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Background Suicide is a leading cause of maternal death during pregnancy and up to a year after birth. Psychological and psychosocial risk factors for maternal suicide ideation and behaviour have been identified but do not account for why mothers begin to experience suicidal thoughts. Qualitative research offers a way of identifying what might drive mothers to initially consider suicide and then go on to act on such thoughts; crucial for the development of assessments to identify, and interventions to target, maternal suicide ideation and behaviour. We aimed to develop a grounded theory outlining what makes women think about suicide and/or engage in suicidal behaviour during pregnancy and the first 12 months following birth? Method Semi-structured interviews were conducted with 12 mothers in the UK who had suicidal thoughts during pregnancy and/or the first year following birth. A constructivist approach to grounded theory was adopted which guided the data collection and analysis processes. Results We developed a model outlining the theorised process of psychological factors that culminates in mothers experiencing suicidal thoughts and then making a suicide attempt during the perinatal period. The process was initiated when mothers felt attacked by motherhood which led to feeling like a failure, self-identifying as a “bad mother” and subsequent appraisals of entrapment and/or defeat. When nothing resolved the distress and as mothers collated reasons for why they perceived they needed to die, suicidal behaviour became a viable and appealing option. We theorised that mothers might make a suicide attempt when they entered a state of intense “darkness” brought on by a trigger, followed by a temporary lapse in the conflict between the desire to live and desire to die and an opportunity to attempt. Conclusions Participants stressed the rapid onset of suicidal thoughts. We suggest that healthcare professionals enquire about the mother’s feelings towards the baby and of isolation, how she views herself as a mother, feelings of entrapment and defeat during routine contacts to aid identification and prevention of suicidal ideation/behaviour. Suggested interventions to prevent suicidal thoughts and behaviour include helping women manage their expectations for pregnancy and the postpartum period.

Background Suicide is the leading cause of death in mothers postpartum and one of the most common causes of death during pregnancy. Mental health professionals who work in perinatal services can offer insights into the factors they perceive as being linked to mothers’ suicidal ideation and behaviour, support offered to mothers and improvements to current practices. We aimed to explore the experiences and perceptions of perinatal mental health professionals who have worked with suicidal mothers during the perinatal period. Method Semi-structured interviews were conducted face-to-face or via telephone with mental health professionals working in perinatal mental health inpatient or community services across England. Data were analysed using reflexive thematic analysis. Results From the professionals’ ( n  = 15) accounts three main themes were developed from their interview data. The first, factors linked to suicidal ideation and behaviour , overarched two sub-themes: (1.1) the mother’s context and (1.2) what the baby represents and what this means for the mother . These sub-themes described factors that professionals assessed or deemed contributory in relation to suicidal ideation and behaviour when a mother was under their care. The second main theme, communicating about and identifying suicidal ideation and behaviour , which outlined how professionals enquired about, and perceived, different suicidal experiences, encapsulated two sub-themes: (2.1) how to talk about suicide and (2.2) types of suicidal ideation and attempts. The third main theme, reducing suicidal ideation through changing how a mother views her baby and herself , focused on how professionals supported mothers to reframe the ways in which they viewed their babies and in turn themselves to reduce suicidal ideation. Conclusion Professionals highlighted many factors that should be considered when responding to a mother’s risk of suicide during the perinatal period, such as the support around her, whether the pregnancy was planned and what the baby represented for the mother. Professionals’ narratives stressed the importance of adopting a tailored approach to discussing suicidal experiences with mothers to encourage disclosure. Our findings also identified psychological factors that professionals perceived as being linked to suicidal outcomes for mothers, such as self-efficacy; these factors should be investigated further.

The COVID-19 pandemic has had wide reaching effects especially for people with disabilities. Drawing on Sen’s Capability approach, we explored experiences of people with disabilities and older adults using semi-structured interviews that were conducted three to four months after the pandemic was declared. We recruited 71 adults from British Columbia, Canada: adults with spinal cord injuries (n = 22), adults who have experienced a stroke (n = 26), adults with general disabilities (n = 13), and older adults (over the age of 65) without reported disabilities (n = 10). Our analysis identified one overarching theme: “navigating the new normal: the societal reconfiguration of functionings and capabilities” described the challenges and successes participants experienced during pandemic-related restrictions and regulations. This theme encapsulated three sub-themes: 1) “Trying to stay connected: resuming functionings via alternative means,” 2) “Worrying about future capability opportunities,” and 3) “Wanting to exert control in the face of constrained capabilities.” The pandemic created unique challenges for people with disabilities. The capability approach appears to be a helpful lens to interpret pandemic restrictions among people with disabilities, which could inform future policy.

Background Reducing stillbirth and early neonatal death is a national priority in the UK. Current evidence indicates this is potentially achievable through application of four key interventions within routine maternity care delivered as the National Health Service (NHS) England’s Saving Babies’ Lives care bundle. However, there is significant variation in the degree of implementation of the care bundle between and within maternity units and the effectiveness in reducing stillbirth and improving service delivery has not yet been evaluated. This study aims to evaluate the impact of implementing the care bundle on UK maternity services and perinatal outcomes. Methods The Saving Babies’ Lives Project Impact and Results Evaluation (SPiRE) study is a multicentre evaluation of maternity care delivered through the Saving Babies’ Lives care bundle using both quantitative and qualitative methodologies. The study will be conducted in twenty NHS Hospital Trusts and will include approximately 100,000 births. It involves participation by both service users and care providers. To determine the impact of the care bundle on pregnancy outcomes, birth data and other clinical measures will be extracted from maternity databases and case-note audit from before and after implementation. Additionally, this study will employ questionnaires with organisational leads and review clinical guidelines to assess how resources, leadership and governance may affect implementation in diverse hospital settings. The cost of implementing the care bundle, and the cost per stillbirth avoided, will also be estimated as part of a health economic analysis. The views and experiences of service users and service providers towards maternity care in relation to the care bundle will be also be sought using questionnaires. Discussion This protocol describes a pragmatic study design which is necessarily limited by the availability of data and limitations of timescales and funding. In particular there was no opportunity to prospectively gather pre-intervention data or design a phased implementation such as a stepped-wedge study. Nevertheless this study will provide useful practice-based evidence which will advance knowledge about the processes that underpin successful implementation of the care bundle so that it can be further developed and refined. Trial registration www.clinicaltrials.gov NCT03231007 (26th July 2017)

IntroductionThe Saving Babies’ Lives Care Bundle (SBLCB) was introduced in England in 2015 and was updated in 2019 (SBLCBv2). This study aimed to describe the degree to which SBLCBv2 was implemented in practice and describe contemporary experiences of receiving and delivering antenatal and intrapartum care informed by the recommendations of SBLCBv2.MethodsThis cross-sectional questionnaire study was conducted in 28 National Health Service maternity units across England between October and December 2023. The study had two arms, one for maternity service users and one for healthcare professionals. Maternity service users aged ≥16 years who had given birth in the last 12 months were invited to participate in an online survey which contained closed questions about elements of the SBLCBv2, and two free-text questions about their experiences of receiving antenatal and intrapartum care. Maternity healthcare professionals from participating sites were invited to complete a separate questionnaire about delivering care. Responses were summarised by descriptive statistics.Results1140 women and 633 healthcare professionals participated. The majority of staff reported implementing all five elements of SBLCBv2, though this varied from 57% (prevention of preterm birth) to 99% (smoking cessation). Service users frequently reported receiving interventions that were part of SBLCBv2: 26% were offered Aspirin and 97% monitored fetal movement. Staff generally reported positive experiences of implementing the SBLCBv2, feeling that it supported clinical decision making. 89% and 86% of service users reported a positive experience in pregnancy and labour, respectively. This was underpinned by positive staff attitudes, behaviours and communication, and being listened to and involved in decisions about care.ConclusionsSBLCBv2 has been integrated into clinical practice, though some elements require additional focus to increase implementation (e.g., preterm birth). Maternity staff may benefit from additional training to discuss the reasons for and results of interventions to reduce the risk of pregnancy complications.

ObjectivesTo explore the views of maternity service users and professionals towards obstetric consultant presence 24 hours a day, 7 days a week.DesignSemistructured interviews conducted face to face with maternity service users and professionals in March and April 2016. All responses were analysed together (ie, both service users’ and professionals’ responses) using an inductive thematic analysis.SettingA large tertiary maternity unit in the North West of England that has implemented 24/7 obstetric consultant presence.ParticipantsAntenatal and postnatal inpatient service users (n=10), midwives, obstetrics and gynaecology specialty trainees and consultant obstetricians (n=10).ResultsFive themes were developed: (1) ‘Just an extra pair of hands?’ (the consultant’s role), (2) the context, (3) the team, (4) training and (5) change for the consultant. Respondents acknowledged that obstetrics is an acute specialty, and consultants resolve intrapartum complications. However, variability in consultant experience and behaviour altered perception of its impact. Service users were generally positive towards 24/7 consultant presence but were not aware that it was not standard practice across the UK. Professionals were more pragmatic and discussed how the implementation of 24/7 working had affected their work, development of trainees and potential impacts on future consultants.ConclusionsThe findings raised several issues that should be considered by practitioners and policymakers when making decisions about the implementation of 24/7 consultant presence in other maternity units, including attributes of the consultants, the needs of maternity units, the team hierarchy, trainee development, consultants’ other duties and consultant absences.

Background There is a strong evidence base for the benefits of parenting interventions for parents without severe mental illness (SMI). As the impact of maternal SMI can be significant on child development, mothers need support to maximise outcomes for themselves and their children. Some mothers with SMI require admission jointly with their baby to a Mother and Baby Unit (MBU), a psychiatric inpatient ward, for assessment and treatment. However, MBUs do not yet offer formally evaluated, evidence-based parenting interventions as a matter of routine. This paper describes a study to investigate the feasibility and acceptability of conducting a randomised controlled trial (RCT) to evaluate a parenting and psychological intervention targeting the mother’s and infant’s wellbeing for mothers admitted to a MBU. Methods/Design This study is a multisite, single-blind feasibility trial with half the participants randomised to the Baby Triple P Positive Parenting Programme plus treatment as usual (TAU) and the other half randomised to TAU alone. Self-report and observer-rated assessments are collected at baseline, 10 weeks post-baseline and 6 months post-baseline. Participants are mothers admitted to a MBU in the Northwest of England or the Midlands. Participants are included if they are fluent in English to provide informed, written consent. Our objective is to determine whether we can recruit 66 women, randomise 60, and retain them in the intervention and study, and whether the intervention and study procedures are acceptable. As part of a nested process evaluation, qualitative interview data from trial participants and MBU staff will inform feasibility and acceptability. The feasibility of collecting data required to conduct an economic evaluation of the intervention will also be explored. Discussion Although research has been conducted in relation to mothers with severe mental illness and MBUs, to our knowledge, this is the first controlled trial to test the feasibility, acceptability, uptake and retention alongside the potential efficacy of a parenting intervention for this population. This study is essential to examine the contextual challenges involved in this setting with this population and to identify any refinements required. Trial registration ISRCTN12765736 . Date of first registration: 2 February 2017.

The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people's daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC's Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants' sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants' COVID-19-related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Findings from our study will inform the development and recommendations of a new resource guide for the post-COVID-19 period and for future public health emergencies. DERR1-10.2196/28337.

Following publication of the original article [1], the authors reported that Elizabeth Camacho was omitted from the author name list.Following publication of the original article [1], the authors reported that Elizabeth Camacho was omitted from the author name list.