the cooling method should be taken into consideration. Women's natural reluctance to sit in iced sitz baths suggests that this cooling method is unpleasant and may explain why there has been a decline in this method being used in clinical practice over the last two decades. The use of localised cooling devices appear to be a more acceptable method for women.
    • Anxiety, bonding and attachment during pregnancy, the transition to parenthood and psychotherapy

      Steen, Mary; Jones, Alun; Woodworth, Barabara; University of Chester ; University of Chester ; Chester and Wirral Partnership NHS Trust (Mark Allen Publishing, 2013-12-01)
      Although becoming and being a parent are considered happy life events, parents can suffer from varying degrees of anxiety and variable mood. Anxiety and mood changes can be missed and this can lead to mental health problems if not recognised at an early stage. An insecure attachment in a parent's early infanthood can contribute to increased levels of anxiety and emotional problems when becoming and being a parent themselves, which can influence mother and child bonding as well as wider difficulties within family relationships. In many instances, attachment styles can be passed on to the infant causing a range of emotional and intellectual difficulties. In certain circumstances, these parents may benefit from psychotherapy. Psychotherapy is a method of addressing troubling emotions along with life difficulties and relationship struggles. Using psychological methods, a psychotherapist can help a person change his or her life for the better by becoming more effective in work or personal relationships. Local community support and befriending approaches have been shown to be beneficial in alleviating anxiety and depression. This article briefly describes what psychotherapy is and demonstrates ways in which interpersonal attachment styles established early on in life can bring difficulties to adult relationships. Two disguised scenarios referring to actual psychotherapy consultations are included to illustrate how plans can be put in place to address interpersonal difficulties related to attachment styles.
    • APT study

      Steen, Mary (Florri-Feme, 2009-02-16)
      To evaluate the effectiveness of a a new cooling device (gel pad) with a standard regimen (ice pack) and compare these with a no localised treatment regimen (control). Design: A randomised controlled trial initially based in hospital and then continued in the community. Setting: A Midwifery Unit in the North of England and then in women's own homes. Participants: 450 women who had undergone either a normal or an instrumental delivery that required suturing of an episiotomy or second degree tear. Key Conclusions: This clinical trial confirms earlier findings in a previous study and provides evidence that the use of a specifically designed cooling gel pad is a safe and effective localised method to alleviate perineal trauma without any adverse effects on healing.
    • Being responsive to the needs of women who are being abused

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (English National Board for Nursing Midwifery and Health Visiting, 2001-07)
      One midwife's account of her work in setting up a training programme with the aim of raising midwives' awareness of the multi-complex issues relating to domestic violence, increasing their knowledge of possible indicators, and increase their confidence to ask questions, as well as documenting any causes for concern and providing useful information about local support agencies
    • Breech birth: Reviewing the evidence for external cephalic version and moxibustion

      Steen, Mary; Kingdon, Carol; University of Chester ; University of Central Lancashire (T G Scott, 2008-12-01)
      Background: Breech presentation, where a baby is buttocks or feet rather than head occurs in about 3 to 4% of singleton pregnancies at term. Worldwide, the majority of babies identified as breech are now delivered by planned caesarean section. Aim: This paper is the second of two that reviews evidence concerning breech presentation and birth mode. This review focuses specifically on women's preferences for birth mode, experiences of breech presentation and the use of external cephalic version (ECV) and moxibustion, which may be used in the third trimester of pregnancy to turn a breech baby to a cephalic presentation. Method: A structured literature review was undertaken using the Cochrane Library, CINAHL, EMBASE, MEDLINE, and AMED. Different permutations of 'breech' ('frank' or 'complete' or 'extended' or 'flexed') and 'alternative' or 'complementary therapies' or 'external cephalic version' or 'ECV' or 'moxibustion' and 'before term' and 'term' and 'singleton' in the title, key words or abstracts were used. Results: There is evidence that the majority of women would prefer a vaginal birth. There is substantial evidence that ECV can reduce the caesarean section rate by turning breech presentation to cephalic. Further research is needed to confirm or refute the clinical effectiveness and women's views of moxibustion therapy. Conclusions: As rates of caesarean section for breech presentation continue to rise, it is important that midwives and women have up-to-date evidence-based information about the alternative to proceeding straight to planned caesarean section when a breech presentation is identified.
    • The burden of shame and stigma

      Steen, Mary; Jones, Alun; University of Chester (Redactive Publishers: Royal College of Midwives, 2014-03-01)
      It is not only women who experience shame and stigma because of their circumstances, it can affect midwives too. Shame and stigma can have a significant impact on both parents and midwife. Expectant parents who are experiencing difficulties with childbirth may become self absorbed. Critical ruminations are likely to ensue and this can lead to these parents failing to care for themselves appropriately. Meanwhile, midwives’ professional practice may also become compromised because of shameful ruminations.
    • Care and consequences of perineal trauma

      Steen, Mary; University of Chester (MA Healthcare, 2010-11-01)
      This article discusses the care and consequences of perineal trauma which affects the majority of women. It is clearly evident from the literature that failure to recognise the extent of trauma, incorrect repair and inadequate pain relief can lead to negative consequences in both the short and long term. Women complain of varying degrees of perineal pain and discomfort and pain relief is an important aspect of midwifery care. It would appear that a combination of systemic and localised treatments is necessary to achieve adequate pain relief which will meet individual women’s needs.
    • Childbearing women and violence: A training programme for midwives

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (New Zealand College of Midwives, 2000-12)
      This article discusses a training programme for midwives to raise their awareness of domestic violence in pregnancy.
    • Childbearing women, violence and abuse in the workplace

      Steen, Mary; Allen, Rose; Leeds Teaching Hospitals NHS Trust/University of Leeds (Mark Allen Publishers, 1999-07-01)
      Pregnancy may trigger or exacerbate domestic violence, but current involvement of health professionals in dealing with this is poor. A training initiative undertaken in Leeds has developed a programme to help the midwife to recognise and support women who experience violence.
    • Cold therapy and perineal wounds: Too cool or not too cool?

      Steen, Mary; Cooper, Keith; Leeds Teaching Hospitals NHS Trust/Leeds Metropolitan University (Mark Allen Publishers, 1998-09-03)
      Perineal trauma following childbirth often has numerous negative consequences for many women and the associated pain can dominate the experience of early motherhood. Applications of cold compresses have been in use for centuries as a form of localized treatment and these have become a generally accepted method to treat acute injuries. However, concerns have been expressed as to whether cold therapy can delay wound healing. The purpose of this article is to review the recent evidence concerning the beneficial use of cold therapy, when applied locally to perineal wounds and non-perineal wounds and to consider if such treatment may have an adverse effect on the rate of wound healing. In addition, the mechanism of the action of cold therapy is discussed. We conclude that there is no clear evidence to support the suggestion that when controlled therapy is applied to the traumatized perineum or other injured parts of the body that this will result in a delay in wound healing. Such treatment should continue until clear evidence is produced to the contrary.
    • Conflict resolution for student midwives

      Steen, Mary; University of Chester. (Elsevier, 2011-03)
      Poor working relationships, aggressive behaviour and bullying within the midwifery profession are a common phenomenon, with student midwives reporting that they have either experienced or witnessed this within their clinical or educational environments. There is a need to address this unpleasant phenomenon and one way is to introduce conflict resolution strategies. This article describes and discusses how the Start Treating Others Positively (STOP) model has been adapted to develop an educational workshop to assist student midwives in enhancing and developing skills to manage conflict in their working and learning environments.
    • The consequences of pregnancy and birth for the pelvic floor

      Steen, Mary; Roberts, Taniya; University of Chester (Mark Allen, 2011-11-02)
      This article discusses the anatomy and physiology of the pelvic floor and the important role it plays during childbirth. It will also consider damage that can be caused to the pelvic floor and in the genital/rectal region. Urinary and faecal incontinence, perineal injury (naturally occurring or surgically induced) and haemorrhoids can cause a lot of distress and pain for many women following childbirth. Alleviating the distress and pain associated with these problems is vitally important and will be explored.
    • Data collection and management

      Steen, Mary; University of Chester (SAGE, 2013-12-14)
      Data collection and management is the information collected by researchers during a study and the steps for monitoring and managing the data.This chapter describes and discusses data collection methods and management of quantitative and qualitative data.
    • The day-by-day baby book

      Bendefy, Ilona; Dale, Bella; Cooper, Carol; Halsey, Claire; Wilcock, Fiona; Hall, Jenny; Barratt, Judy; Sullivan, Karen; Steen, Mary; Laurent, Su; et al. (Dorling Kindersley, 2012-08-01)
      This book provides a visual guide to looking after your baby in the first year. In-depth, daily advice on baby's growth, care and developments are covered. This resource has been writtten by an exceptional team including a paediatrician, child psychologist, nutritionist, midwife and experienced parents.
    • The day-by-day pregnancy book: Comprehensive advice from a team of experts and amazing images every single day

      Blott, Maggie; Cooper, Carol; Eben, Friedericke; Erskine, Katrina; Goetzl, Laura; Green, Belinda; Guerin, Deirdre; Hutcherson, Amanda; Kaye, Philippa; Laurent, Su; et al. (Dorling Kindersley, 2009-07-01)
      The day-by-day pregnancy book is an unprecedented, comprehensive guide to pregnancy, labour and birth. Under the guidance of a consultant obstetrician it presents information from a team of professionals who spend their lives caring for women during pregnancy, labour, birth and following birth
    • Developing midwifery responses to women in their care who are living with violent men

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (MIDIRS, 2000-09)
      It is suggested that one in four women will experience domestic violence sometime in their life and that pregnancy can be a trigger for this violence, resulting in morbidity for both mother and child. Mary Steen describes a project in Leeds set up to train midwives to be more aware of possible domestic violence in their clients and how to support those who are suffering from it.
    • Development of antenatal education to raise awareness of the risk of relationship conflict

      Steen, Mary; Downe, Soo; Graham-Kevan, Niki; University of Chester ; University of Central Lancashire ; University of Central Lancashire (Redactive Publishing, 2011-06)
      Background: Relationship conflict and abuse occurs in every day life and often starts or escalates during pregnancy with devasting health and well-being consequences, the most severe being loss of life. This paper is the second in a series of two - the first paper described and discussed the first phase of the study, exploring the experiences of participants attending Start Treating Others Positively, a UK, Leeds-based charity. Aim: To explore STOP's participants' views of what could be included in an antenatal parenting education session for expectant parents to enable and empower them to manage emotions and behaviour and prevent any relationship conflict escalating to abuse. Method: An exploratory study involving 20 parents attending sessions organised by STOP. The university's health ethics committee granted approval and the standards recommended by the NHS Research Governance Framework for service users' involvement in research were applied. During December 2007 and January 2008, a schedule of open and closed questions was used to guide interviews. Data analysis were conducted by a thematic analysis that involved the identification of emerging themes. Participants' suggestions of useful exercises and techniques to be included in an antenataleducation programme were recorded. Findings: Four themes emerged from the data: 'Why has nobody thought about it before?', 'Sharing the parenting,' 'learning to listen', 'Creating space for me and for you'. Exercises and techniques for an antenatal education programme were suggested that would increase awareness of the risks of relationship conflict and provide preventative methods. Conclusions: Participants' views and suggestions assisted in the development of a specific session on 'managing emotions, behaviour and any relationship conflict when becoming a parent'. Further research will be undertaken to measure the impact of this newly developed programme for expectant parents.