Sex talk? overcoming barriers about sex and contraception after childbirth

Anecdotal evidence tells professionals that childbirth is the best form of contraception. However, sexual health problems are the very common after childbirth with Barrett et al (2000) arguing that only 15% of women who have a postnatal sexual problem reported discussing it with a health professional. As health professionals with a predilection for the ‘clinical’ and the ‘prescriptive’ we organise antenatal classes to discuss bathing the baby and post partum reunions to recount birth stories, but often fail to address sexual health problems and contraception after birth.(Glazener 1997). Many women who have carefully used contraception for years prior to pregnancy are often not helped to re-engage with the issues following birth. This would seem to be a particular problem for the most vulnerable parents such as adolescent mothers and their partners (Social Exclusion Unit 1999, 2004) where some young women go on to have more than one baby in a short time period (Reeves 2003). The focus of this paper is to explore the apparent general failure of health professionals to discuss sex after childbirth and provide information regarding reliable contraception. Glazener (1997) tells us that health professionals are encouraged to educate and prepare patients antenatally, for example to be trained to identify problems and deal with them openly and sympathetically. What is brought into question is why this form of rigorous support is not extended to providing sexual health advice in the immediate and often vulnerable postnatal period and why this provision is not a priority for some groups. The paper will explore if this situation caused by a lack of training or is it a symptom of our culture and a British attitude towards sex and contraception.

Woman-centred care

Changes over the past decade have emphasised the individual service user and their relationship with the health service. Within the maternity services this has been interpreted as woman-centred care a result of key initiatives; the Winterton Report (House of Commons, 1992. Maternity Services. Second Report of the Health Committee (Winterton Report), Vol. 1. HMSO, London) and Changing Childbirth (DoH, 1993a, Changing childbirth: reports of the expert maternity group parts 1 & 2. HMSO, London). Changing Childbirth outlined key principles of the maternity services and the need for the woman (and her partner, if she wishes) to be the focus of care. The key principles are choice, continuity and control. High quality care depends on the recognition of individuals as having unique needs which continues to be reflected within contemporary policy documents (DoH, 1997, The new NHS: modern and dependable. HMSO, London). This paper presents findings related to the provision of woman-centred care from a national research and development study. The study design incorporated (i): a national survey which was undertaken with midwives, midwife supervisors and doctors; and (ii): in-depth case studies in which information was obtained through interviews with midwives, midwife supervisors, educators, managers, doctors and mothers. Midwives, at all levels, are involved in changing maternity service provision and adapting to new systems of care which aim to increase continuity of care and carer for the woman. The researchers sought to understand how woman-centred care was interpreted and experienced in practice. The findings have been used to identify the continuing educational needs of midwives, and to develop an open learning educational package to meet identified need. The curriculum was designed to enhance the move towards the provision of a more integrated woman-centred service.

Critical care in childbearing for midwives

Many women who have higher–risk pregnancies, complications or medical conditions require specialist obstetric or multidisciplinary care. Increasingly women, whose condition deteriorates and becomes critical during childbirth, are being cared for by midwives in obstetric high dependency units within the labour ward, rather than being cared for by nurses in ITU. Critical Care in Childbearing for Midwives explores all aspects of management, support and care of childbearing women who become critically ill due to pre–existing conditions or who develop critical illness as a result of complications of childbearing. It examines predisposing factors which result in the need for critical care, addresses specialist monitoring technology and skills, and explores autonomous practice and team approaches to providing care for critically ill women in childbearing.