Two IPA studies – one issue
Preventing PTSD post childbirth through compassion
How the interactions between women, midwives, and maternity services influence women’s childbirth experiences and subsequent trauma.
Scotland Maternity and Midwifery Festival
27th November 2019
Midwives: Dr. Diane Ménage & Dr. Jenny Patterson
Interpretative Phenomenological Analysis
Deeply exploring and interpreting
How individuals felt What the experience meant to them
(Smith, Flowers and Larkin 2009)
#MidwiferyForum Preventing PTSD post childbirth through compassion
Strongest predictor : Interpersonal factors (Harris and Ayers, 2012)
Significantly correlated with: Quality of Provider Interaction (Sorenson and Tschetter, 2010)
PTSD post childbirth
Interpersonal
Factors
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Lack of response to
Hearing both sides of the story What is your lived experience of being with each other?
Shattered expectations
Threatened & unsafe Power struggles
Workplace pressures
Torn in two
Cope by withdrawing
human needs
#MidwiferyForum Preventing PTSD post childbirth through compassion
Dysfunctional, lost or absent
relationship
Sanctuary Trauma “likely to occur when a woman turns to others, from whom she expects comfort, during or after a traumatic experience, and is subsequently treated with harshness or indifference”
(Silver, 1986)
Unmet desire for support is a significant factor in PTSD-PC
(Patterson et al., 2018)
#MidwiferyForum Preventing PTSD post childbirth through compassion
What is compassion?
‘.. a deep awareness of the suffering of oneself and other living things, coupled with
the wish and effort to relieve it..’
(Gilbert, 2009)
#MidwiferyForum Preventing PTSD post childbirth through compassion
Compassionate Midwifery was needed when women experienced
It was a powerful intervention which:
• Increased trust
• Reduced fear
• Felt safer
• Felt more able to cope
#MidwiferyForum Preventing PTSD post childbirth through compassion
suffering
Need to be seen
and heard
Need to be known and understood
Felt disempowered
The precarious fulcrum
The platform of chaos
The compassionate midwife
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Compassionate Midwifery
• Mechanical care box ticking, bureaucratic
• Midwife/organisation’s
agenda • Directing and telling –
from a position of power
#MidwiferyForum Preventing PTSD post childbirth through compassion
The opposite of Compassionate Midwifery
Conflicting ideologies
(Fox, 1999, Barker, 2011, Walsh, 2011)
QPI
surveillance
authority
knowledge
power
Vigil of care engaging
responding
trust
generosity
Care as Gift
disaffirming object denial of personhood
affirming recognition
support of personhood
#MidwiferyForum Preventing PTSD post childbirth through compassion
Conflicting ideologies
(Fox, 1999, Barker, 2011, Walsh, 2011)
QPI
surveillance
authority
knowledge
power
Vigil of care engaging
responding
trust
generosity
Care as Gift
disaffirming object denial of personhood
affirming recognition
support of personhood
What vs How
#MidwiferyForum Preventing PTSD post childbirth through compassion
Compassion
Vigil of care Care as Gift
Routine vs Remarkable
#MidwiferyForum Preventing PTSD post childbirth through compassion
Human being first Professional second
Employee third
Its not just tea!
Compassion/QPI from carer in
response to suffering
Women’s perceptions of
their experience
high
low
More negative and traumatic
More positive and empowering
high
Yes, its more complex than this! But…
Our hypothesis?
Women in Diane’s study
Women in Jenny’s study
… midwives just need to be more compassionate?
The WHELM Study (Commissioned by RCM 2018)
‘The descriptions of being unable to take a break to use the toilet or to have refreshments were shocking, even more so as they appeared to have become an accepted part of everyday practice.’
Human Rights Issue?
Exploitation
Abuse
Feminist Issue?
#MidwiferyForum Preventing PTSD post childbirth through compassion
(Rosenberg, 2015, Pezaro, 2016, Cullen, 2019, McKlusky, 2019)
• Stop transmission • Change behaviour • Change the norm
(WHO)
• Compassionate or collaborative (Non-Violent) communication
(harmful behaviour arises when we cannot meet our needs)
Hold others to
account compassionately
Self Compassion
Zero tolerance for the bullying and undermining epidemic
Responsibility to call it out
Lead / follow / get out of the way
Listen and reflect Create safe
space
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There is no compassion in midwifery without you!
#MidwiferyForum Preventing PTSD post childbirth through compassion
Thank you Dr. Jenny Patterson Dr. Diane Ménage [email protected] [email protected] @jpmidwifery @Dianethemidwife Midwife and Research Fellow Lecturer in Midwifery Edinburgh Napier University De Montford University Supervisors: Supervisors Prof. Caroline Hollins Martin, Prof. Thanos Karatzias Prof. Jane Coad, Dr. Elizabeth Bailley, Mrs Susan Lees (Coventry University).
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