• Diet and eating habits of expectant parents and families in Ras Al Khaimah, Emirates: an exploratory study.

      Steen, Mary; Mottershead, Richard; Idriss, Johaina; Parletta, Natalie; Ellahi, Basma; Kumardhas, Vijaya; University of South Australia; Higher Colleges of Technology, Ras Al Khaimah; United Arab Emirates University; University of South Australia; University of Chester; RAK Medical and Health Sciences University (Royal College of Midwives, 2017-06-31)
      Background. Obesity is a problem that has reached epidemic proportions around the globe, attaining an alarming level in Arab Gulf countries. Poor diets and a lack of essential nutrients being consumed by pregnant women has been acknowledged, and it is recognised that parental eating habits and preferences can contribute to the development of unhealthy diets in children. However, there have been no studies exploring diet and eating habits that have targeted expectant parents and their families in the United Arab Emirates (UAE). Aim. To explore the diet and eating habits of expectant parents and their families during pregnancy and test the feasibility of introducing an EatWell Assist workshop and diary, to increase awareness of healthy eating to improve family diet and nutritional status. Method. Participants were recruited from three study sites in Ras Al Khaimah, UAE. Initially, a purposive sample of 20 expectant mothers and 10 expectant fathers were interviewed. Phase 2 of the study recruited 15 expectant mothers and five female family members or close friends to attend on e of three EatWell Assist workshops and complete a diary for four weeks. Thematic analysis of interview transcripts and simple analysis of the structured questionnaire was undertaken. Results. The thematic analysis identified seven main themes for expectant mothers’ current diets and eating habits. These were: knowledge and understanding, eating patterns, fast foods, using supplements, likes and dislikes, body image, influences. Five similar main themes emerged for expectant fathers but the theme, ‘no supplements’, was in contrast to expectant mothers’ ‘using supplements’, and ‘body image’ did not emerge. Overall, the findings demonstrated the workshop evaluations were positive and participants gained knowledge and valued the opportunity to attend. Completing an EatWell food diary enabled expectant mothers to improve their diets and eating habits. Conclusions. Expectant parents’ current diet and eating habits were significantly influenced by the availability of a Western diet as well as traditional foods and cultural eating preferences. There was some improvement in healthy eating behaviours after attending a healthy eating workshop and keeping a daily food diary. Expectant fathers’ work commitments and women’s preferences inhibited opportunities for them to receive healthy eating education. Strategies to engage with expectant fathers need to be implemented and online education options may be worth considering.
    • Effectiveness of cooling gel pads and ice packs on perineal pain

      Navviba, Shahin; Abedian, Zahra; Steen, Mary; Zahedan University of Medical Science Nursing & Midwifery, Mashhad Iran ; Faculty of Health & Social Care, University of Chester (Mark Allen, 2009-11-01)
      The purpose of this paper is to report the findings of a randomised controlled trial undertaken at the Hazrat Ommolbanin University Maternity Hospital in Mashhad, Iran which investigated the effectiveness of localised cooling treatments to alleviate perineal trauma. From October 2005 to February 2006, 121 primiparous women who were at term and had an episiotomy were randomly recruited to one of three treatment groups (Group 1 - no localised cooling, Group 2 - Ice pack, Group 3 - cooling gel pad). The intensity of pain, wound healing and women’s satisfaction levels were the main outcomes measured. The intensity of pain was measured by a (Numeric Rating Scale (NRS) (0-10) and wound healing was evaluated by the REEDA scale within 4 hours of episiotomy repair, at Day 1, Day 2, Day 5 and finally at Day 10. The usage of oral analgesia (acetaminophen) was measured at Day 10. Women’s satisfaction levels with oral analgesia and localised cooling treatments were also assessed at Day 10 by a NRS (0-10). There was evidence that localised cooling treatments are effective at alleviating perineal pain which was in favour of the cooling gel pad group. A statistical significant difference was reported at 4 hours (p=0.003) Day 2 (p=0.004) and at Day 10 (p=0.044). At Day 1 and Day 5 there was evidence of a reduction in the intensity of pain but this did not reach a statistical significant difference. A reduction in the usage of oral analgesia (acetaminophen) was reported in favour of the cooling gel pad group (p<0.001). Women’s satisfaction levels with oral analgesia were similar within the three treatment groups but a higher level of satisfaction when assessing localised treatment was reported by the cooling gel pad group (p<0.001). Wound healing rates were also reported to be better in the cooling gel pad group when compared to the other two groups(p<0.001). In conclusion, treatments to alleviate perineal pain without any adverse affects on wound healing and women’s views are important aspects of midwifery care. This trial has demonstrated evidence that localised cooling of the perineum reduces the intensity of pain, women were more satisfied when applying cooling gel pads and this treatment appeared to assist in wound healing.
    • Engaging fathers in childbirth: A meta synthesis

      Steen, Mary; Downe, Soo; Bamford, Nicola; Edozien, Leroy; University of Chester ; University of Central Lancashire ; University of Manchester/St Mary's University Hospital (2012-04-26)
      This presentation explores the evidence from a meta synthesis undertaken as part of a programme of work entitled, Engaging Fathers in Childbirth (EPIC). There is growing evidence that active involvement of fathers in maternity care is associated with many health and social benefits for the mother and baby. However, maternity care expectations and experiences of expectant and new fathers have received little attention from policy makers and maternity service providers. Twenty three papers were included in the meta-synthesis and studies where undertaken in 9 countries (7 UK, 5 Australia, 4 Sweden, 2 USA, 1 Japan, 1 Taiwan, 1 South Africa, 1 Finland, 1 New Zealand). Ten of these focused on the prenatal period (prenatal diagnosis, A/N education & care), 5 focused on the intrapartum period (place of birth, premature birth & experiences),8 focussed on the postnatal period (transition to fatherhood & post-traumatic stress disorder). Six themes emerged from the included studies: risk and uncertainty,exclusion, fear and frustration, the ideal and the reality, issues of support, experiencing transition. 'As Partner and Parent’ fathers experience as not-patient and not-visitor situates them in an interstitial and undefined space with the consequence that many feel excluded and fearful. They cannot support their partner effectively unless they are themselves supported, included, and prepared for the reality of risk and uncertainty in pregnancy, labour and parenthood and for their role in this context.
    • Exploring Nigerian obstetricians’ perspectives on maternal birthing positions and perineal trauma

      Diorgu, Faith; Steen, Mary; Keeling, June J.; Mason-Whitehead, Elizabeth; University of Chester (Royal College of Midwives, 2016-05-26)
      Abstract Background. Evidence recommends encouraging expectant mothers to adopt birthing positions that will assist them in having a normal physiological birth. Upright birthing positions have been shown to have good birth outcomes and assist women to give birth normally. However, adopting the lithotomy position with legs flexed and supported with hands has become an entrenched clinical birthing practice in Nigeria and is associated with an increased risk of a routinely performed episiotomy. Hospital protocols have supported this medicalised approach to how women give birth, with little regard to woman-centred care. Nevertheless, Nigerian obstetricians’ perceptions and experiences on birthing position and perineal trauma have received minimal recognition and research. Aim. To explore perceptions and experiences of Nigerian obstetricians regarding maternal birthing position and perineal trauma following childbirth, and to gain insights as to whether obstetricians’ clinical decisions and practice were influenced by evidence. Methods. A descriptive qualitative study was conducted involving a purposive sample of eight obstetricians recruited from two referral hospitals in the Niger Delta region of Nigeria during November 2014. Data were collected using an interview schedule and a thematic analysis was undertaken. Data analysis was guided by Braun and Clarke’s (2006) six-stage thematic framework. Interviews were transcribed in full and categorisation of the data achieved with several in-depth readings of the transcripts. Data saturation was reached with the facilitation of the second focus group interview as no more emerging themes were identified. The study obtained ethical approval from the health and social research ethics committee at the University of Chester in the UK, and also from the study hospitals in the Niger Delta region in Nigeria. Results. Six participants were doctors undertaking obstetric specialist training and two were consultant obstetricians. The following core themes emerged: entrenched practice, lack of insight for evidence, embracing woman-centred care and professional dominance. An overall finding demonstrated a willingness to support mothers in their choices of birthing position and involved reflections on the indications for an episiotomy and incidences of perineal injuries. The findings also indicated that the obstetricians were prepared to consider woman-centred care in relation to birthing position and perineal trauma. Conclusions. This study has enabled some Nigerian obstetricians to reflect upon their perceptions and experiences of their clinical decisions and practices concerning birthing position and perineal trauma. Their current practice was frequently not supported by evidence. However, it emerged that there was a willingness to listen to women and adopt clinical birthing practices and perineal care that would respect choices based on contemporary evidence. Adopting a woman-centred approach would also enable Nigerian midwives working in the two study hospitals to support women to give birth in a position of their choosing and reduce the risk of a routinely performed episiotomy
    • Feme pad: Out of the ice age and into the new millennium

      Steen, Mary; Leeds Teaching Hospitals NHS Trust (Mark Allen Publishing, 2000-05-03)
      Explains the principles behind and use of the Feme Pad, a new cooling gel pad designed to alleviate perineal pain and reduce swelling following delivery.
    • The handbook of midwifery research

      Steen, Mary; Roberts, Taniya; University of Chester (Wiley-Blackwell, 2011-03-04)
      Part 1 - starts with a chapter on Introduction to Midwifery Research which sets the scene and covers an understanding of the general principles of research, the importance of the research question, the approaches that can be undertaken, the differences between these and the importance of applying evidence to midwifery practice. Chapter 2 - Finding the Evidence, explains in detail how to undertake a literature review, the sources of evidence available, how to use a search strategy and gives useful examples. In addition, midwifery related structured and systematic reviews are described and discussed in an attempt to promote a better understanding of how to undertake these aspects of research. Chapter 3 — Making Sense of the Evidence, covers the critiquing aspects of research evidence, gives an insight into how evidence is graded and clearly differentiates the differences between qualitative and quantitative approaches. Part 2 —focuses on how to undertake research and includes four chapters. Data collection techniques cover both qualitative and quantitative methods and are the focus of chapter 4. This chapter gives specific details on how to undertake a research interview and how to design a questionnaire as these will be the most likely data collection tools a midwife or student will make use of. Chapter 5 - ethics and research governance introduces the role of ethics when undertaking research and discusses the importance of research governance. Ethical issues relating to midwifery research are considered and specific details on how to obtain ethical approval is addressed to help midwives and students achieve this successfully. Data analysis is the focus of chapter 6. An introduction to data analysis which is followed by specific sections of both qualitative and quantitative analysis methods is covered and a basic understanding of statistics is also included to help midwives and students link the type of data collected with the appropriate statistical test required to analyse a specific type of data (fit for purpose). Finally, dissemination and the research dissertation/thesis are the focus of chapter 7. Writing skills and how to structure your dissertation/thesis is described and discussed. Guidelines and advice on how to get your work published and presenting a conference paper are given. A specific section on useful resources and becoming a researcher brings the book to a close.
    • Homeopathic remedies for self-adminstration during childbirth

      Calvert, Jan; Steen, Mary; Leeds Complementary Therapy Centre; Royal College of Midwives/University of Central Lancashire (Mark Allen Publishing, 2007-03)
      The first of two articles. This article discusses a study that assessed the usage and impact of providing a self-administered kit of homeopathic remedies at the end of pregnancy, childbirth, and post-childbirth. The study was undertaken at the hospital and at home. Nineteen women in south Leeds participated in this study between September 2005 and February 2006.
    • Homeopathy for childbirth: Remedies and research

      Steen, Mary; Calvert, Jan; University of Central Lancashire; Royal College of Midwives (2006-11)
      This article discusses the use of homeopathy during childbirth with an overview of a multidisciplinary research study.
    • How to encourage a woman to remain active in labour

      Steen, Mary; University of Chester (Redactive, 2012-03)
      This article gives an insight into how to encourage a woman to remain active in labour. There is substantial evidence that demonstrates being active during labour is beneficial and a range of different positions can be adopted. Good preparation during pregnancy is essential as this will assist women to become confident and believe in their ability to be active during labour. Ideally, upright positions in first and second stage should be encouraged and the use of props such as a chair, bean bag or birth ball. The impact of water immersion during labour should also be highlighted as an effective birthing option.
    • I can't sit down - easing genital tract trauma

      Steen, Mary; Leeds Teaching Hospitals NHS Trust, (Mark Allen, 2005-05-01)
      This article discusses the high prevalence of genital tract trauma and its many negative consequences for women, such as being unable to sit down comfortably. Its highlights how suture technique and suture material can significantly contribute to the severity of perineal pain and discomfort and the importance of asking women about their ‘pain experience’. Treatments to alleviate the pain and discomfort are then reviewed. In conclusion, 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.
    • Ice packs and cooling gel pads versus no localised treatment for relief of perineal pain: A randomised controlled trial

      Steen, Mary; Marchant, Paul; Royal College of Midwives/University of Central Lancashire ; Leeds Metropolitan University (TenAlps, 2007-06-01)
      Background: Trauma to the perineum is extremely common during childbirth and the intensity of perineal pain has been reported to vary from being mild to very severe in nature. Aim: To evaluate the effectiveness of two localised cooling treatments (ice pack and cooling gel pad) compared with a no localised treatment group at relieving perineal pain. Method: A randomised controlled trial conducted in a large maternity unit in the north of England and followed up in women's own homes in which 450 women who had either undergone a normal or instrumental delivery that required suturing of an episiotomy or second-degree tear were randomly assigned to three treatment groups. Results: The response rate was 316 out of 450(71%). Perineal pain was most severe when sitting compared to lying down or walking and there was a significant difference between the three groups in estimates of overall pain when sitting on day four (Kruskal-Wallis test,df=2 p=0.01). Estimates of overall pain were lower in the gel pad group, and the difference between the three groups was significant at days five and day ten (Kruskal-Wallis test,df=2 p=0.02, p=0.01). On days two, three and five, significance was measured when making a binary comparison of reported 'moderate' or 'severe' pain with 'none' or 'mild' (chi-square test, p=0.04,p=0.04, p=0.02). Using a summary pain measurement, mothers experienced fewer painful days in the gel pad group but this did not reach statistical significance (Kruskal-Wallis test, df=2 p=0.26). The use of analgesia was reported to be similar in all three groups. Maternal satisfaction with their overall care was rated more highly in the gel pad group when compared to the two other groups (Kruskal-Wallis test, df=2 p>0.001). Conclusions: Cooling treatments can alleviate pain when compared to no localised treatment. Women appeared to find the cooling gel pad to be a more acceptable treatment.
    • Involving Fathers in maternity care: Best practice

      Steen, Mary; Downe, Soo; Rigby, Katrina; Fisher, Duncan; Burgess, Adrienne; Davies, Jeremy; Leeds Teaching Hospitals NHS Trust ; UCLan ; Fatherhood Institute (2008-11-19)
      This presentation described and discussed a structured review of the evidence to support best practice when involving fathers during pregnancy, birth and following birth.
    • Making normal birth a reality

      Steen, Mary; Walsh, Denis; University of Central Lancashire/Royal College of Midwives (APEO - Associacao Portuguesa Enfermeiros Obstetras, 2007-05-05)
      This article describes and discusses an conference paper given at the Dia Internacional do Enfermeiro de Saude Materna e Obstetrica, Viseu, Portugal. It highlights that many childbearing women in the 21st century now fear birth and the RCM's concerns that both women and maternity care professionals have become more dependent on technology during childbirth. This instigated the RCM's campaign for normal birth, which aims to inspire and support normal birth practice to maximise opportunities for women to experience normal birth and to reduce unncessary medical interventions. The importance of being with woman is stressed and a social model versus medical model of care is compared. Midwife's skills such as 'sussing out labour' and 'intuition' is explored as is 'working with pain' rather than a pain relief approach and 'holistic approaches to support normal birth practices are also discussed. In particular, active birth and the use of complementary therapies are reviewed. Midwives around the world can play an important role in making normal birth a reality once again.
    • Maternal health & well-being project

      Steen, Mary; Leeds Teaching Hospitals NHS Trust/Leeds City Council (2005)
      A Maternal Health & Well-Being Initative that involved workshops and exercise classes that promoted normal birth and public health.
    • Maternal health & well-being project

      Steen, Mary; University of Central Lancashire/Royal College of Midwives/Leeds Teaching Hospitals NHS Trust (2006-05-12)
      It is important that women receive information and advice about normal birth practices and healthy lifestyles. In the United Kingdom,the Royal College of Midwives Campaign for Normal Birth, ‘aims to inspire and support normal birth practice’(RCM, 2005) and the Department of Health has acknowledged that ‘Healthy mothers are key for giving healthy babies a healthy start in life’.(DoH, 2004) This presentation describes a holistic health and fitness programme specifically designed to raise awareness of the health benefits of normal birth and the general health and wellbeing of women, their babies and their families.
    • Maternal mental health: Stigma and shame

      Steen, Mary; Jones, Alun; University of Chester ; University of Chester (Medical Education Solutions Ltd, 2013-06-01)
      For some vulnerable women, a major life event such as becoming pregnant can bring out a predisposition to mental illness. Receiving mental health care can invoke stigma and shame in varied and complex ways causing a sense of entrapment.
    • The maze of midwife practice

      Steen, Mary; Royal College of Midwives/UCLan (2005-11)
      This presentation discusses the role of a midwife and debates whether she practises as an expert,a specialist or obstetric nurse. Essential midwifery practice focuses on autonomy, normality, holistic care, woman centredness and respecting differences. 'Every Midwife Matters', the challenges and barriers to midwifery care in the UK in the 21st century are explored and debated.
    • Men and women’s perceptions and experiences of attending a managing abusive behaviour programme

      Steen, Mary; Downe, Soo; Graham-Kevan, Niki; University of Chester ; University of Central Lancashire ; University of Central Lancashire (Royal College of Midwives, 2009-12)
      Background: Domestic violence is a global and pernicious problem affecting all spheres of society. It has traditionally been seen as a social problem, but is now recognised to be a public health issue and reducing the incidence is a Priority Action 1 within Public Service Agreement 23. Sadly, domestic violence sometimes commences or escalates during pregnancy and during the transition to parenthood. It has been identified as a significant contributor to maternal and fetal morbidity and mortality, through both direct and indirect means. This paper describes the first phase of a study exploring the views of men and women, who had attended Start Treating Others Positively (STOP) a charity based in Leeds, UK. The adapted Appreciative Inquiry model of behavioural change underpins the work of STOP. Aim of the study: To explore the perceptions and experiences of participants attending STOP, to gain an insight of the effect this has had upon their ability to change their abusive behaviour to non-abusive and manage relationship conflict. Method: An exploratory study involving 20 participants (15 men and 5 women) who are parents and attending Start Treating Others Positively (STOP voluntarily. Ethics approval was granted by the university’s health ethics committee and guidance cited in the NHS Research Governance Framework was addressed throughout the study. Semi-structured interviews were undertaken during December 2007 and January 2008. An interview schedule of open and closed questions was used to gain an insight into respondents’ perceptions and experiences. Data were analysed by using a thematic analysis which entailed the identification of 6 primary emerging themes, 3 secondary core themes, then a final core theme, and the development of a synthesis statement. Findings: This first phase of this study explored the perceptions and experiences of 20 participants who attend STOP on how they have learnt to manage their behaviour to prevent themselves being abusive in their family relationships, and the impact this has had on their lives. Participants agreed that there were no excuses for domestic violence. Initially, six sub-themes emerged from the data: emotional regulation, emotional understanding, developing empathy skills, changed behaviour, developing conflict resolving skills, coping strategies. These were integrated into three overarching themes: emotional stability, cognitive empathy, conflict competency. Following synthesis, these were summarised into one phrase: ‘positive life skills’. The interviews demonstrated the participants had developed positive life skills whilst attending STOP to enable them to manage their emotions, behaviour and family relationship conflict. There was also evidence that these positive life skills were being taught to the participant’s own children Conclusions: Domestic violence has enormous implications for the health sector in general and within maternity services. Preventing future cases of domestic violence will reduce both maternal and fetal mortality and morbidity rates. The government has recognised the need to reduce the prevalence of domestic violence as a high priority, yet there is limited research to demonstrate effective preventative measures.
    • Midwives reflections: Exploring attitudes, feelings and experiences when caring for women who are being abused

      Steen, Mary; Bharj, Kuldip; Leeds Teaching Hospitals NHS Trust/University of Leeds (MIDIRS, 2003-03)
      Domestic violence is a global concern and a major public health issue for midwives. In this article, the authors describe an in-service training programme developed to increase midwives' understanding of domestic violence as well as the use of reflective practice as a learning tool in exploring attitudes and experiences of midwives
    • A new device for the treatment of perineal wounds

      Steen, Mary; Cooper, Keith; Leeds Teaching Hospitals NHS Trust/Leeds Metropolitan University (Emap, 1999-02-01)
      This article describes the design, development and evaluation of a new cooling maternity gel pad for the alleviation of perineal pain. Specific details of laboratory investigations of cooling and warm curves for different gel compositions, microbiological challenge tests and MDSA data are discussed. A risk assessment for the designed established that the new device has a low hazard rating and negligible exposure potential. Women’s opinions of treatment effect are highly significant.