Midwifery Dissertations and Theses

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    Homebirth outcomes and postnatal experiences in Canterbury (HOPE) study
    (2023) Clapham, Violet
    Background: Homebirth and home postnatal outcomes are not well described within midwifery literature. What evidence exists supports the high value of continuity of midwifery care and the positive experiences of homebirth and a home postnatal course. What is considered ‘normal’ in relation to newborn weight change is also poorly understood and is informed almost entirely by institutional postnatal care outcomes. Despite implementation of policies protecting exclusive breastfeeding for newborns, breastfeeding outcomes in Aotearoa New Zealand are sub-optimal at six weeks postpartum. Aim: To describe neonatal outcomes in relation to breastfeeding and newborn weight change following homebirth in Aotearoa New Zealand and to understand how women’s experiences of a home postnatal course with continuity of midwifery care following homebirth might contribute to understanding these outcomes. Methods: This research employed a mixed methods triangulation design consisting of concurrent collection of equally weighted quantitative and qualitative data sets. There were two sets of participants: eight focus group participants (50% primiparous) and 90 survey participants (21% primiparous). Reflexive thematic analysis was used to identify key qualitative themes from focus group discussions with eight homebirth parents in Christchurch, New Zealand. Descriptive statistical analysis was applied to report quantitative homebirth postnatal outcomes from survey data of 90 homebirths in the Canterbury/West Coast region. This research was underpinned by a critical realist framework that enabled exploration of the complex social and cultural factors that shape midwifery practice and maternal and neonatal health outcomes. Findings: Women described the importance of support and creating a safe space for birth and early breastfeeding. Homebirth was described as a shared, empowering experience, and this positive birth experience had a direct impact on women’s postnatal experience. Continuity of midwifery care was a key factor in building maternal confidence and trust in normal physiology and progress. There was a high rate of physiological birth (both of baby (100%) and placenta (91%)) and low rates of postpartum haemorrhage >1000 mls (3%) and 3rd degree perineal tearing (1%). Most women used a range of labour coping strategies, and most gave birth in an upright position (92%). The postpartum hospital transfer rate was 7%. Babies born at home experienced a mean of 127 minutes of uninterrupted skin-to-skin contact with their mother after birth and on average initiated breastfeeding 36 minutes after birth. Babies fed for a mean 52 minutes during their first breastfeed and went on to establish a high rate of exclusive breastfeeding (95%) at discharge from midwifery care. Women described their commitment to establishing breastfeeding and some women described the need for perseverance in working through initial breastfeeding issues to achieve their breastfeeding goals. Nearly half (42%) of the babies born at home were at or above their birthweight at one week of age. The mean weight change at one week was -0.5% from birthweight (M= 21g loss, SD 155g). All women received full continuity of postnatal care from their LMC midwife and received a mean of 10 postnatal home visits over the six week postnatal period. The postnatal outcomes data, while not relating to the same families, affirms that such an environment can produce excellent conditions for optimal maternal and neonatal wellbeing. Discussion: Homeborn babies were able to thrive instinctively when they were allowed to take the lead on initiating feeding and resting periods. Reported weight change at one week found minimal weight loss and there were high rates of exclusive breastfeeding at six weeks. These research findings suggest that breastfeeding intervention for healthy term neonates is rarely needed, and mother/baby dyads will usually achieve breastfeeding success in a supportive environment with continuity of care. Conclusions: In this study, homebirth outcomes were consistently positive and laid the foundations for a positive postnatal course. Women felt empowered by their homebirth and home postnatal experiences and embraced a trust in their breastfeeding journey that enabled instinctive thriving for babies through the postnatal phase. This was enabled and enhanced by continuity of midwifery care, which women valued highly. Home born babies often lost minimal weight in the first week and they maintained high rates of exclusive breastfeeding through the first six weeks of life. These findings should encourage a challenge to the current approach to early postnatal support provided in an institutional environment.
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    An exploration of the maternity experiences of wāhine Māori in their encounters with midwife Lead Maternity Carers
    (2022) Burne-Vaughn, Korina; https://online.op.ac.nz/industry-and-research/research/expertise/search/
    The purpose of this research was to explore the maternity experiences of Māori women to understand the optimal conditions needed to provide women-centred relationships with midwife Lead Maternity Carers (LMC). The research focussed on the pregnancies, birth and motherhood experiences of Māori women and their relationships with LMC midwives.This research used kaupapa Māori theory and mana wāhine theory to explore the pūrākau (stories) of Māori women and their midwifery care to answer the research question “What are the maternity experiences of wāhine Māori in their encounters with Lead Maternity Care (LMC) midwives?” The purpose of this research project was to move beyond the deficit-focussed research of Māori women that is prevalent in the literature. Ten wāhine Māori mothers participated in this research project: five first-time mothers and five mothers who had previously given birth to one or more babies. The age of the participants at the time of the study ranged from 21–38 years old. Online digital platforms replaced the planned kanohi kitea interviews and group wānanga (meeting or gathering) during COVID-19 level four restrictions. Thematic analysis was used to explore the pūrākau to reveal two main themes of whakamana wāhine (empowerment), whakawhānaungatanga (connections). Six subthemes were also identified tino rangatiratanga (self-determination), mana motuhake (autonomy), mātauranga Māori (knowledge), whanau (family), wawata (navigating relationships and wairua (spirituality). Wāhine Māori shared their stories of resilience and determination, their trust in their whānau and whakapapa, and spoke of how mātauranga Māori (knowledge) was critical to their care. LMC midwives were valued most highly when they provided support and encouragement for wāhine and their whānau to be self-determining and autonomous. This study contributes to the growing research being prompted by calls for improvements in midwifery education and practice. Furthermore, decolonising maternity spaces through revitalisation of pūrākau and reclamation of mātauranga Māori will influence change as seen from the perspective of wāhine Māori and their whānau.
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    Women's views on postnatal care from a midwife who has not provided their pregnancy and birth care: Implications for midwifery relationships
    (2022) Horncastle, Sally; https://online.op.ac.nz/industry-and-research/research/expertise/search/
    In Aotearoa New Zealand (from hereafter New Zealand), postnatal care is typically provided in hospital and at home by a known Lead Maternity Carer (LMC) midwife who has provided continuity of care and lead maternity care throughout the childbearing episode. While this model of maternity care is accepted as optimal, increasingly and for a myriad of reasons, postnatal care is being provided by a midwife or midwives previously unknown to the woman and her family. This study aimed to explore women’s experience of postnatal care when provided in this context, in order to understand the critical components for establishing a constructive and supportive postnatal care experience. The study design was qualitative descriptive to enable a rich and data-close explication of the women’s experiences. Semi-structured interviews with eleven first-time mothers were analysed thematically to develop three main themes that captured the essence of their experiences. The findings confirmed that postnatal midwifery care is a highly valued and vital component of postnatal adjustment as a new parent. While continuity of care was desired by most women, they articulated a range of ways that midwives can build meaningful relationships when they meet women for the first time postnatally. Themes centred around how women navigated the postnatal period which was characterised as being challenging and how the midwife provided an anchoring presence as these new mothers grew in confidence as new mothers and when caring for their babies. Sub-themes identified why the study participants were cared for postnatally by midwives who were previously unknown to them, examined their postnatal experiences in hospital prior to going home and describes their first meetings with their postnatal midwives and the key ingredients which enabled their alliances to work constructively.
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    Seeking safe harbour: Water immersion for women with complex pregnancy
    (2021) Kara, Kelly; Otago Polytechnic
    BACKGROUND Water immersion is used by women, particularly within midwifery-led settings, as a strategy to manage the sensations of labour. Low-risk women who have used water immersion in labour express feelings of increased relaxation, support and control in their labour and birth experience. Being labelled ‘high risk’ can significantly impact both a woman’s experience of her pregnancy and her opportunity for experiencing a physiological birth. Women with complex pregnancies have reported an increase in anxiety and a feeling that their normal childbearing journey has been interrupted and subsumed by medical monitoring and risk management. Midwifery frameworks in Aotearoa New Zealand protect and promote the woman’s role as a decision maker within her experience and her right to make informed decisions about her care. AIMS The aim of this research was to develop an understanding of the influences, facilitators and barriers for women who chose to use water immersion for labour and birth, in a hospital setting, when they were labelled/identified as being clinically complex, as well as to explore their experience of using water immersion in labour. METHODS A qualitative descriptive inquiry, using semi-structured interviews was undertaken to explore seven women's experiences of using water immersion during their labour and/or birth after having a complex pregnancy. Inductive thematic analysis was used to analyse participant data. FINDINGS Thematic analysis identified four themes within the women’s experiences. Women use water immersion to resist the medicalisation of their birthing experience and protect themselves from the iatrogenic risks of birthing within a hospital setting. The desire to use water immersion is often driven by dissatisfaction with previous medicalised experiences of birth and the women’s desire to avoid repeating these experiences. Water provides a safe and protected space to labour which supports a sense of control and privacy. The LMC midwife is a vital ally and advocate in negotiating to use water immersion within the hospital setting. In this environment, staff can either facilitate or be barriers to using water immersion in labour with a complex pregnancy. CONCLUSIONS Women use water immersion in labour to optimise their opportunity for physiological birthing, often in response to previous medicalised births. Water immersion is experienced positively as a strategy to manage labour. Individualised holistic midwifery care from a Lead Maternity Care midwife was valued by the women and viewed as a key support in negotiating for the choice of water immersion. Women needed to purposefully seek a midwife who was willing to support them in their choice to use water immersion.
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    A weighty issue: The implications of an ultrasound prediction of a large baby in pregnancy
    (2021) Baddington, Cara; Otago Polytechnic
    Ultrasound scans are an increasingly normalised part of pregnancy in Aotearoa New Zealand. In the third trimester, fetal measurements and weight estimations are undertaken at all scans, regardless of clinical indication. Even though these size predictions can be inaccurate, they heavily influence clinical decision-making. As a result, people with a scan prediction of a large baby may be more likely to have unnecessary interventions that do not improve outcomes, irrespective of the baby’s actual birthweight. My study aimed to explore the implications of an ultrasound prediction of a large baby on birthing people’s perceptions and experiences of their pregnancies and births, including their birth choices and relationships with caregivers. The study was underpinned by feminist poststructural theory, which is interested in the exposure of apparently fixed truths as socially and politically situated, and the creation of possibility for different ways of knowing and being through the deconstruction of those fixed truths. This focus was consonant with the objectives of my work: to expose the current apparent truths and practices about large babies and birth as the products of dominant medical discourse, and then set about disturbing them and creating space for a midwifery and women-centred narrative of fetal growth. In conducting the study, I carried out semi-structured interviews with people who had experienced a large baby prediction in pregnancy. I then analysed the data using reflexive thematic analysis. My analysis identified three overarching themes. The first described the two dominant medicalising discourses that prioritised surveillance and risk-centric care, and problematised large babies. The second identified the oppressive effects that engagement with these discourses had, including women experiencing fear, guilt, and a loss of control as they were directed on high intervention care pathways. The third explored the ways that women attempted to resist the oppressive effects of dominant discourse by privileging women’s ways of knowing, trusting their bodies to grow and birth normally, and seeking to gain control of decision-making about their experience. My findings demonstrated the negative impact that a large baby prediction had on women’s experiences and care pathways and identified opportunities for those women to challenge the problematisation of predicted large babies. The importance of a supportive midwifery relationship to these resistances was clear. The role of midwives in partnering with women to challenge medical meanings and practices related to large babies is affirmed as a key finding in this research.