Dr Kirsty Budds

Objective This paper explores how discourses of discretion are constructed in online discussions about breastfeeding in public. Method and Measures We analysed 4204 online newspaper comment threads from 15 UK-based publications using Discursive Psychology. We explored how discretion was constructed and mobilised to facilitate discourses of breastfeeding in public. Results Indiscretion was used to construct dispositional traits of mothers typically associated with sexualised, immoral female behaviour and therefore incompatible with ‘good’ motherhood. Responsibility for preventing public upset was placed on breastfeeding mothers, whilst discretion was constructed as easily achievable, and therefore a reasonable expectation. By implication, women who chose not to be discreet, were constructed as deliberately provocative, and so not entitled to claim or protest negative treatment. Notably, within our data the relevance of discretion when breastfeeding in public appeared discursively difficult to reject or challenge. Conclusion Our findings confirm empirically that support for public breastfeeding is constructed as contingent on mothers displaying discretion. Our analysis highlights the challenges for mothers and babies for whom breastfeeding is compromised by an unwillingness to feed in public, perhaps due to pervasive constructions of breastfeeding women as selfish, exhibitionist, inconsiderate and unfit mothers in public discourse. Finally, our findings demonstrate the practical accomplishment in everyday life of the type of constructions of breastfeeding women that have been powerfully conceptualised by previous researchers.

This Handbook takes readers through the foundational theories, functions, strategies, and approaches to qualitative research design, before showcasing how it negotiates different data and research environments and produces credible, ...

In this piece, I reflect on the current model of motherhood that prevails in Western countries, often termed ‘intensive mothering'. I will briefly trace the history of this approach, focusing in particular on how theory from developmental psychology has, to some extent, functioned to reinforce it by foregrounding the mother–child dyad and emphasizing the importance of maternal practices for children's developmental outcomes. I will then consider the particular implications of this cultural approach to motherhood for women's experiences of motherhood and maternal wellbeing. Finally, I reiterate that we need to continue to challenge this western-centric model of motherhood, which risks both isolating and overburdening women, by highlighting the ways in which both women and children benefit from wider social support systems, yet also by making it permissible for women to access social support without compromising a ‘good mother' identity. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health'.

The period before conception is increasingly claimed to be of critical importance for pregnancy and birth outcomes, prompting calls for public health advice and interventions to be targeted at women before rather than during pregnancy. Drawing on Foucault’s concepts of governmentality and technologies of the self, this article explores the implications of preconception health messages for women of reproductive age. Following a critical discursive analysis of 57 UK newspaper articles, three dominant representations of preconception health were identified: preconception health as optimizing fertility, as determining infant health, and as point of intervention. I suggest that these representations reflect neoliberal health agendas, positioning women as in control of and responsible for their fertility; the health of their future children, future generations, and of the wider population, all through careful self-policing of their lifestyles. In this way, ‘good’ preconception health is emphasized as an increasingly important form of health citizenship. Furthermore, the analysis highlights the gendered nature of these expectations, with a disproportionate focus on the potential impact of women’s preconception health. Few challenges to these dominant messages were identified, and concerns are raised about the potential impacts on the autonomy and subjectivities of women of reproductive age, regardless of pregnancy intentions.

Over the last few decades the number of women becoming pregnant later on in life has markedly increased. Medical experts have raised concerns about the increase in the number of women having babies later, owing to evidence that suggests that advancing maternal age is associated with both a decline in fertility and an increase in health risks to both mother and baby. In recognition of these risks, experts have warned that women should aim to have their children between the ages of twenty and thirty-five. As a consequence, women giving birth past the age of thirty-five have typically been positioned as older mothers. In this paper we used a social constructionist thematic analysis in order to analyse how older mothers are represented in newspaper articles in the British press. We examined how the topics of choice and risk are handled in discussions of delayed motherhood, and found that the media position women as wholly responsible for choosing the timing of pregnancy and, as a consequence, as accountable for the associated risks. Moreover, we noted that newspapers also constructed a right time for women to become pregnant. As such, we discuss the implications for the ability of women to make real choices surrounding the timing of pregnancy. © 2013 Taylor & Francis Group, LLC.

Intensive parenting debates reflect the critical importance of a child’s early years, and parents’ roles in determining later developmental outcomes. Mothers are usually assigned primary responsibility for facilitating their infants’ cognitive development through adequate and appropriate sensory stimulation. Drawing on Foucault’s technologies of the self, this article explores how new mothers shape their mothering practices in order to provide appropriately stimulating interactions. Using findings from 64 interviews (31 women were interviewed twice, 2 women were interviewed only once) three main positions are identified of how mothers function in relation to their infants’ development: mother as committed facilitator, creative provider and careful/caring monitor. The study considers the perceived normative nature of these positions and the impact they can have on middle-class women’s subjectivities as new mothers. This analysis of parental agendas and infant cognitive development suggests that a continued focus on the mother’s role within early infant development reflects and upholds ideologies of child-centred, intensive mothering, which risks precluding ‘alternative’ maternal subjectivities and promotes conservative feminine identities.

In the current research-focused climate, academics are facing increasing pressure to produce research outputs. This pressure can prove particularly daunting for early career (EC) academics, who are simultaneously attempting to master new teaching and administrative demands while establishing their own independent research trajectories. Previous reports suggest that academic writing retreats can be an effective way of increasing research outputs. Such retreats generally involve academics from a range of career stages and require expert facilitators. Through organising a series of structured writing events, this project aims to cultivate an enduring community of practice for academic writers. Reflecting on our EC retreat and subsequent writing days with academics from different career stages, we suggest that success hinged on three key factors: (1) A formal structure comprising bounded periods of intense writing, flanked by group reviewing and goal-setting; (2) Co-located writing with participants based in a shared space, away from their usual workstation and distractions; (3) Peer discussions involving participants at a similar career stage. Specifically we found that writing amongst ‘equals’ increased productivity and confidence amongst EC academics.

Over the past few decades the number of women having their first babies over the age of 35 in the United Kingdom has increased. Women’s timing of motherhood is invariably bound up with a discourse of “choice”, and in this paper we consider the role choice plays in the timing of motherhood among women who have been defined as “older” mothers. This article is based on data from 11 semi-structured interviews that explored the transition to motherhood among “older” middle-class mothers. The interviews were analysed using critical discursive psychology. The women drew upon two dominant repertoires when making sense of their timing of motherhood. Within the first repertoire, “older motherhood as circumstance”, older motherhood was presented as the outcome of life circumstances beyond their control, with a lack of the “right” circumstances facilitating “delayed” motherhood. Within the second repertoire, “older motherhood as readiness”, women constructed themselves as (now) prepared for motherhood. “Readiness” was bound up with notions of self-fulfilment, yet also assessments of their ability to be “good” mothers. We conclude that, far from a straightforward choice, the timing of motherhood is shaped by cultural definitions of the “right” circumstances for parenthood, but also cultural definitions of “good” motherhood, which may define when women are “ready”.

Teenage mothers find themselves caught between two discourses: the irresponsibility of youth and the responsibility of motherhood. We unravel some of the complexities surrounding the performance of socially approved ‘good mothering’, from a social position of restricted resources. We demonstrate the relevance of Skeggs’ notion of respectability in order to forge a deeper understanding of how young, low-income new mothers seek to secure social value and legitimacy via the marketplace. We identify a number of consumption strategies centred around identification and dis-identification, yet we recognise that young mothers’ careful marshalling of resources, in relation to consumption, risks being misread and could leave young women open to further scrutiny and negative evaluation, ultimately limiting their opportunity to secure a legitimate maternal identity.

Over the past few decades, the number of women having their first babies over the age of 35 in most developed societies has steadily increased. Concerns have been raised over this trend amidst warnings of both the increased risk of fertility problems and health risks to mother and child. Despite this, research into the timing of pregnancy in the context of decreasing fertility has been somewhat neglected, with research typically framed in biomedical rather than social terms. However, this area merits closer attention, given the contradictory nature of societal messages that simultaneously encourage women to pursue careers and enhance lifestyle, whilst warning of 'risks' of infertility and problems in 'delaying' motherhood. This article is based on a small-scale qualitative study that uses data drawn from 11 in-depth interviews with 'older mothers' about their transition to motherhood. The data were thematically analysed. We found that the women drew upon risk discourses around decreasing fertility and advancing maternal age, and that these discourses impacted on their decisions about the timing of their pregnancies. Some mothers felt that they started trying to conceive at 'non-ideal' times, owing to the expectations they held about decreasing fertility. We suggest that the impact of contradictory societal messages around the timing of motherhood need to be more clearly considered for their potential effects on the timing of pregnancy and note how this topic brings the personal, and, by implication, the societal, into conflict with the (narrated) biological. © 2013 Taylor & Francis.

This case explores the application of a combined approach to discourse analysis to the topic of ‘older motherhood’ and is based on a PhD project carried out by the first author (K.B.). In this case, we discuss the forms of discourse analysis that are generally applied within psychology, namely, Foucauldian discourse analysis and discursive psychology, and the strengths and limitations of these approaches. Furthermore, we discuss how these two approaches might be combined for the purpose of qualitative psychological research. We demonstrate how such a combined approach was developed and applied to the topic of ‘older motherhood’, and finally, we offer some guidance on how others might appropriate a similar approach in their research projects.

This paper outlines a qualitative methodological approach called Critical Discursive Psychology (CDP), considering its applicability to health psychology research. As applied to health psychology, the growth of discursive methodologies within the discipline tends to be located within a critical health psychology approach (Lyons & Chamberlain, 2006; Murray, 2014) where CDP and others enable a consideration of how wider societal discourses shape understandings and experiences of health and illness. Despite the increasing usage of CDP as a methodology, little has been written on the practical application of the method to date, with papers instead focusing on the theoretical underpinnings of a CDP approach. This paper seeks to address that gap and offers a step by step guide to the key principles and analytic stages of CDP before giving a worked example of CDP applied to a health topic, in this case ‘baby-led weaning’ (BLW). As we discuss, a key strength of CDP, particularly in relation to health psychology, is in its attempts to understand both macro and micro levels of data analysis. By doing so it offers a nuanced and richer understanding of how particular health topics are working within context. Therefore, CDP is a readily applicable analytic approach to contested and complicated topic areas within health research.

Overview of the book In this book, we take a highly pragmatic approach which first and foremost situates qualitative psychological research in applied real- world settings. There are very many excellent resources available for psychology  ...

OBJECTIVE: Women's preconception health is increasingly viewed as playing a critical role in pregnancy and birth outcomes and is becoming an increasing focus of public health messages within the UK and internationally. However, little is known about how women respond to and are impacted by preconception health messages as they try to conceive a baby. METHODS: Reflexive Thematic Analysis was used to analyse 193 responses from women in the UK to a qualitative survey on experiences of trying to conceive. As part of the survey women were asked to reflect on their engagement with preconception health practices. RESULTS: Three themes were generated: 1) Being fit for conception; 2) Preconception health and emotional labour, and 3) Interrogating preconception health expectations. CONCLUSION: The findings demonstrate that whilst engagement with preconception health changes was empowering for some, more troubling implications included: heightened self-surveillance, stress, risks to wellbeing, and feelings of responsibility for poor outcomes. This demonstrates the importance of considering the unintended consequences of preconception health messaging in the shape of increased 'reproductive burden'. Furthermore, future development of preconception health policy and practice must also consider women's access to psychological support when trying to conceive.

Background An offshoot of selfie taking is the “Brelfie” – a self-image capturing breastfeeding. Brelfie images and accompanying text are particularly useful to understanding how parents see themselves in their role within the digital age. The aim of this research was to understand how women posting #brelfies construct breastfeeding, motherhood, and identity through this modality. Methods This study used content analysis to examine 173 Instagram posts consisting of 199 Instagram breastfeeding images. The first author used open coding to create three visual representations and seven visual categories (e.g. focus on mother, child or both) from the corpus of data. An inductive interpretive thematic analysis was then performed to investigate the accompanying in post texts. Results were then analysed using chi-square tests. Although England was most prevalent, the Instagram search gleaned posts from nine other countries and posters used eight different languages. Results Content analyses indicated three types of visual image (breastfeeding portrait, breastfeeding selfie, and breastfeeding baby portrait) were tagged as brelfies, this supported the seven visual themes. Textually, three themes were developed: Breastfeeding as a Natural and Magical Journey, Breastfeeding as Female Empowerment, and Breastfeeding as a Struggle with the Desire for Support and Normalization. When analysed, breastfeeding portraits were associated with captions around the theme of female empowerment. The themes of a natural magical journey and struggle for support and normalisation were not related to any of the types of photos. Non-English language text was associated with the theme of the struggle. Conclusions This research supports the idea that mothers depict breastfeeding as largely positive, but that there are still perceived barriers and a voiced need for support. The type of brelfie presented and the language/cultural origin of the text could inform their intended message, thus helping understand how the parents see themselves. Brelfies should be encouraged to post this media to potentially help signpost to other breastfeeding parents that they are not alone in their breastfeeding journey.

Background and aims: Internet use in new mothers is common, with increasing numbers of women seeking support online in lieu of consulting health professionals. The current study sought to explore women’s experiences of using online parenting forums to seek advice and support for their maternal mental health. Although benefits of virtual support have previously been highlighted, little research has examined any potential harmful consequences of utilising online forum support for mental health concerns. Methods: New mothers (n=70) completed an online survey as a qualitative account of their motivations for, and experiences of, using online forums. Additionally, mothers were questioned about their experiences of healthcare professional support. Findings: Through reflexive thematic analysis, four themes were generated: (1) The value of shared experiences and empathy; (2) Forum dynamics – a double edged sword; (3) Contextual challenges and opportunities; and (4) Inconsistency of HCP support – the need for an instant solution. Findings emphasised the importance, and effectiveness, of this kind of virtual peer support that forums provide. For many, the responses indicated that forums have a great potential to foster an atmosphere of supportive and helpful feedback, creating a (self-reported) positive impact on postnatal mental health. However, the fact that some women experienced negative feedback led to feelings of motherhood failure on some occasions, and avoidance of posting through fear of negative responses. Conclusion and implications: These findings could inform future decisions made by both parenting website providers and healthcare professionals in making support for mothers more effective and accessible. These may include considerations around the integration of online and offline support services, and the potential increase in trained peer supporters working with mothers.

The literature has focused on women’s use of online support for perinatal mental health. However, research exploring the scope of available well-being services and the views of healthcare professionals (HCPs) who deliver this provision is extremely limited. This study focused on HCPs’ experiences providing online perinatal mental health and well-being support. Based on interviews with eight UK-based HCPs providing various forms of online perinatal mental health and well-being support, reflexive thematic analysis distilled four themes that captured experiences and perceptions of online provision: 1) New ways of working bring new opportunities; 2) Obstacles and areas for development; 3) Bridging the gap— formal and informal peer support; and 4) Too little too late: lack of mental health education in antenatal services. HCPs indicated that blended ways of working (online and face-to-face) were valuable within their services. Findings emphasize the need for online support services to be available to new and expectant mothers who may not require an HCP referral. The versatility, convenience, and accessibility of online resources bridge the gap between face-to-face services and a viable economic and effective form of mental health provision. Keywords: postpartum, mental health, health professionals, online support

BACKGROUND The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified. OBJECTIVE AND RATIONALE The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women’s QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show? SEARCH METHODS The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms ‘EHP30’, ‘EHP5’, ‘EHP-30’, ‘EHP-5’, ‘endometriosis health profile 30’, and ‘endometriosis health profile 5’. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). OUTCOMES The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs’ robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the ‘control and powerlessness’ domain post-intervention, followed by ‘pain’. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review. WIDER IMPLICATIONS Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research.

Background This scoping review was undertaken as part of an NIHR-commissioned study, APPRAISE, to develop a patient-reported outcome measure (PROM) and experience measure (PREM) to assess outcomes relevant to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI) and pelvic mesh complications surgery, with cross-cultural applicability. Objectives To identify PROMs and PREMs used to assess POP, SUI and mesh complication surgery; to compare the length, recall periods, response options of these tools and the outcomes/experiences assessed. Search Strategy Three databases searched from inception to September 2023 were screened by two independent reviewers. Selection Criteria Primary studies using subjective measures to assess POP, SUI and mesh complication surgery for women aged 16+ years were eligible for inclusion. Related systematic reviews were also reviewed. Data Collection and Analysis Data were extracted into a piloted electronic form by one reviewer and checked by a second. A narrative synthesis of the data was performed. Main Results Of the 2079 included primary studies, 1607 (77%) used a PROM with evidence of psychometric testing. Five hundred and twenty-two (25%) studies used one PROM; 1082 studies (52%) used two or more PROMs. One hundred and fifty-one measures were extracted; of these, condition-specific measures were the most highly cited. There was limited use of PROMs specific to surgery, mental health, body image and PREMs. Some outcomes (e.g., urinary symptoms, emotional wellbeing) are measured in a significantly higher proportion of PROMs than other outcomes. Conclusions Currently, no existing validated PROM evaluates all patient-reported outcomes relevant to surgery for POP, SUI or mesh complications.

The perinatal period can be challenging and yet reluctance to disclose wellbeing concerns to health professionals is well documented. The current study sought to explore how women use online parenting forums to seek advice and support for maternal mental health concerns. Forum threads (n = 153) from a popular UK parenting website were analysed to explore postpartum mothers’ discussions about their maternal mental health. Through reflexive thematic analysis, four themes were generated: (1) Navigating the motherhood role: unprepared and overwhelmed; (2) ‘I’m struggling, but looking on here I know I’m no way alone!’; (3) Challenging feelings of failure: ‘it doesn’t make you a bad mother’; and (4) Forums facilitate help seeking. There were two main findings; first, forums may act as a potential solution to providing a supportive, reassuring community and safe space for disclosure around maternal mental health concerns. Furthermore, forums are beneficial in providing women with an honest, realistic view and expectation of motherhood, thus supporting their transition to parenthood. Consequently, forums could be utilised to inform training for healthcare professionals to understand disclosure barriers.