• 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.
    • 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.
    • 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
    • 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.
    • A review of baby skin care

      Steen, Mary; Macdonald, Susan; UCLan/Royal College of Midwives ; Royal College of Midwives (Royal College of Midwives, 2008-08)
      This article describes and discusses the findings from a structured review of baby skin care and guidelines based on the best available evidence which was undertaken on behalf of the Royal College of Midwives. Health professionals and parents can download the full article from the RCM URL: