Calvert, Jan; Steen, Mary (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.
Steen, Mary; Jones, Alun (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.
OBJECTIVE: To evaluate the effectiveness of standard regimes (ice packs and Epifoam) at relieving perineal trauma and compare these with a new cooling device (maternity gel pad). DESIGN: A randomised controlled trial involving three treatment groups. The women were free to choose the time of initial application (within four hours after delivery) in all treatment groups and the number of subsequent treatments up to 48 hours after suturing. SETTING: A midwifery unit in the north of England and then continued in the women's own homes. PARTICIPANTS: 120 women who had undergone an instrumental delivery and had a 48 hours post-delivery stay in a postnatal ward. MEASUREMENTS AND FINDINGS: The ordinal scale of none, mild, moderate and severe was used to determine the levels of perineal oedema and bruising at initial assessment (less than 4 hours), 24 hours and at 48 hours, by use of a newly developed visual evaluating tool. Self-assessed pain was recorded using a 10-point visual analogue scale within four hours, at 24 hours, 48 hours, and finally at five days after suturing. Women's opinions as to the effectiveness of their treatment was rated by use of a 5-point scale describing the categories; poor, fair, good, very good and excellent. A high proportion of women had some perineal oedema at initial assessment. A statistically significant difference in the proportion of women with oedema was found between treatment groups at 48 hours (p = 0.01), which was in favour of the maternity gel pad group. This was particularly noticeable for women with initial levels of mild oedema (p = 0.017). Localised treatment with the gel pad caused a significant decrease in reported pain at 48 hours in women who initially demonstrated moderate or severe pain (p = 0.048). A significant increase in the proportion of women with some bruising was seen across all treatment groups from initial assessment, through 24 hours to 48 hours (p < 0.0005). The bruising was significantly less in the gel-pad group in women who initially had no bruising (p = 0.021). There was no statistically significant effect of treatment at other initial levels of severity for oedema, bruising or pain at 24 hours, 48 hours and five days (for pain). Women in the gel-pad group rated the effectiveness of their localised treatment to be significantly higher than women in the other two treatment groups (p < 0.0005). KEY CONCLUSIONS: This trial demonstrated that a high proportion of women experience perineal oedema, bruising and pain following an instrumental delivery, which continues for at least five days for perineal pain, despite oral analgesia. Maternity gel pads, which were specially designed to cool the perineal region, were more effective in alleviating perineal trauma when compared with hospital standard regimens and were more highly rated by women.
Continence in women during pregnancy and following childbirth is an important issue that needs to be managed appropriately. Urinary and bowel problems can have numerous negative physical and psychological consequences, and women may be too embarrassed to seek help. Healthcare professionals need to encourage and support women to identify any changes in their normal bowel and bladder habits. They also need to have knowledge of the anatomy and physiology of the urinary, reproductive and digestive systems to understand how continence may be affected during pregnancy and following childbirth.
Steen, Mary; Steen, Scott (Medical Education Solutions Ltd, 2014-03-01)
Mental health is an integral part of health and a state of wellbeing. The concept of ‘parity of esteem’ increases awareness that mental health needs to be treated as seriously as physical health. During the childbirth continuum, women and their partners can be at increased risk of mental health problems; therefore it is important to embrace the ‘parity of esteem’ concept. This article highlights links between mental and physical health problems and discusses the vital role that midwives can play in promoting better maternal mental health. It considers the challenges this can present to midwives and maternity services.
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.
Steen, Mary; Calvert, Jan (Mark Allen Publishing, 2007-06)
This paper discusses a follow up study that used a semi-structured interview technique to further explore the experiences of women and their partners following the use of a specifically chosen homeopathic kit that included ten remedies that were self-administered.The interview data demonstrated that women and several birth partners experienced positive emotional, psychological and physical benefits from using the kit of homeopathic remedies. Implications: Self administered homeopathic remedies have the potential to promote a women-led approach to childbirth and an active supportive role for the birth partner. The findings will form the foundations to undertake further research in this field.
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.
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