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19 Things That Show Workplace Compassion for Healthcare Staff

We are all well aware of how the wellbeing of healthcare staff can affect the quality and safety of care. I have also talked at length about the wellbeing of health care staff and the theories surrounding work-related psychological distress. But do we really have any concrete idea of what shows workplace compassion for healthcare staff?

My research published in collaboration with Dr. Wendy Clyne, Dr. Karen Deeny and Dr. Rosie Kneafsey asked Twitter users to contribute their views about what activities, actions, policies, philosophies or approaches demonstrate workplace compassion in healthcare using the hashtag #ShowsWorkplaceCompassion. It can be cited as follows:

Clyne W, Pezaro S, Deeny K, Kneafsey R. Using Social Media to Generate and Collect Primary Data: The #ShowsWorkplaceCompassion Twitter Research Campaign. JMIR Public Health Surveill 2018;4(2):e41. DOI: 10.2196/publichealth.7686. PMID: 29685866

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The results of this study outlined 19 things or ‘Themes’ in relation to what shows workplace compassion for healthcare staff as follows…

  Leadership and Management
1 Embedded organizational culture of caring for one another
2 Speaking openly to learn from mistakes
3 No blame/no bullying management
4 Inspiring leaders and collective leadership
5 Financial investment in staff
6 Recognize humanity and diversity
  Values and Culture
7 Common purpose in a team
8 Feeling valued
9 Being heard
10 Enjoying work
11 Being Engaged at work
12 Use of caring language
  Personalized Policies and Procedures
13 Recognition of the emotional and physical impact of healthcare work
14 Recognition of non-work personal context
15 Work/life balance is respected
16 Respecting the right to breaks
17 Being treated well when unwell
  Activities and Actions
18 Small gestures of kindness
19 Provision of emotional support

How will you implement these things within your healthcare workplace? I would love to hear your thoughts on this…

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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How to publish your PhD thesis in 6 easy steps

Whilst I am sure that there are many reputable companies who will publish your thesis out there, I wanted to share with you all how I published mine.

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First of all, I believe that if you have a PhD then your work must be adding some original knowledge to the world. That means that your work is of value, and should therefore be published and disseminated widely. This is also true for students, whose work is of great value to the academic community.

See my post here about ‘Why Midwifery and Nursing Students Should Publish their Work and How’

But here, I wanted to map out one way to publish your thesis. It is the way I published mine.

Step one…

Publish background literature reviews to outline how you arrived at your research questions. Much of this work will summarize the first chapters of your thesis. It will also help you refine your ideas if you publish as you write.

My initial chapters were published as follows:

Pezaro, S The midwifery workforce:  A global picture of psychological distress – Article inMidwives: Official journal of the Royal College of Midwives (2016): 19:33

Pezaro S Addressing psychological distress in midwives. Nursing Times (2016): 112: 8, 22-23.

Pezaro, S., Clyne, W., Turner, A., Fulton, E. A., & Gerada, C. (2015). ‘Midwives overboard! ‘Inside their hearts are breaking, their makeup may be flaking but their smile still stays on. Women and Birth 29.3 (2016): e59-e66.

Step two…

Publish your ideas around the theories used in your work.

I did this by publishing a blog on theories of work-related stress. I also published a paper exploring the ethical considerations of what I was trying to do entitled ‘Confidentiality, anonymity and amnesty for midwives in distress seeking online support – Ethical?’. Opening this up for discussion meant that my thesis was much stronger overall.

Step three…

Publish your methods via research protocols.

Not only does this mean that you have claimed the idea for yourself in the academic world, but you also then get the benefit of a wider peer review of your work. I published the protocol of my Delphi study as follows:

Pezaro, S, Clyne, W (2015) Achieving Consensus in the Development of an Online Intervention Designed to Effectively Support Midwives in Work-Related Psychological Distress: Protocol for a Delphi Study. JMIR Res Protoc 2015 (Sep 04); 4(3):e107

Step four…

Publish each chapter of your work as you go.

Again, this gives your work added peer review in the process of developing your thesis. I published the two largest pieces of research in my thesis as follows:

Pezaro, S, Clyne, W and Fulton, E.A  “A systematic mixed-methods review of interventions, outcomes and experiences for midwives and student midwives in work-related psychological distress.” Midwifery (2017). DOI: http://dx.doi.org/10.1016/j.midw.2017.04.003

Pezaro, S and Clyne, W “Achieving Consensus for the Design and Delivery of an Online Intervention to Support Midwives in Work-Related Psychological Distress: Results From a Delphi Study.” JMIR Mental Health3.3 (2016).

Step five…

Publish summaries of your work for different audiences

Once you begin to pull together your entire thesis, you will begin to discuss the findings and arrive at certain conclusions. You can summarise these in a series of blogs and papers as you go. I published the following summary papers to reach both national and international audiences.

Pezaro, S (2018) Securing The Evidence And Theory-Based Design Of An Online Intervention Designed To Support Midwives In Work-Related Psychological Distress (Special Theme on Women in eHealth). Journal of the International Society for Telemedicine and eHealth. Vol 6, e8. 1-12.

Pezaro, S “The case for developing an online intervention to support midwives in work-related psychological distress.” British Journal of Midwifery 24.11 (2016): 799-805.

Step six…

Use info graphics to map out key points in your thesis

Once complete, your thesis will be published in full. Mine can be accessed here via the British Library and via Coventry University’s open collections. But it’s a mighty big document. Therefore, I produced the following infographic to map out my PhD journey for those looking for a shorter, yet engaging summary.

PhD infographic

…and there you have it. A fully published PhD thesis via a variety of avenues. I hope that you enjoy publishing your PhD thesis, and that publishing it helps you to defend it.

Also…If you need a co-author, let me know!🎓😉

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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10 Top tips for caring for women with Hypermobile Ehlers-Danlos Syndrome in pregnancy for International Day of the Midwife #IDM2018 & #EDS awareness month

 or ‘International Day of the Midwife’ falls on May the 5th of every year. The theme for 2018 in three languages is…

  • Midwives leading the way with quality care
  • Sages-femmes, ouvrons la voie avec la qualité des soins
  • Matronas liderando el camino con un cuidado de calidad 

Also… Every May is Ehlers-Danlos Syndrome (EDS) awareness month around the world.

As such….for , and EDS awareness month… I shared 10 top tips for caring for women with hypermobile Ehlers Danlos Syndrome (hEDS) during pregnancy birth and beyond. These tips come from my latest paper, authored in partnership with Dr. Gemma Pearce (@GemmaSPearce) and Dr. Emma Reinhold (@DrEReinhold ), entitled …

Hypermobile Ehlers-Danlos Syndrome during pregnancy, birth and beyond

Here, we present care considerations for midwives and the multidisciplinary team caring for this unique subgroup of childbearing women. However, we hope that women with hEDS will also benefit from this paper, as they make decisions in partnership with their professional health care teams. You can read the press release from this paper here.

I would personally like to thank the board members of the British Journal of Midwifery for making this article FREE for all to read. I would also like to thank the Royal college of Midwives for sharing news of the article here…and the Nursing Times for sharing further news here.

So what can midwives do to maximize the quality of care given to women with hEDS throughout pregnancy birth and beyond?…First of all….Know the facts…

  • There have been no prevalence studies since EDS received a major reclassification in 2017
  • Earlier estimates from 2006 suggest a prevalence rate of 0.75-2% for hyper mobile EDS
  • hEDS is the most common form of EDS
  • Up to 78% of women with hEDS could also have a diagnosis of Postural Orthostatic Tachycardia Syndrome (POTS)
  • POTS predominantly occurs in women of childbearing age
  • EDS is considered to remain largely under diagnosed.

Tips for midwives

  1. Discuss individual needs with women, as no two cases will be the same. Do this early, and always in partnership with the woman and the wider multidisciplinary healthcare team.
  2. Consider early referral to obstetric, physiotherapy and anaesthetic teams in partnership with the woman.
  3. Consider the need for alternate maternal positioning during pregnancy, birth and beyond. To minimise the risk of injury, positioning should be led by the mother.
  4. As wound healing can be problematic, the use of non-tension, non-dissolvable, deep double sutures, left in for at least 14 days is advisable.
  5. Wait longer for local anaesthetics to take effect and consider giving maximum dosage. Always be led by the mother on whether pain relief is sufficient
  6. Always consider the significance of a routine observation in light of existing POTS and/or EDS symptoms
  7. Promote spontaneous pushing rather than directed pushing during birth
  8. Promote effective pain management and the use of therapeutic birthing environments to promote reductions in stress
  9. Consider additional joint support for newborns suspected of having hEDS
  10. Document all joint dislocations and bruising marks on the newborn from birth to avoid misdiagnosis and/or wrongful accusations of mistreatment.

Research into EDS and childbearing is in it’s very early stages. We hope to build on this work to make a difference for all women with hEDS during pregnancy, birth and beyond.

pregnant belly

If you would like to follow the progress of this work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

 

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Being Examined: Tips for your viva

This wisdom comes from the 10th annual ‘Life beyond the PhD’ conference () hosted at Cumberland Lodge. I was lucky enough to win a scholarship to attend and gather a multitude of hints and tips for my academic career…Now I plan to share them here for those who wish to read them…I have also experienced a viva voce examination…so these viva tips also come from me too.

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What is a viva voce?

In a nutshell it is the oral assessment of your PhD Thesis.

So your first viva tip would be….know how a PhD/doctorate/thesis is defined!…Here is a sample of some of the key phrases and expressions relating to ‘doctorateness’:

  • worthy of publication either in full or abridged form;

  • presents a thesis embodying the results of the research;

  • original work which forms an addition to knowledge;

  • makes a distinct contribution to the knowledge of the subject and offers evidence of originality shown by the discovery of new facts and/or the exercise of independent critical power;

  • shows evidence of systematic study and the ability to relate the results of such study to the general body of knowledge in the subject;

  • the thesis should be a demonstrably coherent body of work;

  • shows evidence of adequate industry and application;

  • understands the relationship of the special theme of the thesis to a wider field of knowledge;

  • represents a significant contribution to learning, for example, through the discovery of new knowledge, the connection of previously unrelated facts, the development of new theory or the revision of older views;

  • provides originality and independent critical ability and must contain matter suitable for publication;

  • adequate knowledge of the field of study;

  • competence in appropriate methods of performance and recording of research;

  • ability in style and presentation;

  • the dissertation is clearly written;

  • takes account of previously published work on the subject.

Source: Searching for ‘Doctorateness’.

The problem is…..that a range of literature has pointed out the variability in examination processes across universities, individual examiners, disciplines. Yup, this can be a fairly subjective process. So it is your job within your thesis and within your viva to make your case and convince your examiners that your work is indeed doctoral work.

Within Wellington’s (2013) framework for assessing ‘Doctorateness’, there are seven categories listed for which doctorates may contribute original knowledge. Therefore, in order for ‘Doctorateness’ to be unequivocally established for your thesis, it is important to apply the categories of this framework to each component of your research. The table below was added to my own thesis in order to prove how and why my work was indeed doctoral work.

Category number Category description Evidence
1 Building new knowledge, e.g. by extending previous work or ‘putting a new brick in the wall’. The Delphi method has been used previously to assess the workplace needs of midwifery populations (Hauck, Bayes and Robertson 2012). Yet the views and opinions of an expert panel about the design and development of an online intervention designed to support midwives in work-related psychological distress have been gathered and presented for the first time within this thesis.
2 Using original processes or approaches, e.g. applying new methods or techniques to an existing area of study. As the Delphi study presented within this thesis was a modified one, where the identity of experts remained unknown to the researcher, and free text response options accompanied each statement, it has also applied somewhat original processes and approaches to an existing area of study.

 

3 Creating new syntheses, e.g. connecting previous studies or linking existing theories or previous thinkers. Chapter one presents the first narrative review to integrate studies of midwives in work-related psychological distress (Pezaro et al. 2015). This original knowledge demonstrates how midwives working in rural, poorly resourced areas who experience neonatal and maternal death more frequently can experience death anxieties, where midwives working in urban and well-resourced areas do not. This creation of new syntheses connects previous studies and existing theories together to form new knowledge.

 

The mixed-methods systematic review presented within chapter three is the first of its kind to collate and present the current and available evidence in relation to existing interventions targeted to support midwives in work-related psychological distress (Pezaro, Clyne and Fulton 2017).

 

4 Exploring new implications, for either practitioners, policy makers, or theory and theorists. Chapter two makes an original contribution to ethical decision making, and may be extrapolated and applied to other healthcare professions who may also now consider the provision of confidential support online.
5 Revisiting a recurrent issue or debate, e.g. by offering new evidence, new thinking, or new theory. The original research presented in chapter two contributes to an ongoing academic dialogue in relation to ethical decision making.
6 Replicating or reproducing earlier work, e.g. from a different place or time, or with a different sample. The mixed-methods systematic review, presented in chapter three somewhat replicates earlier work from a different place, time, and with a different inclusion sample (Shaw, Downe and Kingdon 2015).

 

7 Presenting research in a novel way, e.g. new ways of writing, presenting, disseminating. The results of this research have been disseminated via popular media publications throughout. A further summary of this research is planned for publication. Furthermore, this research has also informed new guidance, published by the Royal College of Midwives, who also present the findings of this research in a new way. This new guidance is intended to guide heads of midwifery to support midwives experiencing work-related stress. Evidence of this can be found in Appendix 15.

 

Adapting this table to fit your own work should assist you in realizing how your own research can be argued to be doctoral work, both in your thesis and in your viva. Once this argument is clear in your own mind, your confidence should rise and enable you to direct your thoughts towards a really positive goal. Getting your PhD!…and not just because you want it, but because you are worthy of it! You have worked really hard for this opportunity, and seeing your work match up to this framework can really help you to visualize your successes. But now there are other things you can do to help you prepare…

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Viva tips

Just because you have submitted your thesis, this does not mean you can sit back a relax until your viva day. Following a short break, and with fresh eyes, you should be revisiting your thesis and getting to know it really well. Also, be sure to keep up to date with any new research arising in your field, it may well be discussed in your viva!

Get to know your university’s policies and procedures. This will help you to prepare for how the viva voce may play out on the day. As your examiners will be drawing upon their own expertise, make sure that you also have a broad knowledge of their work!

Pick your battles. Fighting every point can be really jarring for everyone in the room, and your examiners need to see that you can accept constructive criticism and reflect. Decide what you will really defend, and what you are willing to let go of. This means that you will need to anticipate what your examiners may ask you. Here, it is a good idea to mock up some practice questions. Try defending the questions you fear most. This will help you to face your demons and formulate your arguments….constructively. An extra tip here would be to record yourself arguing your points. How do you sound? are you believable? How do you come across?

Having your supervisor with you can be very reassuring and comforting, although they may well not be allowed to speak during your viva voce. However, try to have them sit next to you or behind you, as eye contact or some other gestures, however well meaning may put you off your game.

Once you get to the viva, be prepared to break the ice. Your examiners are not ogres. They want you to pass! Starting your viva with a warm greeting can set the tone for the session, so don’t start with your defensive wall up too high! You can also set the scene with a short presentation to cover some broad points you anticipate coming up. Use this time to also show your knowledge and demonstrate your own unique way of thinking and working.

If there has been a long gap between your thesis submission and your viva, you may now have moved on to new ways of thinking or changed your original work to move on to a new project. Remember that this new work does not count in your viva. You must remain focused on what you submitted.

If the discussion moves to really complex debates, it is important to keep your cool, remain professional and don’t turn into a robot who has learnt their responses off by heart. Also, don’t be overly humble or point out your own weaknesses directly…if they are raised by the examiners, then you can show respectful considerations to other methods, but it is still important not to shoot yourself in the foot.

Your viva can last a good few hours…it is basically a brain marathon! So you will need to prepare both mentally and physically. This means de-stressing, eating and sleeping well…and generally giving time to your own self care regime. If you need a break during the session, don’t be afraid to ask for one. If you feel overwhelmed at any time, take a constructive pause to write or read and deliberate. It can’t be an extremely emotional and draining experience.

However, some people can enjoy their viva. After all, you will be speaking about your own work with experts in the field for some time. This is a chance to show off, be proud of what you have achieved and even learn more! Thinking in this positive way may make the viva experience not seem so daunting.

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I personally found my own viva experience very daunting, emotional and stressful. However, my examiners were not ogres…they too wanted me to pass and to help me make the best of my work… Following the submission of my revised thesis, I realized how much better my thesis now is because of this viva process and the input of my examiners. Having now gone beyond the viva process, I believe that I have truly earned my PhD. I worked hard for it. It didn’t come easy. It was a brain marathon. But would a PhD really be worth having if it was easy to achieve?

I can also now reflect on this process and learn from it. It is an experience that will certainly stay with me and enrich my future work. I hope it will also enable me to improve my own examination and supervisory skills in future.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

 

 

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The #QualWorld2017 Virtual international conference, hosted by the International Institute for Qualitative Methodology (@theIIQM)

The virtual international conference, hosted by the International Institute for Qualitative Methodology (IIQM)  is the first online conference focused on the subject of qualitative research. I gravitated towards this as something new, exciting and inclusive. Plus, as my new daughter has just been born….a virtual online conference seemed to be the perfect way to share my latest work and breastfeed at the same time.

The poster I presented was:

Exploring the perceptions of new mother’s in relation to psychological distress and workplace support in midwifery. A Patient and Public Involvement study

I was representing The Centre for Innovative Research Across the Life Course at Coventry University. This work was formed in partnership with Dr. Gemma Pearce and Dr. Elizabeth Bailey, also from Coventry University.

Qual-World Interactive Virtual Conference

The conference theme was: Qualitative Research Across Boundaries

Keynote Speakers:

Prof. Amanda Kenny, La Trobe University, Australia
Prof. Trish Greenhalgh, University of Oxford, UK
Prof. Martyn Hammersley, The Open University, UK
Prof. Babette Babich, Fordham University, The Jesuit University of New York City

Here are a few snapshots of the keynote speeches…

As an early career researcher (post-doc) I really appreciated the insights shared in relation to progressing an academic career and thriving in a research centre. The idea that collaborations and publications can be planned to achieve maximum impact really appeals to me…. a few hints and tips in the right direction were very welcome.

I have yet to use or explore storytelling and narratives in my research career thus far in any great depth. As such, it was really inspiring to see how these have been used in other qualitative work. Ethnography is also an area fairly new to me, and so being introduced to new topics in this way really helped me to digest and think about new directions for my own research.

Then, to  fall in love with philosophy again was wonderful…looking at what makes science….science….within the terminology of the postmodern? Lot’s to think about here. And certainly lot’s to discuss. The online chat room was on the go throughout the conference, and on Twitter. The conversations really made me think about my own future directions in research and how it may be grounded.

Yet the best thing about this conference for me was the fact that it has been so accessible for me. Having just had a new baby girl, this conference gave me the chance to share new findings from our PPI study from the comfort of home. This meant that I could care for my baby and breastfeed whilst not missing out on the career I love. Thank you to the conference organizers for making this possible. …and thank you to the Centre for Innovative Research Across the Life Course for funding my place.

As you can see, this tweet of my experience was the most popular one of the conference… I think that these accessible conferences are really making history and showing the way for future conferences of this type.

In conclusion…I would like to reiterate the following tweet:

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

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Exploring ‘obstetric violence’ and ‘birth rape’

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Recently, the wonderful Ibone Olza (Perinatal Psychiatrist and Childbirth Activist from Childbirth is Ours, Spain) contacted me about her work on obstetric violence, birth rape and professional trauma. After reading her papers and watching her present her work, I was compelled to document and reflect upon some of the issues raised, here.

The following points are made within the paper: Fernández, Ibone Olza. “PTSD and obstetric violence.” Midwifery today with international midwife 105 (2013): 48-9.

Birth trauma has been defined as “Actual or threatened injury or death to the mother or her baby” (Beck 2008). Yet such trauma lies in the eye of the beholder, therefore, any trauma experienced by either the mother, newborn or the birth attendant may be due to a subjective experience of stress which does not need to fit any particular criteria necessarily. This means that some traumatic events may be subjective in their nature, and as such, we cannot judge what may or may not cause another person trauma. It is a personal interpretation or perception.

A meta-ethnographic analysis of studies about women’s perceptions and experiences of a traumatic birth reported that women are often traumatized as a result of the actions or inactions of midwifery staff (Elmir et al. 2010). Whatever, such inactions or actions may be…women often use words such as ‘barbaric’, ‘intrusive’, ‘horrific’ and ‘degrading’ to describe their mistreatment (Thomson and Downe 2008).

For Hodges, drugging or cutting a pregnant woman with no medical indication is an act of violence, even when performed by a medical professional in a hospital. Inappropriate medical treatment is also clearly abusive, although few women are aware that this is deliberate mistreatment (Hodges 2009).

The term ‘birth rape’ has been used by women who feel that their bodies have been violated. Kitzinger highlighted that many women who have experienced a traumatic birth display similar symptoms to rape survivors (Kitzinger 2006). The video below explores these issues in greater detail, as we can hear the lovely  Ibone Olza  sharing this work.

 

One of the things I was most encouraged about, was that  Ibone Olza  considers the wellbeing of the midwifery staff in her work. Birth attendants are often also traumatized by these acts, and may feel powerless to intervene. In a recent study by Beck, 26% of obstetric nurses met all the diagnostic criteria for screening positive for PTSD due to exposure to their patients who were traumatized (Beck and Gable 2012). Being present at  abusive deliveries can magnify staffs’ exposure to birth trauma.

staff use phrases such as…

“the physician violated her”

“a perfect delivery turned violent”

“unnecessary roughness with her perineum”

“felt like an accomplice to a crime”

“I felt like I was watching a rape.”

….to describe the guilt that ensued when they felt like they had failed women or they did not speak up and challenge/question…

Article 51 establishes that: The following acts implemented by health personnel are considered acts of obstetric violence:

  1. Untimely and ineffective attention of obstetric emergencies
  2. Forcing the woman to give birth in a supine position, with legs raised, when the necessary means to perform a vertical delivery are available
  3. Impeding the early attachment of the child with his/her mother without a medical cause thus preventing the early attachment and blocking the possibility of holding, nursing or breastfeeding immediately after birth
  4. Altering the natural process of low-risk delivery by using acceleration
    techniques, without obtaining voluntary, expressed and informed consent of the woman
  5. Performing delivery via cesarean section, when natural childbirth is possible, without obtaining voluntary, expressed, and informed consent from the woman

(D’Gregorio 2010)

trauma

Yet whilst people do bad things, it is important to remember that they are not necessarily bad people…

This work explains how professionals may exert obstetric violence due to:

  • Lack of technical skills to deal with emotional and sexual aspects of childbirth.
  • Unsolved trauma. The medicalization of childbirth produces more severe iatrogenic
    complications (Johanson, Newburn and Macfarlane 2002; Belghiti et al. 2011). If the
    professionals do not have a supportive space to reflect or to deal with this aspect of iatrogenic care, they may fall into a spiral of continuously increased medicalization as a defensive strategy. Childbirth is then perceived as a very dangerous event, “a bomb ready to explode,” without realizing that interventions cause more unnecessary interventions and pain.
  • Professional burnout in birth attendants will lead to increased dehumanized care and therefore never-ending figures of women experiencing childbirth as very traumatic.

..and so the challenge will be to identify and address these root causes to ensure that maternity staff are able to provide excellence in midwifery care. My work explores how we might support the psychological wellbeing of health care staff may increase levels of humanity and compassion in care. I hope to keep in touch with Ibone Olza and many others around the world who share the same passion for this work. Together we may collectively work towards a time where maternity workers are psychologically safer, and therefore better able to provide the excellence in care they strive to give.

If you would like to follow the progress of my work going forward..

Follow me via @SallyPezaroThe Academic MidwifeThis blog

Until next time…Look after yourselves and each other 💚💙💜❤

References and further reading

  • Soet JE, Brack GA, DiIorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth 2003 Mar;30(1):36-46.
  • Creedy DK, Shochet IM, Horsfall J. Childbirth and the development of acute trauma symptoms: incidence and contributing factors. Birth 2000 Jun;27(2):104-111.
  • Ayers S, Pickering AD. Do women get post traumatic stress disorder as a result of childbirth? A prospective study of incidence. Birth 2001 Jun;28(2):111-118.
  • Beck CT, Gable RK, Sakala C, Declercq ER. Post traumatic stress disorder in new mothers: results from a two stage U.S. national survey. Birth 2011 Sep;38(3):216-227.
  • Allen S. A qualitative analysis of the process, mediating variables and impact of traumatic childbirth. Journal of Reproductive and Infant Psychology 1998;16(2-3):107-131.
  • Beck CT, Watson S. Impact of birth trauma on breast-feeding: a tale of two pathways. Nurs Res 2008 Jul-Aug;57(4):228-236.
  • Beck CT. Post-traumatic stress disorder due to childbirth: the aftermath. Nurs Res 2004 Jul-Aug;53(4):216-224.
  • Beck CT. Birth trauma: in the eye of the beholder. Nurs Res 2004 Jan-Feb;53(1):28-35.
  • Ayers S. Delivery as a traumatic event: prevalence, risk factors, and treatment for postnatal posttraumatic stress disorder. Clin Obstet Gynecol 2004 Sep;47(3):552-567.
  • Olde E, van der Hart O, Kleber R, van Son M. Posttraumatic stress following childbirth: a review. Clin Psychol Rev 2006 Jan;26(1):1-16.
  • Elmir R, Schmied V, Wilkes L, Jackson D. Women’s perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs 2010 Oct;66(10):2142-2153.
  • Nicholls K, Ayers S. Childbirth-related post-traumatic stress disorder in couples: a qualitative study. Br J Health Psychol 2007 Nov;12(Pt 4):491-509.
  • Ayers S. Thoughts and emotions during traumatic birth: a qualitative study. Birth 2007 Sep;34(3):253-263.
  • Thomson G, Downe S. Widening the trauma discourse: the link between childbirth and experiences of abuse. J Psychosom Obstet Gynaecol 2008 Dec;29(4):268-273.
  • Goldbort JG. Women’s lived experience of their unexpected birthing process. MCN Am J Matern Child Nurs 2009 Jan-Feb;34(1):57-62.
  • Sawyer A, Ayers S. Post-traumatic growth in women after childbirth. Psychol Health 2009 Apr;24(4):457-471.
  • Hodges S. Abuse in hospital-based birth settings? J Perinat Educ 2009 Fall;18(4):8-11.
  • Kitzinger S. Birth as rape: There must be an end to ‘just in case’ obstetrics. British Journal of Midwifery 2006;14(9):544-545.
  • Beck CT. The anniversary of birth trauma: failure to rescue. Nurs Res 2006 Nov-Dec;55(6):381-390.
  • Beck CT, Gable RK. A Mixed Methods Study of Secondary Traumatic Stress in Labor and Delivery Nurses. J Obstet Gynecol Neonatal Nurs 2012 Jul 12.
  • Perez D’Gregorio R. Obstetric violence: a new legal term introduced in Venezuela. Int J Gynaecol Obstet 2010 Dec;111(3):201-202.
  • Callister LC. Making meaning: women’s birth narratives. J Obstet Gynecol Neonatal Nurs 2004 Jul-Aug;33(4):508-518.
  • Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far? BMJ 2002 Apr 13;324(7342):892-895.
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