Experiences of Impacted Foetal Head: Findings from a Pragmatic Focus Group Study of Mothers and Midwives
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Ethical Considerations
2.3. Setting
2.4. Participants and Recruitment
2.5. Data Collection
2.6. Data Analysis
3. Results
3.1. Current Knowledge of Impacted Foetal Head
3.2. Current Management of Impacted Foetal Head
3.3. Experiences and Outcomes of Impacted Foetal Head
4. Discussion
4.1. Main Findings
4.2. Strengths, Limitations, and Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Core Principles of the Tydeman Tube | To Improve Outcomes for Mother and Baby in the Second Stage of Labour | To Reduce the Risk of Trauma to Mother and Baby in Complicated Births | To Increase Respectful Care for Women in Labour | ||||||
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Preliminary template | Patient perspectives of complicated birth | Devices to deliver the foetal head | Manoeuvres to deliver an impacted foetal head | Expectation of trouble delivering the foetal head | Midwives’ role in management of impacted foetal head | Experience of impacted foetal head | Experience of ‘pushing up’ | Debriefing after complicated birth | How partners coped |
Final template | Current Knowledge of Impacted Foetal Head | Current Management of Impacted Foetal Head | Experiences and Outcomes of Impacted Foetal Head | ||||||
Supporting data | From a patient’s perspective I think all they want is something that works………and is… you know, poses least risk to them or their baby…………. that any new thing needs properly investigating and researching to check how good it is before being introduced (Woman 1) My midwife was incredible though she stayed close by at all times and kept talking to me even when she needed to do other stuff……..her voice was really calming….. and of course [Doctor name] kept up a running commentary throughout [laughs] (Woman 2) I agree, I think any new thing that might make any part of labour and birth………. well, any bit of pregnancy safer and easier should be researched and once the evidence is available for doctors, midwives, and women to make proper choices, introduced, or not according to what is discovered (Woman 4) [Tydeman Tube]……….. I like the head and the fact it is flexible………….and does not look too big………. I think it looks more likely to work than the foetal pillow, you know……. just looking at it……… The handle is good too……I can see that even if I have to push up from below I will be outside the mum………still under the drapes possibly [laughs] but then I probably would be with the Foetal Pillow too [laughs]………..I’d like to see it work. (Midwife 1) …well anything that improved outcomes for mums and babies has got to be good………. I would want to see it [foetal pillow] first and again, maybe in mandatory training, have the chance to make sure I knew how to use it before being faced, you know, needing to use it, …. in the situation. (Midwife 2) | I was warned it could be tricky because of the forceps not working. ……But to be honest by that stage I just wanted it all to be over……………I’m not sure I understood what the doctor meant when he said that… (Woman 5) I am also aware that sometimes the team’s body language gives them away. You know, the anxious look in the eyes, the way people move, all those sort of things that partners, and women actually, really pick up on, but for staff are so very difficult to hide…………..I’m not sure how we deal with those, so I guess a device that might make the situation easier will help with that too. (Midwife 1) I don’t think any of us like being asked to do that………………..I was never trained how to do it…………..so I always,… always worry about the pressure on the baby’s head………I also have fairly short fingers so also worry about whether I am doing enough, …….or maybe anything at all (Midwife 2) I think we are also lucky here that we are a team that have you know worked together for years, we are all very much part of the community and as a team we support each other,……….I’m not sure that happens everywhere, so you know, if there is a difficult case, and you know in this situation babies have been damaged, and mothers too, I really feel that here we would all support the parents, obviously, but also support each other, you know get each other through it (Midwife 2) I think we need to go back to training both undergraduate and ongoing……………I’ve been qualified and working as a midwife for a while now, and I was certainly never taught how to push up from below, or indeed any management of the impacted foetal head……… I guess it must be covered in medical school, but having said that, many of the juniors do not seem to have been taught it, it comes as a shock when they actually have the problem in theatre. Maybe if there are going to be new devices one of the benefits of that will be, you know will be that difficult caesarean birth gets on the curriculum for both midwives and doctors (Midwife 4) | It was the midwife who told me ……….when she was checking the baby she said she was looking for bruising, which might come out later because they had had a bit if trouble getting the [babies name] head out……………..I just thought oh, OK (Woman3) But seriously,…I think he [partner] was quite traumatised by the experience overall………..as I said before [Dr name] was really calm throughout and I think he was reassured by that……….he didn’t realise the doc was probably really worried as he had this unexpected issue with a staff member [laughs] (Woman 4) yeah, yeah I think mine [partner] was freaked out in general by the time we got to theatre, and he was really upset when the baby couldn’t be born with the forceps…………I’m not sure we really discussed the actual, you know, the actual operation, the process at all (Woman 5) Yes…… my midwife did that too, she sort of disappeared under the drapes but I was not sure what was going on…………….good job the spinal was working [laughs] (Woman 5) From a staff point of view it is always difficult to gauge how the partner is doing at times like this, you know when you know there is a little complication and you are very aware that the partner is witnessing the whole thing, so you need, you know to give some explanation to him, but you don’t want to freak him out further… (Midwife 1) I think assisting at these sections…you know in when the head is wedged should be included in training………..not just basic training, but you know mandatory training…………it should be something you practice like shoulder dystocia and PPH…………..especially if you are not regularly working on the labour ward (Midwife 4) |
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Briley, A.L.; Silverio, S.A.; Shennan, A.H.; Tydeman, G. Experiences of Impacted Foetal Head: Findings from a Pragmatic Focus Group Study of Mothers and Midwives. Int. J. Environ. Res. Public Health 2023, 20, 7009. https://doi.org/10.3390/ijerph20217009
Briley AL, Silverio SA, Shennan AH, Tydeman G. Experiences of Impacted Foetal Head: Findings from a Pragmatic Focus Group Study of Mothers and Midwives. International Journal of Environmental Research and Public Health. 2023; 20(21):7009. https://doi.org/10.3390/ijerph20217009
Chicago/Turabian StyleBriley, Annette L., Sergio A. Silverio, Andrew H. Shennan, and Graham Tydeman. 2023. "Experiences of Impacted Foetal Head: Findings from a Pragmatic Focus Group Study of Mothers and Midwives" International Journal of Environmental Research and Public Health 20, no. 21: 7009. https://doi.org/10.3390/ijerph20217009