Commercial ultrasounds: Blurring and renegotiating boundaries in prenatal care.

In 2019, NHS England launched the second version of the Saving Babies' Lives Care Bundle (SBLCBv2), recommendations that maternity providers are expected to fully implement, in an ongoing effort to reduce stillbirths and preterm births. Although stillbirth rates have seen an overall significant reduction since the inception of the SBLCB, experiences of maternity care in England are deteriorating. This study aimed to explore service users' experiences of SBLCBv2-informed maternity care to help understand the aspects of care they received positively and those needing improvement. This qualitative study captured service users' experiences of receiving maternity care across England between November 2022 and December 2023. Purposive sampling was employed to include service users from diverse backgrounds with a variety of experiences of each element of SBLCBv2. Participants (n=29) were 16 years or older, had given birth within the previous 12 months and could comprehend and speak English. Semi-structured interviews were conducted via video call and the data analysed using reflexive thematic analysis. Four main themes with nine subthemes were developed: (1) feelings towards measuring and monitoring, (2) the importance of clear communication, (3) healthcare professionals' roles in decision-making and (4) belief in service users, trust in healthcare professionals. Each theme is discussed in relation to the five elements, and the 'Important Principles', of SBLCBv2. Our findings echo maternity care needs reported elsewhere in the literature, suggesting the interventions introduced in SBLCBv2 are generally acceptable but that information about SBLCBv2 must be personalised, and clearly presented, to each individual. Professionals play an important role in service users' decision-making, and participants' perceptions of how collaborative and supportive professionals were in decision-making processes varied. Believing service users and trusting professionals are of paramount importance for ensuring service users have positive maternity care experiences.

To investigate factors influencing maternal health care utilisation in western rural China and its relation to income before (2002) and after (2007) introducing a new rural health insurance system (NCMS). Data from cross-sectional household-based health surveys carried out in ten western rural provinces of China in 2003 and 2008 were used in the study. The study population comprised women giving birth in 2002 or 2007, with 917 and 809 births, respectively. Correlations between outcomes and explanatory variables were studied by logistic regression models and a log-linear model. Between 2002 and 2007, having no any pre-natal visit decreased from 25% to 12% (difference 13%, 95% CI 10-17%); facility-based delivery increased from 45% to 80% (difference 35%, 95% CI 29-37%); and differences in using pre-natal and delivery care between the income groups narrowed. In a logistic regression analysis, women with lower education, from minority groups, or high parity were less likely to use pre-natal and delivery care in 2007. The expenditure for facility-based delivery increased over the period, but the out-of-pocket expenditure for delivery as a percentage of the annual household income decreased. In 2007, it was 14% in the low-income group. NCMS participation was found positively correlated with lower out-of-pocket expenditure for facility-based delivery (coefficient -1.14 P < 0.05) in 2007. Facility-based delivery greatly increased between 2002 and 2007, coinciding with the introduction of the NCMS. The rural poor were still facing substantial payment for facility-based delivery, although NCMS participation reduced the out-of-pocket expenditure on average.

Background: Reflexive thematic analysis is widely used in qualitative research published in Palliative Medicine, and in the broader field of health research. However, this approach is often not used well. Common problems in published reflexive thematic analysis in general include assuming thematic analysis is a singular approach, rather than a family of methods, confusing themes and topics, and treating and reporting reflexive thematic analysis as if it is atheoretical. Purpose: We reviewed 20 papers published in Palliative Medicine between 2014 and 2022 that cited Braun and Clarke, identified using the search term ‘thematic analysis’ and the default ‘relevance’ setting on the journal webpage. The aim of the review was to identify common problems and instances of good practice. Problems centred around a lack of methodological coherence, and a lack of reflexive openness, clarity and detail in reporting. We considered contributors to these common problems, including the use of reporting checklists that are not coherent with the values of reflexive thematic analysis. To support qualitative researchers in producing coherent and reflexively open reports of reflexive thematic analysis we have developed the Reflexive Thematic Analysis Reporting Guidelines (the RTARG; in Supplemental Materials) informed by this review, other reviews we have done and our values and experience as qualitative researchers. The RTARG is also intended for use by peer reviewers to encourage methodologically coherent reviewing. Key learning points: Methodological incoherence and a lack of transparency are common problems in reflexive thematic analysis research published in Palliative Medicine. Coherence can be facilitated by researchers and reviewers striving to be knowing – thoughtful, deliberative, reflexive and theoretically aware – practitioners and appraisers of reflexive thematic analysis and developing an understanding of the diversity within the thematic analysis family of methods.

New guidelines in the Consensus Statement on Management of Intersex Disorders by the Lawson Wilkins Pediatric Endocrine Society/European Society for Paediatric Endocrinology Consensus Group 2006 introduced multidisciplinary teams (MDTs) to provide care that involves collaboration between healthcare professionals, parents, and children with variations of sex characteristics (VSC). The aim of this study was to examine a neglected but important field of collaboration among healthcare professionals and peer support groups who provide care for people with VSC. The study outcome was the information obtained regarding the actual composition and collaboration of the multidisciplinary teams caring for children with VSC, including their collaboration with parents, peer support groups, and other care providers. In this study we used an exploratory qualitative design based on mixed focus groups (in terms of professional background) and reflexive thematic analysis. Semi-structured focus group interview guides were used to obtain information about the participants' viewpoints on the composition and challenges of, and collaboration between, peer support groups and members of multidisciplinary teams working to care for children with VSC and their parents. Seven focus groups were conducted with healthcare professionals and peer support groups in care teams in Central, Northern, and Western Europe. The data from the focus groups were examined using reflexive thematic analysis. The participants in the focus groups provided information regarding the use of multidisciplinary and interdisciplinary child- and family-oriented approaches and the strengths and challenges of collaboration and peer support groups. The results showed that the teams used a predominantly multidisciplinary approach and suffered from a lack of psychosocial providers, poor collaboration with peer support groups, and poor implementation of shared decision-making to address the clinical uncertainty of parents and people with VSC. Clinicians should provide more psychosocial support and improve collaboration with peer support groups and nonmedical professionals. This study is one of the first qualitative studies to provide information on the collaboration of multidisciplinary teams working to provide care for children with VSC and collaborate with their parents in the European context. However, due to language barriers, the dropout rate of participants, and the under-representation of peer support groups in the sample there was a lack of information on collaboration among healthcare professionals and peer support groups. The collaboration between MDTs and parents does not involve adequate psychosocial and peer support or shared decision-making to address the uncertainty experienced by children and families when faced with information about variations of sex characteristics.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

A transparent analytical process contributes to the methodological rigor of reflexive thematic analysis. To enhance such transparency in reflexive thematic analysis, novice researchers need to document and present the analytical processes of theme development. In this article, we showcase how qualitative comparative analysis can be integrated into reflexive thematic analysis as a strategy for novice researchers. We demonstrate how novice researchers can develop codes and categories, use qualitative comparative analysis to facilitate the exploration of the complex causal relationships between categories, and construct candidate themes based on these analyses. We then show how novice researchers can continue developing these themes by creating relationships between codes and categories on the basis of qualitative data and existing literature. Such integration of methods not only facilitates theme development, but also assists researchers in justifying the decisions made in a reflexive thematic analysis process. The analytical procedures presented in this article may thus help novice researchers engaged in reflexive thematic analysis to enhance the transparency of their analytical process.

Course leaders in rehabilitation healthcare professionals' higher education face challenges stemming from multi-disciplinarity and the co-existence of different stakeholders. So far, the literature mainly attributed to course leaders' managerial tasks, neglecting other fundamental transversal skills. Students represent an essential source of information for understanding the expected characteristics and roles of course leaders in rehabilitation healthcare degree programmes. This study explored students' expected features of the course leaders in the rehabilitation healthcare professionals' higher education. A qualitative interview study was carried out. A group of recent graduates and students of the MSc in 'Healthcare Professionals Rehabilitation Sciences' (University of Verona, Verona, Italy) was recruited using purposive sampling. Data were analysed using 'Reflexive Thematic Analysis' by Braun & Clarke. Ten healthcare professionals agreed to partake in the study (age 30 ± 9; men N = 2; women N = 8). Five themes were generated from the analysis: 1) 'A Collaborative Manager', as students perceived course leaders as non-authoritarian managers who involved all the stakeholders in the decision-making process addressing aspects such as curriculum adjustments, program improvements, and any challenges faced; 2) 'A Diplomatic yet Honest Communicator', as students needed course leaders capable of communicating transparently; 3) 'A Flexible Mediator', as course leaders should actively listen to all stakeholders, mitigating conflicts; 4) 'An Empathic and Available Guide', as students need course leaders available and ready to help; 5) 'An Experienced Healthcare Professional', as students felt course leaders should have a clinical background related to the course they lead. The results of this study suggested that students expect the course leaders to have a wide range of qualities and attitudes about soft (i.e., adaptation, communication, organisation skills, teamwork) and hard skills (i.e., clinical experience, evidence-based practice updated). They expect a course leader to consider all stakeholders' needs and preferences to guarantee course harmony and satisfaction.

Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.

Shared decision making (SDM) is core to person-centered care and is associated with improved health outcomes. Despite this, there are no validated scales measuring women’s agency and ability to lead decision making during maternity care.ObjectiveTo develop and validate a new instrument that assesses women’s autonomy and role in decision making during maternity care.DesignThrough a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making.Setting and participantsPregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples.Main outcome measuresWe assessed reliability, item-to-total correlations, and the factor structure of the The Mothers’ Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making.ResultsThe MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (<15 minutes). Among women who preferred to lead decisions around their care (90.8%), and who were dissatisfied with their experience of decision making, MADM scores were very low (median 14). Women with physician carers were consistently more likely to report dissatisfaction with their involvement in decision making.DiscussionThe Mothers Autonomy in Decision Making (MADM) scale is a reliable instrument for assessment of the experience of decision making during maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women’s ability to lead decision making, whether they are given enough time to consider their options, and whether their choices are respected. Women who experienced midwifery care reported greater autonomy than women under physician care, when engaging in decision-making around maternity care options. Differences in models of care, professional education, regulatory standards, and compensation for prenatal visits between midwives and physicians likely affect the time available for these discussions and prioritization of a shared decision making process.ConclusionThe MADM scale reflects person-driven priorities, and reliably assesses interactions with maternity providers related to a person’s ability to lead decision-making over the course of maternity care.

Nonsyndromic craniosynostosis is a congenital condition causing abnormal skull shape and growth, that is typically surgically treated in the first year of life. Parents of children diagnosed with craniosynostosis endure parental stress and complex emotional responses to their child's diagnosis and treatment. This study examines the psychosocial experiences of parents and their support needs across the diagnostic and perioperative period. Semi-structured interviews with 17 Australian families who had a child diagnosed with nonsyndromic craniosynostosis were undertaken. Reflexive thematic analysis, conducted with an inductive and social-constructionist epistemological approach, generated 5 themes. These themes were: (1) the journey begins; (2) the advocate; (3) waiting for surgery; (4) traveling on the "right" path; and (5) the "different" child. Challenges faced by parents across their journey were multi-faceted and disproportionately impacted mothers. Health care professionals must be responsive to parent support needs and attend to the provision of psychological support for families affected by appearance-altering surgery. Findings highlighted the value of interinstitutional collaboration between Australian craniofacial units, and the importance of family-oriented approaches to care.

Objective Previous research exploring patient-practitioner communication in relation to adherence in cystic fibrosis (CF) is limited. This UK study explored the views of adults with CF on how treatment adherence (related to all CF treatments) is discussed in routine CF care. Methods 12 White British adults (ten females; aged 20–37 years; mean 30.1 years) with CF participated in semi-structured interviews. Results Three overarching themes were developed through reflexive thematic analysis: (1) ‘The power of language’; (2) ‘Healthcare professionals do not recognise the importance of context’; and (3) ‘“Admitting” non-adherence is difficult’. The way in which adherence is discussed in adult CF care is viewed as paternalistic and infantilising. Participants reported that healthcare professionals do not always consider the desire to balance treatment-taking with living a normal life. Unwelcome responses from healthcare professionals, and the inability to accurately self-report the amount of treatment taken made it difficult to ‘admit’ non-adherence. Conclusions A culture change is needed in CF care such that people who struggle to take their treatments are not labelled as disobedient, wilfully disobeying orders from healthcare professionals in positions of authority. Instead, an open, honest, non-judgemental approach, as recommended by healthcare agencies for over a decade, should be adopted.

Background and Aims Loin pain in immunoglobulin A nephropathy (IgAN) is not included in standard reports of clinical manifestations or management of IgAN, and notably has not been a focus for research. Loin pain is a commonly reported symptom by patients with IgAN, yet there is little known about the frequency of loin pain, the impact of loin pain on quality of life or appropriate strategies to manage loin pain. This research aims to explore detailed experiences and perceptions of loin pain in patients with IgAN through one-to-one interviews with patients, loved ones of patients with IgAN, and healthcare professionals working with patients with IgAN, to highlight the impact, individual differences in experiences, and contextual factors of loin pain. Method Qualitative materials were co-developed and reviewed with both kidney experts and a patient and public involvement and engagement group of IgAN patients and family. Participants were recruited from the United Kingdom via advertisement in IgAN social media, within a UK Rare Kidney Disease Registry (RaDaR) survey, charity newsletters, and professional kidney networks. 48 remote individual semi-structured interviews asking about perceptions and experiences of IgAN and loin pain were conducted, which included 21 patients, 13 family members, and 14 kidney healthcare professionals. Of these, 33/48 were conducted by Microsoft Teams and 15/48 by telephone based on participant preference following informed consent and all participants were debriefed following the interview. Interviews were audio-recorded via encrypted dictaphone and transcribed verbatim. Data was coded inductively with reflexive thematic analysis by two researchers, one with clinical IgAN experience. Results Following guidelines for reflexive thematic analysis, themes were developed that encompassed the individual, group, and overall perceptions and experiences of loin pain in IgAN. Five themes were developed: (i) ‘Achy pain’ in the ‘kidney area’, (ii) Managing pain with limited options, (iii) Pain as a warning: anxiety of declining kidney function, (iv) Impact to daily life dependent on severity, (v) Differing opinions between patients and healthcare professionals. Individual differences in experiences were discussed, with contrast between patient and family perspectives and healthcare professional reports. Most cases of loin pain were mild or moderate, however, concern for whether the loin pain was a symptom of kidney function decline was distressing for many patients and their families. Healthcare professionals report not being concerned about loin pain in IgAN and view it as rare. Conclusion This study provides important context to understand experiences of loin pain in IgAN patients, with key findings on loin pain description, management, and impact. Patients and their family report feeling uninformed and unsupported, and identify communication conflict with healthcare professionals as a key barrier to loin pain management.

Ultrasound (US) imaging is an essential diagnostic technique in prenatal care, enabling enhanced surveillance of fetal growth and development. Fetal ultrasonography standard planes are crucial for evaluating fetal development parameters and detecting abnormalities. Real-time imaging, low cost, non-invasiveness, and accessibility make US imaging indispensable in clinical practice. However, acquiring fetal US planes with correct fetal anatomical features is a difficult and time-consuming task, even for experienced sonographers. Medical imaging using AI shows promise for addressing current challenges. In response to this challenge, a Deep Learning (DL)-based automated categorization method for maternal fetal US planes are introduced to enhance detection efficiency and diagnosis accuracy. This paper presents a hybrid optimization technique for feature selection and introduces a novel Radial Basis Function Neural Network (RBFNN) for reliable maternal fetal US plane classification. A large dataset of maternal–fetal screening US images was collected from publicly available sources and categorized into six groups: the four fetal anatomical planes, the mother's cervix, and an additional category. Feature extraction is performed using Gray-Level Co-occurrence Matrix (GLCM), and optimization methods such as Particle Swarm Optimization (PSO), Grey Wolf Optimization (GWO), and a hybrid Particle Swarm Optimization and Grey Wolf Optimization (PSOGWO) approach are utilized to select the most relevant features. The optimized features from each algorithm are then input into both conventional and proposed DL models. Experimental results indicate that the proposed approach surpasses conventional DL models in performance. Furthermore, the proposed model is evaluated against previously published models, showcasing its superior classification accuracy. In conclusion, our proposed approach provides a solid foundation for automating the classification of fetal US planes, leveraging optimization and DL techniques to enhance prenatal diagnosis and care.

Many women start pregnancy with obesity. It is also common for women to gain excess weight during pregnancy, and many find it challenging to lose this weight after birth. Pregnant and postnatal women may seek weight management support through online discussion forums. This study aimed to explore the experiences and views of weight and weight management in pregnant and postnatal women living with excess weight through analysing discussion forum posts on UK website, Mumsnet. Data from Mumsnet discussion forum posted from 7th July 2021 to 7th March 2022 were extracted and included in analysis if they pertained to the experiences of, or views on diet, exercise, or weight management of users with self-reported excess weight during pregnancy or within one-year postnatal. Data were analysed using reflexive thematic analysis. In all, 113 posts were included. Generally, users had poor awareness of gestational weight gain recommendations. Some reported trying to lose weight during pregnancy (Theme 1: Intentions to lose weight while pregnant: conflicting advice and limited awareness of clinical guidelines). Users shared strategies to manage their weight during and after pregnancy, and specific challenges to this (Theme 2: Approaches and challenges to managing weight during and after pregnancy). Users had mixed experiences of engaging with maternity healthcare professionals and services. Users under consultant-led care reported their concerns about the impact of their weight were dismissed and minimised by healthcare professionals (Theme 3: Mixed experiences of interactions with maternity healthcare services and professionals and unaddressed concerns). Analysing posts on Mumsnet provided insight into the relatively underreported intention of trying to lose weight while pregnant which is not endorsed by clinical guidelines. It also highlighted the potential for online forums to promote these unendorsed practices. Maternity care professionals should be aware of this and use their encounters with women to discourage intentional weight loss while pregnant. Users under consultant-led care felt that their concerns about their weight were minimised by professionals. Support such as regular weighing was desired but not often provided. Future studies should explore how these aspects of care can be improved.

Healthcare professionals (HCPs) have been identified as key messengers for disabled adults in promoting physical activity (PA). However, few studies revealed the disabled adults’ views and preferences for HCPs in PA. This study aimed to understand disabled adults’ perceptions and experiences of the role of HCPs in promoting PA in China. Forty-one Chinese disabled adults participated in one-to-one semi-structured interviews, recruited by three purposive sampling strategies: maximum variation, criterion-based and snowball sampling. Data from interviews were analysed using reflexive thematic analysis. Three themes were identified: (1) mastery beyond the medical, (2) title clarification within a HCP hierarchy, and (3) balancing medical and lay words with accessibility. Participants valued the role of HCPs in integrating PA within medical care but noted gaps such as insufficient guidance on transitioning PA to daily life, lack of diverse options, and limited support for fostering autonomy in PA quality participation. Misunderstandings about HCP roles hindered effective healthcare interactions, while clear, disability-sensitive communication was essential for building trust and fostering PA participation. This study highlights the need for HCP training to improve personalised PA guidance, role clarity, and communication skills alongside policy changes to better support disabled adults in PA participation. Additionally, future research should involve a broader sample to improve these PA strategies and assess their impact.