This chapter examines several case studies using Coutu's three principal qualities of resilience provide a starting point for discussion: These qualities are illustrated through the use of experiential examples taken from various studies. Case studies, based on lived experiences, highlight the tensions in practice which draw out what is within and beyond the everyday practice realities and gesture to best practice that nurtures and sustains optimal psychosocial resilience in maternity care providers. The chapter suggests for individual and maternity care system psychosocial resilience are offered. Gaining perspective, seeking out social support and using reflection for self-awareness contributed to author's ability to continue and nurture author's joy of midwifery practice; attributes that have since been identified in the midwifery sustainability and resilience literature. The harshness of the practice reality in maternity care, that can often take an emotional toll on the individual, must be acknowledged and appreciated by the team of professionals and the organisation.
This chapter explores how childbirth is spiritually experienced and meaningful within society revealing how childbirth has purpose both individually and collectively. The notion of an 'ecology of childbirth' and its implications for how childbirth occurs within contemporary maternity systems is used as a point of departure in the explorations and is not intended to be taken as a fixed and inflexible notion. According to Haeckel ecology is the science of relationship of living things/beings and their environments. The rationale for using hyphens in 'being-at-birth' is to foreground the unifying quality of the phenomenon, thus 'being-at-birth' signals not how people are 'in' the event of birth, but how they 'are' the unfolding events at birth. Birth place is often referred to in terms of physical structures such as home, hospital or birth centre. Conversely the notion of birth space or atmosphere is the feeling dimension of place, an attuned space, a lived-space which is not necessarily connected to physical places.
Hypertensive disorders in pregnancy account for 12% of all maternal deaths globally. The risks of suboptimal outcomes from these disorders might be greater in rural and remote locations. These potential risks might be related to poor intra- and interprofessional communications due to geographic and digital isolation. Studies in low- and middle-income countries suggest that improving communications is essential and that mobile health (m-health) interventions can improve outcomes. However, for such interventions to be successful they must involve midwives in any design and software development. This study explored how an m-health intervention might support midwives in the management of women with pre-eclampsia in Scottish rural and remote locations.A qualitative descriptive approach was adopted. Rural and remote practising community midwives (n=18) were recruited to participate in three focus groups. The data were gathered through digital recordings of conversations at these focus groups. Recordings were transcribed and thematically analysed. Themes were agreed by consensus with the research team in an iterative process.Five principal themes were identified: 'working in isolation', 'encountering women with pre-eclampsia in rural and remote settings', 'learning on the move', 'using audio-visual resources' and 'unease with advances in technology'.Geographic and digital isolation pose significant challenges to rural midwifery practice in a high income country such as Scotland. Midwives need to be involved in the development of m-health interventions for them to be acceptable and tailored to their needs in a rural and remote context. The study highlights how m-health interventions can support continuous professional development whilst on the move with no internet connectivity. However, pride in current practice and unease with advances in mobile technology are barriers to the adoption of an m-health intervention. M-health interventions could be of value to other specialised healthcare practitioners in these regions, including general practitioners, to manage women with complications in their pregnancies.
Functioning central venous catheters (CVC) are essential for the delivery of home parenteral nutrition (HPN). Occluded CVC result in delayed treatment and increased risk of infection. Various techniques to restore patency have been described in this patient group, however the percussive POP technique has not been evaluated. The POP technique generates shock waves through the CVC loosening the obstruction, allowing it to be extracted, rather than introduced into the patient.1This study aimed to evaluate the technique in patients on HPN.
Method
Occlusions between January 2012 and December 2014 were recorded. Total occlusion indicated the CVC could not be flushed, partial indicated resistance. Techniques used to salvage the CVC and outcomes were recorded. 1st line techniques were clearing the hub of any physical matter with a 21G needle and POP technique where a 2.5 ml Luer lock syringe with 1ml 0.9% sodium chloride was attached directly to the CVC hub (tip pointing down). The plunger was then pulled up 1 ml and released. This was repeated until blood backflow or debris was seen in the syringe. 2nd line involved Urokinase 10,000 units or 70% alcohol. Primary outcome was catheter salvage. Other outcomes were CVC rupture, “ballooning” (where the CVC becomes permanently stretched), bacteraemia or recurrence of occlusion within 30 days of intervention.
Results
There were 39 occlusions (30 total, 9 partial) in 27 patients; occlusion rate 0.1 per 1000 CVC days. 25 patients had CVC, 2 patients ports. Patency was restored in 38 (97%) episodes. The 1 unsuccessful episode was a total occlusion in a port resistant to all methods. The 30 total occlusions occurred in 19 patients; 17 patients CVC, 2 patients port. Patency restored on 29 (97%) occasions. Hub clearout used in 5 (17%) episodes, in 2(7%) this was the only method used. POP technique used for 28 (93%) episodes, 3(10%) following hub clearout. Urokinase used in 4 (13%) episodes. In 2 cases patency was restored by the POP technique but with some residual resistance. Urokinase was instilled using the POP technique on 1 occasion. Alcohol was only used once and was unsuccessful. Of the 9 partial occlusions, patency was restored in all. Hub clearout alone was used in 7(78%) occasions. POP technique used in 2(22%) episodes and once with Urokinase (11%). There were no catheter ruptures, “ballooning” or bacteraemia. There was 1 recurrence of total occlusion in a patient on a trial off HPN who was non compliant with weekly CVC flushing.
Conclusion
The results indicate that restoring patency using the percussive POP technique is safe and effective. In addition, it is simple and inexpensive. Urokinase may have an additional role alongside non pharmaceutical methods, but is not often required.
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