midwives: dr. diane ménage & dr. jenny patterson...it was a powerful intervention which: •...

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

#MidwiferyForum Preventing PTSD post childbirth through compassion

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

#MidwiferyForum Preventing PTSD post childbirth through compassion

Compassionate Midwifery

• Mechanical care box ticking, bureaucratic

• Midwife/organisation’s

agenda • Directing and telling –

from a position of power

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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

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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 j.patterson@napier.ac.uk diane.menage@dmu.ac.uk @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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