ORCID Profile
0000-0002-3749-3473
Current Organisation
Coventry University
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Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.WOMBI.2018.03.002
Abstract: Exposure to alcohol prenatally can result in a child being diagnosed with fetal alcohol spectrum disorder. Affected infants experience lifelong impairments that can involve, physical, cognitive, behavioural and emotional difficulties that impact on their functional capacity. Effective prevention of fetal alcohol spectrum disorder is critically needed in Australia. Reduction in the prevalence of this disorder will only be possible if we prevent alcohol consumption during pregnancy. This paper provides an overview of fetal alcohol spectrum disorder and discusses the role of caseload midwifery as part of a multi-level prevention approach. Drawing on previous research, caseload midwifery has potential to support the prevention of fetal alcohol spectrum disorder through continuity of care. Prevention of fetal alcohol spectrum disorder will be more likely if women experience a supportive relationship with a known midwife, who has received appropriate training and can enable women to feel comfortable in discussing and addressing alcohol use.
Publisher: Wiley
Date: 27-08-2004
Publisher: Wiley
Date: 10-2006
DOI: 10.1111/J.1365-2648.2006.03991_1.X
Abstract: This paper is a report of a study to describe the childbirth expectations, influences and knowledge of a group of Western Australian women who experienced a cesarean section (CS) and would prefer a CS in a subsequent pregnancy. Evidence suggests that a previous CS is not an indication for an elective CS in a subsequent pregnancy, but western world data indicate high probability of repeat CS. Community advertisements invited women who had experienced a CS to participate in a telephone interview. The thematic analysis presented in this paper is derived from data collected during 2003/2004 from 49 participants who had initially expected to birth vaginal but had a CS and who had planned a CS in a subsequent pregnancy or stated that they would choose this option in a future pregnancy. Before the first CS most women expected and wanted to give birth normally. After having a CS, however, many reframed vaginal birth as uncertain, unsafe and unachievable. For this group of women, the medical discourse that promoted CS as the safest option was a major influence on their decisions. As a result, they reconstructed CS as an acceptable alternative that was safer for them and their babies, allowed them to be better prepared, and was convenient. In the present climate, enabling women to keep birth 'fear' in perspective may be an important strategy if we are to improve the uptake of vaginal birth after CS and the quality of care offered to women during the normal, but major, life event of childbirth.
Publisher: American Psychological Association (APA)
Date: 08-2012
DOI: 10.1037/A0028781
Abstract: This study evaluated the effectiveness of couple relationship education in assisting couples to sustain relationship functioning and parenting sensitivity, and whether benefits were moderated by risk of maladjustment in the transition to parenthood ("risk"). Two hundred fifty couples expecting their first child were assessed on risk and randomly assigned to either the Couple CARE for Parents (CCP), a couple relationship- and coparenting-focused education program (n = 125), or the Becoming a Parent Program (BAP), a mother-focused parenting program (n = 125). Couples completed assessments of their couple relationship during pregnancy, after intervention at 4 months postpartum, and at 16 and 28 months postpartum. Observed parenting and self-report parenting stress were assessed at 4 months postpartum, and parenting stress was assessed again at 16 and 28 months postpartum. Risk was associated with greater relationship and parenting adjustment problems. Relative to BAP, CCP women decreased their negative communication and showed a trend to report less parenting stress irrespective of risk level. High-risk women receiving CCP reported higher relationship satisfaction, and were less intrusive in their parenting, than high-risk women receiving BAP. There were no effects of CCP on sensitive parenting and parenting intrusiveness for women. High-risk men in CCP showed a trend for higher relationship satisfaction than high-risk BAP men, but there were no effects of CCP for men on any parenting outcomes. CCP is a potentially useful intervention, but benefits are primarily for high-risk women.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2021
Publisher: Elsevier BV
Date: 09-2009
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.WOMBI.2015.11.002
Abstract: The Australian national midwifery education standards require students to complete a number of continuity of care (COC) experiences. There is increasing evidence outlining the value of this experience to the student, but there is limited research examining women's experiences of having a COC midwifery student. This study aimed to investigates the woman's experiences. A retrospective descriptive cohort design was used. A paper-based survey was posted to all women cared for by a midwifery student in 2013 (n=698). Descriptive statistics were used to explore the proportion, mean score, standard deviation and range of the variables. Construct validity of the Satisfaction and Respect Scales was tested using exploratory factor analysis. Free text responses were analysed using latent content analysis. One-third of women returned a completed survey (n=237/698, 34%). There was a significant positive correlation (p<0.05) between the number of AN/PN visits a midwifery student attended and women's levels of satisfaction. Women were very satisfied with having a student midwife provide continuity. The qualitative data provided additional insight demonstrating that most women had a positive relationship with the midwifery student that enhanced their childbearing experience. The women in this study valued continuity of midwifery care and were able to form meaningful relationships with their midwifery student. Programs leading to registration as a midwife should privilege continuity of care experiences. Not only does this benefit women but provides the future midwifery workforce with a clear understanding of models that best meet women's in idual and the benefits of working in these models.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.NEPR.2016.06.007
Abstract: Education programs leading to professional licencing need to ensure assessments throughout the program are constructively aligned and mapped to the specific professional expectations. Within the final year of an undergraduate degree, a student is required to transform and prepare for professional practice. Establishing assessment items that are authentic and able to reflect this transformation is a challenge for universities. This paper both describes the considerations around the design of a capstone assessment and evaluates, from an academics perspective, the quality and applicability of an e-portfolio as a capstone assessment item for undergraduate courses leading to a professional qualification. The e-portfolio was seen to meet nine quality indicators for assessment. Academics evaluated the e-portfolio as an authentic assessment item that would engage the students and provide them with a platform for ongoing professional development and lifelong learning. The processes of reflection on strengths, weaknesses, opportunities and threats, comparison of clinical experiences with national statistics, preparation of professional philosophy and development of a curriculum vitae, whilst recognised as comprehensive and challenging were seen as highly valuable to the student transforming into the profession.
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.WOMBI.2013.05.001
Abstract: To describe the health service utilisation and birth outcomes of pregnant women with moderate to super-extreme obesity. Maternal obesity is increasingly recognised as a key risk factor for adverse outcomes for both women and their babies. Little is known about the service utilisation and perinatal outcomes of women with obesity beyond a body mass index of 40. Women with a self-reported pre-pregnancy BMI of 40 or more, who had received care and birthed a baby at the study site between 1 January 2009 and 31 December 2010. Clinical audit was used to identify the health service utilisation and birth outcomes of these women. 153 women had a BMI of 40 or more. Women saw 6 different health professionals during pregnancy (1-16). Most of their visits were with a medical practitioner, often with limited experience, and almost all women only saw a midwife once at their booking visit (n=150, 98.0%). While the majority of women experienced a normal pregnancy, free from any complications, almost half the women in this study experienced a caesarean section (n=74, 48.4%). Clinical audit has been useful in providing additional information which suggests current maternity care provision is not meeting the needs of this group of women. The model of antenatal care provision may be a mediating factor in the birth outcomes experienced by obese women. The development of effective, targeted antenatal care, designed to meet the needs of these women is recommended.
Publisher: Wiley
Date: 10-02-2021
DOI: 10.1111/JMWH.13195
Publisher: Springer Science and Business Media LLC
Date: 16-06-2023
DOI: 10.1186/S12913-023-09612-3
Abstract: There is an increasing focus on the development of research capacity and culture in Nursing, Midwifery and Allied Health Professions (NMAHP). However, better understanding of the existing research success and skills, motivators, barriers, and development needs of NMAHP professionals is required to inform this development. This study sought to identify such factors within a university and an acute healthcare organisation. An online survey, incorporating the Research Capacity and Culture tool, was administered to NMAHP professionals and students at a university and an acute healthcare organisation in the United Kingdom. Ratings of success/skill levels of teams and in iduals were compared between professional groups using Mann–Whitney U tests. Motivators, barriers, and development needs were reported using descriptive statistics. Descriptive thematic analysis was used for open-ended text responses. A total of 416 responses were received (N& M n = 223, AHP n = 133, Other n = 60). N& M respondents were more positive than their AHP counterparts about the success/skill levels of their teams. There were no significant differences between N& M and AHP in their ratings of in idual successes/skills. Finding and critically reviewing relevant literature were identified as specific in idual strengths with weaknesses in securing research funding, submitting ethics applications, writing for publication, and advising less experienced researchers. The main motivators for research were to develop skills, increased job satisfaction, and career advancement whilst barriers included lack of time for research and other work roles taking priority. Key support needs identified included mentorship (for teams and in iduals) and in-service training. Open-ended questions generated main themes of ‘Employment & staffing’, ‘Professional services support’, ‘Clinical & academic management’, ‘Training & development’, ‘Partnerships’ and ‘Operating principles’. Two cross-cutting themes described issues common to multiple main themes: ‘Adequate working time for research’ and ‘Participating in research as an in idual learning journey’. Rich information was generated to inform the development of strategies to enhance research capacity and culture in NMAHP. Much of this can be generic but some nuances may be required to address some specific differences between professional groups, particularly related to perceived team success/skills and priorities identified for support and development.
Publisher: Springer Publishing Company
Date: 03-2022
Abstract: Australian rural areas access to midwifery continuity of carer models is restricted. Lack of medical support has been identified as one of the reasons midwifery continuity of carer models have not been implemented. The purpose of his study was to explore rural Australian doctors’ views about midwifery and midwifery continuity of carer models. A qualitative study with general practitioner and specialist obstetricians ( n = 10) working in Australian rural maternity services. Semi-structured interviews were undertaken and analyzed using thematic analysis. Participants’ views of midwifery and midwifery continuity of carer models were expressed in three themes. The themes related to the concepts of knowing: knowing the model, knowing the midwife, and knowing the system. Participants had misconceptions and misunderstandings of the model, midwifery, and systems issues relating to midwifery continuity of carer models. Increasing understanding about midwifery and midwifery continuity of carer models may facilitate implementation of these models. A national education program for doctors about the structure and function of midwifery continuity of carer models would support knowledge building for obstetric doctors. Strong leadership and incentivization for health services may be needed to sustainably roll-out rural models. At a service level, responsibility for establishing and sustaining models should shift from local midwife leaders to hospital executives.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.WOMBI.2015.05.002
Abstract: Low intensity anxiety in pregnancy is normal however high levels of fear affect between 20% and 25% of women, with around 10% suffering severe levels. Research from Scandinavian countries includes women with severe levels of fear, with little work undertaken in Australia. This paper explores predictors of fear and the relative benefits of screening women for childbirth fear at high or severe levels. A secondary analysis of data collected for the BELIEF study was conducted to determine differences for demographic, psycho-social and obstetric factors in women with severe fear (W-DEQ ≥85, n=68) compared to women with less or no fear (n=1318). Women with severe fear (W-DEQ ≥85, n=68) were also compared to those with high fear scores (W-DEQ ≥66-84, n=265). Logistic regression modelling was used to ascertain if screening for high or severe levels of fear is most optimal. 1386 women completed the W-DEQ. There were no differences on demographic variables between women with severe or high fear. Depression symptoms, decisional conflict and low self-efficacy predicted high and severe fear levels. Nulliparity was a predictor of high fear. A previous operative birth and having an unsupportive partner were predictors of high fear in multiparous women. Psychosocial factors were associated with both high and severe fear levels. Screening for severe fear may detect women with pre-existing mental health problems that are exacerbated by fear of birth. Australian women with high childbirth fear levels (W-DEQ ≥66) should be identified and provided appropriate support.
Publisher: Wiley
Date: 26-02-2007
Publisher: Elsevier BV
Date: 10-2015
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.MIDW.2014.08.007
Abstract: developing a student's sense of capability, purpose, resourcefulness, identity and connectedness (five-senses of success) are key factors that may be important in predicting student satisfaction and progression within their university program. the study aimed to examine the expectations and experiences of second and third year midwifery students enroled in a Bachelor of Midwifery program and identify barriers and enablers to success. a descriptive exploratory qualitative design was used. Fifty-six students enroled in either year 2 or 3 of the Bachelor of Midwifery program in SE Queensland participated in an anonymous survey using open-ended questions. In addition, 16 students participated in two year-level focus groups. Template analysis, using the Five Senses Framework, was used to analyse the data set. early exposure to 'hands on' clinical midwifery practice as well as continuity of care experiences provided students with an opportunity to link theory to practice and increased their perception of capability as they transitioned through the program. Students' sense of identity, purpose, resourcefulness, and capability was strongly influenced by the programs embedded meta-values, including a 'woman centred' approach. In addition, a student's ability to form strong positive relationships with women, peers, lecturers and supportive clinicians was central to developing connections and ultimately a sense of success. A sense of connection not only fostered an ongoing belief that challenges could be overcome but that students themselves could initiate or influence change. the five senses framework provided a useful lens through which to analyse the student experience. Key factors to student satisfaction and retention within a Bachelor of Midwifery program include: a clearly articulated midwifery philosophy, strategies to promote student connectedness including the use of social media, and further development of clinicians' skills in preceptorship, clinical teaching and facilitation. Program delivery methods and student support systems should be designed to enable maximum flexibility to promote capability and resourcefulness and embed sense of purpose and identity early in the program.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.WOMBI.2017.05.001
Abstract: Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data. 1) Evaluate the outcomes of women and newborns cared for by midwives with visiting access at one Queensland facility and 2) explore private midwives views about the structures and processes contributing to clinical outcomes. Mixed methods. An audit of the 'all risk' 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis. Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p=0.007), to commence labour spontaneously (84.7% vs 52.7%, p<0.001), experience a spontaneous vaginal birth (79% vs 54%, p<0.001) and not require pharmacological pain relief (52.9% vs 23.1%, p<0.001). The caesarean section rate was significantly lower than the national rate (13% vs 32.8%, p<0.001). In addition fewer babies required admission to the Newborn Care Unit (5.1% vs 16%, p<0.001). Midwives were proud of their achievements. Continuity of care was considered fundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model. Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised.
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.WOMBI.2021.01.002
Abstract: To investigate the experiences, perspectives and plans of students who had a six-month placement with the midwifery group practice. Focus groups were conducted with fifteen third - year Bachelor of Midwifery students who had undertaken an extended placement at a midwifery group practice in a large tertiary referral hospital in Queensland, Australia. Four main themes were identified in the data: Expectations of the Placement Facilitating learning within a midwifery group practice model Transitioning between models of care and Philosophy and culture of midwifery group practice. Third-year midwifery students valued the experience of working one-on-one for an extended placement with a midwife providing continuity of care within a caseload model. The experience was the highlight of their degree and they learned 'how to be a midwife'. Most students found reintegrating back into the hospital system of care challenging, reporting that their developed skills of supporting women holistically and facilitating normal birth were not fully utilised when returning to the task-orientated birth suite. Students valued thoughtful, kind and supportive midwifery preceptors who supported them to transition back into the hospital. Undertaking an extended placement within a midwifery group practice provides students with a rich and holistic learning experience and helps them develop a sense of professional identity. Student placements situated within models of care which provide continuity of midwifery care should be proactively enabled by health services and universities. Research of the longer-term impacts of an extended midwifery group practice clinical placement on midwifery graduates' capabilities and competencies 3-5 years post registration should be conducted.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.WOMBI.2016.05.003
Abstract: Evidence is emerging of the benefits to students of providing continuity of midwifery care as a learning strategy in midwifery education, however little is known about the value of this strategy for midwifery students. To explore Indigenous students' perceptions of providing continuity of midwifery care to Indigenous women whilst undertaking a Bachelor of Midwifery. Indigenous Bachelor of Midwifery students' experiences of providing continuity of midwifery care to Indigenous childbearing women were explored within an Indigenous research approach using a narrative inquiry framework. Participants were three Indigenous midwifery students who provided continuity of care to Indigenous women. Three interconnected themes facilitating connection, being connected, and journeying with the woman. These themes contribute to the overarching finding that the experience of providing continuity of care for Indigenous women creates a sense of personal affirmation, purpose and a validation of cultural identity in Indigenous students. Midwifery philosophy aligns strongly with the Indigenous health philosophy and this provides a learning platform for Indigenous student midwives. Privileging Indigenous culture within midwifery education programs assists students develop a sense of purpose and affirms them in their emerging professional role and within their community. The findings from this study illustrate the demand for, and pertinence of, continuity of care midwifery experiences with Indigenous women as fundamental to increasing the Indigenous midwifery workforce in Australia. Australian universities should provide this experience for Indigenous student midwives.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH17271
Abstract: Objective Fear of childbirth is known to increase a woman’s likelihood of having a Caesarean section. Continuity of midwifery care is known to reduce this risk, but less than 8% of women have access to this relationship-based, primary care model. The aims of this study were to determine whether healthcare use and access to continuity models are equal across different indicators of socioeconomic status for women who are fearful of birth. Methods A secondary analysis was conducted of data obtained during a randomised controlled trial of a psychoeducation intervention by trained midwives to minimise childbirth fear (the Birth Emotions and Looking to Improve Expectant Fear (BELIEF) study). In all, 1410 women were screened, with 339 women reporting high levels of fear (Wijma-Delivery Expectancy/Experience Questionnaire ≥66). Demographic, obstetric information, birth preference and psychosocial measures were collected at recruitment and at 36 weeks gestation for the 339 fearful women, with the birth method and health service use returned by 183 women at 6 weeks after the birth. Results Univariate analysis revealed no significant difference in the number of general practitioner and midwife visits between women of high and low income and high and low education. However, women with higher levels of education had 2.51-fold greater odds of seeing the same midwife throughout their pregnancy than women with lower education (95% confidence interval 1.25–5.04), after adjusting for age, parity and hospital site. Conclusions Given the known positive outcomes of continuity of midwifery care for women fearful of birth, health policy makers need to provide equity in access to evidence-based models of midwifery care. What is known about this topic? Caseload midwifery care is considered the gold standard care due to the known positive outcomes it has for the mother and baby during the perinatal period. Pregnant women who receive caseload midwifery care are more likely to experience a normal vaginal birth. What does this paper add? There is unequal access to midwifery caseload care for women fearful of birth across socioeconomic boundaries. Midwifery caseload care is not used for all fearful mothers during the perinatal period. What are the implications for practitioners? Health policy makers seeking to provide equity in access to maternity care should be aware of these inequalities in use to target delivery of care at this specific cohort of mothers.
Publisher: Wiley
Date: 25-07-2007
DOI: 10.1111/J.1365-2702.2006.01747.X
Abstract: This study explored the childbirth expectations and knowledge of women who had experienced a caesarean and would prefer a vaginal birth in a subsequent pregnancy. Vaginal birth after caesarean is considered best practice. However, in most western world countries, despite the inherent risks of caesarean for both mother and baby, the number of women labouring after a previous caesarean is declining. Newspaper advertisements were used to recruit Western Australian women who had experienced a caesarean. Thematic analysis was used to analyse the interview data collected from women who attempted a vaginal birth (n=24), or stated they would choose this option, in a subsequent pregnancy (n=11). For this cohort of women, their caesarean experience reinforced their previously held expectations about birthing naturally. The women held strong views about the importance of working with their bodies to achieve a vaginal birth, which was considered an integral part of being a woman and mother. Positive support from family and friends and a reluctance to undergo another caesarean was also influential. Women articulated the risks of caesarean and considered vaginal birth enhanced the health and well-being of the mother and baby, promoted maternal infant connection and the eased the transition to motherhood. This study documents how the importance of birth, as a significant life event, remained the focus of these women's childbirth expectations influencing future decisions on birth mode and mediating against the 'pressure' of medical discourse promoting caesarean. Knowledge and appreciation of the multiple dimensions that contribute to women's decisions after a caesarean provides valuable information on which service providers and researchers can draw as they investigate interventions that enhance the uptake and success of women birthing vaginally after a caesarean.
Publisher: Informa UK Limited
Date: 14-10-2015
DOI: 10.1080/07399332.2014.946510
Abstract: This descriptive longitudinal cohort study investigated the prevalence and psychological risk factors for depression in new mothers living in Pingtung County, southern Taiwan. Expectant mothers (n = 236) were recruited through antenatal clinics, and 162 participants were followed up at 6 weeks postpartum. The estimated prevalence of probable depression (at a cut-off score ≧ 13 on the Edinburgh Postnatal Depression Scale) was 17.3% before birth and 24.1% after birth. Several risk factors for postnatal depression were identified, including maternal self-esteem, antenatal depression, and psychiatric morbidity. The regression of intention on predictive variables yielded an adjusted R(2) of.70. The findings can help clinical nurses effectively recognize and implement risk mitigation plans for the health benefits of rural childbearing women.
Publisher: Elsevier BV
Date: 03-2013
Publisher: BMJ
Date: 29-06-2012
Publisher: Wiley
Date: 22-02-2005
DOI: 10.1111/J.0730-7659.2005.00340.X
Abstract: Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder. The objective of this study was to assess a midwife-led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms. Of 348 women screened for trauma symptoms, 103 met inclusion criteria and were randomized into an intervention (n = 50) or a control (n = 53) group. The intervention group received face-to-face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum. Main outcome measures were posttraumatic stress symptoms, depression, self-blame, and confidence about a future pregnancy. At 3-month follow-up, intervention group women reported decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self-blame. Confidence about a future pregnancy was higher for these women than for control group women. Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum, but this result was not statistically significant. A high prevalence of postpartum depression and trauma symptoms occurred after childbirth. Although most women improved over time, the intervention markedly affected participants' trajectory toward recovery compared with women who did not receive counseling. A brief, midwife-led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma, depression, stress, and feelings of self-blame. The intervention is within the scope of midwifery practice, caused no harm to participants, was perceived as helpful, and enhanced women's confidence about a future pregnancy.
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.WOMBI.2011.03.001
Abstract: The detection of maternal depression can be improved with routine screening. This practice is expected to be integrated into midwifery practice under the Australia National Perinatal Depression Initiative. To describe midwives' self-reported practice in caring for women suffering from antenatal and postpartum depressive symptoms and assess midwives' ability to detect depression and their knowledge of therapeutic interventions for depressive symptoms in childbearing women. Using a descriptive cohort study design, a postal survey was sent to all members of the Australian College of Midwives (n=3000). The survey consisted of items drawn from beyondblue's "National Baseline Survey--Screening Evaluation Questionnaire" and questions relating to a hypothetical case study of a depressed woman "Mary" developed by Buist et al. A total of 815 completed surveys were received. 69.1% of midwives reported screening for antenatal and postpartum depression using instruments such as the Edinburgh Postnatal Depression Scale. Time constraints were perceived as the major barrier to effective emotional care. 63.3% of midwives correctly recognised depression in the case study and 82.4% reported that "Mary" required assistance. Antidepressants were more likely to be recommended postnatally (93.2%) than antenatally (61.5%) by midwives. Further training is required to ensure midwives' competency in psychosocial assessment and management of women experiencing antenatal and postpartum depression. Systemic issues (e.g. time constraints) encountered by midwives need to be addressed to support the delivery of effective emotional care to childbearing women.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.MIDW.2016.06.008
Abstract: the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons. to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the s le and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated. completed surveys were received from 2585 midwives (Australia 1037 New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p<.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria. midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.WOMBI.2011.03.002
Abstract: Young pregnant women who continue a pregnancy are primarily from a socioeconomically deprived background. The risk factors associated with low socio-economic status may independently affect perinatal and neonatal morbidity to a greater extent than the young age of the woman. Young pregnant women are frequently sceptical about health care providers who they can perceive to be judgemental. This may lead to late booking for pregnancy care, attending few appointments, or not attending the health service for any antenatal care. Does the way maternity care is provided affect maternal and neonatal outcomes for young women? A systematic search of the major health databases. Nine research articles met the eligibility criteria: one randomised controlled trial, three prospective cohort studies, two comparative studies with concurrent controls, two comparative studies with historical controls, and one case series. Providing young women with a non-standard model of maternity care has some beneficial and no known detrimental effects on childbirth outcomes. While there is a dearth of evidence on the effectiveness of a Midwifery Group Practice model of care for young women, there is strong evidence to suggest that a Group Antenatal Care model increases antenatal visit attendance and breastfeeding initiation, and decreases the risk of preterm birth. There is research to indicate that a Young Women's Clinic model may also increase antenatal visit attendance and decrease the incidence of preterm birth. More well-designed and resourced midwifery models of care for young women should be implemented and rigorously researched.
Publisher: Wiley
Date: 13-04-2022
DOI: 10.1111/AJO.13529
Abstract: Australia's caesarean section (CS) rate has been steadily increasing for decades. In response to this, we co‐designed an evidence‐based, multi‐pronged strategy to increase the normal birth rate in Queensland and reduce the need for CS. We conducted three workshops with a multi‐stakeholder group to identify a broad range of options to reduce CS, prioritise these options, and achieve consensus on a final strategy. The strategy comprised of: universal access to midwifery continuity‐of‐care and choice of place of birth multi‐disciplinary normal birth education resources to facilitate informed decision‐making respectful maternity care and positive workplace culture and establishment of a Normal Birth Collaborative.
Publisher: Elsevier BV
Date: 09-2020
DOI: 10.1016/J.WOMBI.2019.09.010
Abstract: Little emphasis has been given to the standardised measurement of midwifery students' perceptions of their clinical learning experiences. To develop a tool that evaluates students' perceptions of their clinical learning experiences according to environment and impact of preceptors on professional development. A cross-sectional design was used. Tool development had three phases: item generation expert review to assess clarity, apparent internal consistency and content validity and psychometric testing. All Bachelor of Midwifery students at one university in Australia were invited to complete the online survey. Psychometric testing included dimensionality, internal consistency and test-retest reliability. A 74% (n=279) response rate was achieved. Factor analysis revealed the Clinical Learning Environment Scale and Impact of the Midwifery Preceptor Scale accounting for 53.6% and 71.5% of variance respectively. Both scales were reliable (Cronbach's alpha=.92 and .94) and valid. Overall, students positively rated the clinical learning environment and preceptors' abilities to foster their sense of identity as a midwife. Students were less satisfied with preceptors' understanding of the academic program. The new tool consists of two scales that reliably measure midwifery students' perceptions of how the clinical learning environment develops their skills and reflects a midwifery philosophy. Preceptors had a positive influence on students' skills and professional development. The Midwifery Student Evaluation of Practice tool is the first valid and reliable measure of students' perceptions of their clinical learning experiences. Students' feedback provides valuable information to educators and preceptors on how best to optimise clinical learning.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.NEPR.2017.04.010
Abstract: Evolving knowledge and professional practice combined with advances in pedagogy and learning technology create challenges for accredited professional programs. Internationally a sparsity of literature exists around curriculum development for professional programs responsive to regulatory and societal drivers. This paper evaluates a participatory curriculum development framework, adapted from the community development sector, to determine its applicability to promote engagement and ownership during the development of a Bachelor of Midwifery curriculum at an Australian University. The structures, processes and resulting curriculum development framework are described. A representative s le of key curriculum development team members were interviewed in relation to their participation. Qualitative analysis of transcribed interviews occurred through inductive, essentialist thematic analysis. Two main themes emerged: (1) 'it is a transformative journey' and (2) focused 'partnership in action'. Results confirmed the participatory curriculum development process provides symbiotic benefits to participants leading to in idual and organisational growth and the perception of a shared curriculum. A final operational model using a participatory curriculum development process to guide the development of accredited health programs emerged. The model provides an appropriate structure to create meaningful collaboration with multiple stakeholders to produce a curriculum that is contemporary, underpinned by evidence and reflective of 'real world' practice.
Publisher: Elsevier BV
Date: 03-2020
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.WOMBI.2017.03.008
Abstract: Rates of elective and unplanned caesarean section continue to increase in high income countries. Evidence-based clinical guidelines aim to promote and support normal birth but are rarely evaluated. The Queensland Normal Birth Guideline was developed in consultation with stakeholders and disseminated to public and private hospitals and released in 2012. Impact of the Guideline on practice has not been investigated. Although most midwives (90%) were aware of the guideline, only 71% reported that it routinely guided practice.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Wiley
Date: 07-2011
DOI: 10.1111/J.1542-2011.2011.00039.X
Abstract: Emotional care provided by midwives may improve health and well-being reduce stress, trauma, and depressive symptoms and enhance maternal outcomes in childbearing women. The provision of intrapartum and postpartum emotional care can be challenging and requires a good knowledge base for the provider to screen and assist distressed women. This study assessed Australian midwives' levels of knowledge and learning needs regarding antenatal depression and postpartum depression. Eight hundred and fifteen members of the Australian College of Midwives completed a postal survey, which consisted of 20 items drawn from the literature and the National Baseline Survey-Health Professional Knowledge Questionnaire. On average, respondents correctly answered 62.9% of items related to antenatal depression and 70.7% of questions about postpartum depression. Many midwives were unable to identify the risk factors (70.6%) or prevalence of antenatal depression (49.6%). Nearly all (98.3%) respondents underestimated the percentage of antenatally depressed women that attempts suicide. Significant percentages of midwives did not correctly identify the incidence (44.4%), onset period (71%), and treatment options (32%) associated with postpartum depression. About half did not understand the use of antidepressant medications (48.6%) and incorrectly reported that the Edinburgh Postnatal Depression Scale was a suitable instrument to assess symptoms of psychotic depression (43.8%). There are key knowledge deficits relating to onset of, assessment of, and treatment for depressive symptoms during the antenatal and postpartum periods. There is a need for continuing professional education to improve midwives' knowledge and competency in the assessment and care of women suffering depression.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Publishing Company
Date: 03-2018
DOI: 10.1891/2156-5287.7.4.227
Abstract: Certification as a lactation consultant is based on practitioners having achieved a standard of knowledge indicative of their competence to practice by passing a psychometric examination. The underpinning principle of recertification programs is to support clinicians to become lifelong learners by progressively enhancing and advancing their knowledge and skills in line with contemporary evidence. The aim of this study was to investigate the factors that influence International Board Certified Lactation Consultants (IBCLCs) to advance their practice. A mixed-methods study was conducted in two phases. Phase 1 included focus groups, interviews, and participants’ demographic data. Phase 2 comprised of an online questionnaire to IBCLCs. This approach was designed to provide a comprehensive qualitative understanding of the IBCLCs’ experiences, which was then triangulated with quantitative data from a significantly larger population of IBCLCs in Phase 2. The findings are described in themes and subthemes. Participants in phase 2 ( n = 3,946) reported being intrinsically motivated (93.3%, n = 3,631) and committed to providing evidence-based guidance and optimal care to support breastfeeding mothers. They identified various sources of continuing education, although attendance at conferences, peer support, and reflective sessions were the most common approaches to enhancing knowledge. They recognized that it was through extension of knowledge that they were able to advance their practice. This article identifies strategies that the managers, educators, and certification bodies can adopt to support the IBCLCs in continuing to advance their practice, which will ultimately improve breastfeeding outcomes for mothers.
Publisher: Wiley
Date: 14-05-2021
DOI: 10.1111/JOCN.15846
Abstract: This study investigated the effects of social support, parenting stress and maternal self‐efficacy on postpartum depression among adolescent mothers in Jordan. Adolescent pregnancy may have serious health, social and economic consequences for young women, families and communities. In Jordan, the incidence of adolescent pregnancy has increased from 5% in 2012 to 15% in 2018. Little attention has been given to postpartum depression among adolescent mothers in Arab and Middle Eastern countries. In a cross‐sectional design using convenience s ling, 200 women aged less than 20 years, six to eight weeks postpartum and who could speak and read Arabic were interviewed in a participating health clinic. The interview occurred before or after a woman's scheduled clinic appointment and included socio‐demographic data, Edinburgh Postnatal Depression Scale (EPDS), Maternity Social Support Scale (MSSS), Parenting Stress Scale (PSS) and Perceived Self‐efficacy Scale (PSES). Data collection took place between December of 2018 and April of 2019. Reporting followed the STROBE guidelines. Results revealed that 28.5% of adolescent mothers had probable postpartum depression. Mothers who reported high social support, high parenting stress, low self‐efficacy, financial stress and marital conflict had significantly higher EPDS scores than those who did not report these stressors. Prevalence of postpartum depression reported in this study warrants immediate action on early assessment, detection and intervention. High levels of social support may feel overwhelming for young mothers and contribute to high parenting stress, low maternal self‐efficacy and marital conflict. Adolescent mothers are at increased risk of PPD compared to mothers over 20 years of age. Perceived quality rather than availability of social support needs to be considered. Young mothers require education and early intervention prevention strategies to better prepared them for motherhood and manage stressors associated with their changing social role.
Publisher: CSIRO Publishing
Date: 2021
DOI: 10.1071/AH19264
Abstract: ObjectiveTo determine maternal access to continuity of midwifery care in public maternity hospitals across the state of Queensland, Australia. MethodsMaternal access to continuity of midwifery care in Queensland was modelled by considering the proportion of midwives publicly employed to provide continuity of midwifery care alongside 2017 birth data for Queensland Hospital and Health Services. The model assumed an average caseload per full-time equivalent midwife working in continuity of care with 35 women per annum, based on state Nursing and Midwifery Award conditions. Hospitals were grouped into five clusters using standard Australian hospital classifications. ResultsTwenty-seven facilities (out of 39, 69%) across all 15 hospital and health services in Queensland providing a maternity service offered continuity of midwifery care in 2017 (birthing onsite). Modelling applying the assumed caseload of 35 women per full-time equivalent midwife found wide variations in the percentage of women able to access continuity of midwifery care, with access available for an estimated 18% of childbearing women across the state. Hospital classifications with higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas. Regional health services with level 3 district hospitals assisting with & births showed higher levels of access, potentially due to additional challenges to meet local population needs to those of a metropolitan service. Access to full continuity of midwifery care in level 3 remote hospitals (& births) was artificially inflated due to planned pre-labour transfers for women requiring specialised intrapartum care and women who planned to birth at other hospitals. ConclusionsDespite strong evidence that continuity of midwifery care offers optimal care for women and their babies, there was significant variation in implementation and scale-up of these models across hospital jurisdictions. What is known about the topic?Access to continuity of midwifery care for pregnant women within the public health system varies widely however, access variation among different hospital classification groups in Australian states and territories has not been systematically mapped. What does this paper add?This paper identified differential access to continuity of midwifery care among hospital classifications grouped for clinical services capability and birth volume in one state, Queensland. It shows that higher clinical services capability and birth volume did not equate with higher access to continuity of midwifery care in metropolitan areas. What are the implications for practitionersScaling up continuity of midwifery care among all hospital classification groups in Queensland remains an important public health strategy to address equitable service access.
Publisher: Elsevier BV
Date: 08-2010
DOI: 10.1016/J.MIDW.2008.10.011
Abstract: a growing number of childbearing women are reported to prefer a caesarean section in the absence of a medical reason. Qualitative research describing factors influencing this preference in pregnant women is lacking. to describe Australian women's request for caesarean section in the absence of medical indicators in their first pregnancy. advertisements were placed in local newspapers inviting women to participate in a telephone interview exploring women's experience of caesarean section. Thematic analysis was used to analyse data. two states of Australia: Queensland and Western Australia. a community s le of women (n=210) responded to the advertisements. This paper presents the findings elicited from interviews conducted with 14 women who requested a caesarean section during their first pregnancy in the absence of a known medical indication. childbirth fear, issues of control and safety, and a devaluing of the female body and birth process were the main themes underpinning women's requests for a non-medically-indicated caesarean section. Women perceived that medical discourses supported and reinforced their decision as a 'safe' and 'responsible' choice. KEY CONCLUSIONS AND RECOMMENDATIONS FOR PRACTICE: these findings assist women and health professionals to better understand how childbirth can be constructed as a fearful event. In light of the evidence about the risks associated with surgical birth, health-care professionals need to explore these perceptions with women and develop strategies to promote women's confidence and competence in their ability to give birth naturally.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.MIDW.2022.103426
Abstract: To compare Nepalese and Jordanian midwifery and nursing students' perceptions of respectful maternity care (RMC) and witnessing of disrespect and abuse and determine factors that predict scores on a scale measuring perceptions of RMC. A descriptive, comparative design was used. Recruitment took place from two medical colleges in Nepal and one University in Jordan. A convenience s le of students (n = 276) enrolled in a Bachelor or Diploma level midwifery or nursing degree who were undertaking or had recently completed their midwifery clinical placement were recruited. The online or hard copy survey included the Students' Perceptions of Respectful Maternity Care (SPRMC) Scale and nine questions on witnessing different types of disrespect and abuse. Nepalese students were slightly older (mean = 23.68 years) than Jordanian students (mean = 21.36). Mean duration of clinical placement was longer for Jordanian students (11.24 compared to 6.28 weeks). However, mean number of births observed was higher among Nepalese students (19.6 compared to 18.62). Overall, perceptions of RMC were more positive among Jordanian students (t (199.97) = 6.68, p < 0.001). A multiple regression analysis found that duration of clinical placement (beta = 0.22, p < 0.001), witnessing disrespect and abuse (beta = 0.11, p = 0.08) and age (beta = -0.14, p = 0.03) explained 12.2% of variance in SPMRC scores. Compared to students in Nepal, all Jordanian students had observed non-consented care during their clinical practicum. However, Nepalese students were more likely to observe poor adherence to women's privacy and confidentiality. This is the first study to compare midwifery and nursing students' perceptions of RMC across two middle-income countries. Although Jordanian students held more positive perceptions of RMC than those in Nepal, more had witnessed different forms of disrespect and abuse. Variations in students' perceptions of RMC and witnessing of abuse across countries highlight the need for assessment of workplace cultures to inform the development of tailored education and practice interventions for students, clinicians, and managers. Future research needs to explore how to best support students to consistently offer RMC and how to improve the experiences of childbearing women.
Publisher: Elsevier BV
Date: 02-2021
DOI: 10.1016/J.MIDW.2021.103228
Abstract: To develop and test a tool to measure Bachelor of Nursing students' perceptions towards respectful maternity care in Nepal, a lower-middle income country. A cross-sectional design was used. Phases of tool development included item generation, expert review for content validity testing, and psychometric testing. The draft tool had 42 items on a 5-point Likert response scale of 1 = strongly disagree to 5 = strongly agree. Psychometric testing included dimensionality, internal consistency, and test-retest reliability. A t-test assessed mean score differences between students who had witnessed or not witnessed disrespect and abuse. Two medical colleges in Chitwan, Nepal PARTICIPANTS: Undergraduate Bachelor of Nursing students (n = 171) undertaking their midwifery clinical practicum were invited to complete the online survey. Principal component analysis generated three factors: Respectful Care, Safety and Comfort, and Supportive Care and explained 37.44% of the variance. The 18-item tool demonstrated good internal reliability (Cronbach's alpha of 0.81). The mean total scale score was 71.23 (SD 7.47, range 52-88 out of 90). Pearson's correlation coefficient confirmed test-retest reliability at one week (r = 0.91, p <0.001). The magnitude of difference in mean scores between those who had witnessed or not witnessed disrespectful and abusive care was very small (η The new Student Perceptions of Respectful Maternity Care tool is the first valid and reliable measure of students' perceptions of respectful maternity care. Validation of the newly developed tool in other low- and middle-income countries is recommended. Measuring students' perceptions provides information to educators on how best to enhance students' understanding and provision of respectful care to women.
Publisher: Wiley
Date: 25-04-2014
DOI: 10.1111/INR.12102
Abstract: Dissatisfaction with childbirth care can have a negative impact on a woman's health and well-being, as well as her relationships with her infant. To investigate the prevalence and associated factors of dissatisfaction with intrapartum care by Jordanian women. A descriptive cross-sectional study was used. Participants (n = 320) who were 7 weeks post-partum were recruited from five maternal and child health centres in Irbid city in northern Jordan. Participants provided personal and obstetric information, and completed the Satisfaction with Childbirth Care Scale. The majority of women (75.6%) were dissatisfied with their intrapartum care. Dissatisfaction was associated with the attendance of unknown and unwanted persons during childbirth, experiencing labour as more painful than expected, and perceptions of inadequate help from healthcare providers to manage pain during labour. Findings are limited to Jordanian women accessing public sector perinatal health services. The high percentage of women reporting dissatisfaction with intrapartum care in this study is of concern. Women's perception of pain and expectations of staff during labour and birth need to be addressed through education and improved communication by staff. Development of national evidence-based policies and quality assurance systems would help reduce the rate of obstetric interventions and give greater emphasis to respect for women's preferences during labour and birth.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.MIDW.2015.04.006
Abstract: midwifery continuity of care experiences can provide high quality clinical learning for students but can be challenging to implement. The Rural and Private Midwifery Education Project (RPMEP) is a strategic government funded initiative to (1) grow the midwifery workforce within private midwifery practice and rural midwifery, by (2) better preparing new graduates to work in private midwifery and rural continuity of care models. this study evaluated midwifery students׳ experience of an innovative continuity of care clinical placement model in partnership with private midwifery practice and rural midwifery group practices. a descriptive cohort design was used. All students in the RPMEP were invited to complete an online survey about their experiences of clinical placement within midwifery continuity models of care. Responses were analysed using descriptive statistics. Correlations between total scale scores were examined. Open-ended responses were analysed using content analysis. Internal reliability of the scales was assessed using Cronbach׳s alpha. sixteen out of 17 completed surveys were received (94% response rate). Scales included in the survey demonstrated good internal reliability. The majority of students felt inspired by caseload approaches to care, expressed overall satisfaction with the mentoring received and reported a positive learning environment at their placement site. Some students reported stress related to course expectations and demands in the clinical environment (e.g. skill acquisition and hours required for continuity of care). There were significant correlations between scales on perceptions of caseload care and learning culture (r=.87 p<.001) and assessment (r=.87 p<.001). Scores on the clinical learning environment scale were significantly correlated with perceptions of the caseload model (rho=.86 p<.001), learning culture (rho=.94 p<.001) and assessment (rho=.65 p<.01) scales. embedding students within midwifery continuity of care models was perceived to be highly beneficial to learning, developed partnerships with women, and provided appropriate clinical skills development required for registration, while promoting students׳ confidence and competence. The flexible academic programme enabled students to access learning at any time and prioritise continuity of care experiences. Strategies are needed to better support students achieve a satisfactory work-life balance.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.NEPR.2022.103317
Abstract: This systematic review critiqued the impact of educational interventions for midwives, nurses, or midwifery/nursing students to enhance respectful maternity care. Treating women with respect during maternity care has gained considerable global attention. Although research has focused on raising awareness about respectful care among health care professionals, the effectiveness of educational interventions remains uncertain. A mixed-methods systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review used a convergent segregated approach, and methodology recommended by Joanna Briggs Institute (JBI) mixed-methods systematic reviews, to synthesise and integrate research findings. Multiple databases were searched. JBI critical appraisal checklists for quasi-experimental studies, cross-sectional, and qualitative studies, as well as a mixed-methods appraisal tool were used. Nine educational interventions studies met the inclusion criteria, and most were conducted in Africa. Quantitative evidence supported the effectiveness of interventions to improve knowledge erceptions of midwives and/or nurses regarding respectful maternity care, and woman-provider communication, and reduce women's experience of disrespect and abuse. However, variation in content, intervention delivery mode, duration, timing of pre and post-test, evaluation methods, and difficulty distilling findings from multi-pronged interventions hindered robust conclusions. Only one study used a valid and reliable tool to measure women's experience of respectful care. Qualitative findings suggest continuous education rather than one-off interventions and inclusion of other health care providers as well as managerial staff working in maternity care would help promote respectful care. There is low level evidence that educational interventions can improve midwives', nurses', and students' knowledge and attitudes towards RMC. Outcomes of education and training need to be monitored regularly with valid and reliable tools. There is a need for respectful maternity care education interventions in high as well as middle and low-income countries.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.WOMBI.2021.05.001
Abstract: The capacity for midwifery to improve maternity care is under-utilised. Midwives have expressed limits on their autonomy to provide quality care in relation to intrapartum fetal heart rate monitoring. To explore how the work of midwives and obstetricians was textually structured by policy documents related to intrapartum fetal heart rate monitoring. Institutional Ethnography, a critical qualitative approach was used. Data were collected in an Australian hospital with a central fetal monitoring system. Midwives (n=34) and obstetricians (n=16) with experience working with the central fetal monitoring system were interviewed and observed. Policy documents were collected and analysed. Midwives' work was strongly structured by policy documents that required escalation of care for any CTG abnormality. Prior to being able to escalate care, midwives were often interrupted by other clinicians uninvited entry into the room in response to the CTG seen at the central monitoring station. While the same collection of documents guided the work of both obstetricians and midwives, they generated the expectation that midwives must perform certain tasks while obstetricians may perform others. Midwifery work was textually invisible. Our findings provide a concrete ex le of the way policy documents both reflect and generate power imbalances in maternity care. Obstetric ways of knowing and doing are reinforced within these documents and continue to diminish the visibility and autonomy of midwifery. Midwifery organisations are well placed to co-lead policy development and reform in collaboration with maternity consumer and obstetric organisations.
Publisher: Springer Science and Business Media LLC
Date: 21-11-2016
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.AJIC.2013.05.022
Abstract: Preventing health care-associated infections is essential to the safety and quality of health care. Although patients' experience of care under isolation is well established, little is known of health care workers' experiences when providing such care. This study explored the health professionals lived experience of caring for patients under transmission-based precautions. Interpretive phenomenology was used to examine 12 health care professionals' lived experience of providing care under transmission-based precautions in 3 health care facilities in Australia. Data were obtained from in-depth interviews and observations of health professionals. The essential phenomena of "recognizing rapport" represented the health professionals' lived experience. Three themes emerged starting with (1) relationships with others, their rapport and communication with patients, patients' families and visitors, and colleagues. These relationships are influenced by (2) barriers to practice, such as personal level of comfort when wearing personal protective equipment, physical limitations of the environment, and management of workload and resources. Such barriers influence (3) patient outcomes, namely the quality of the care provided and adverse events. In the context of caring for patients under transmission-based precautions, the relationships between health professionals and their patients are critical to the quality and safety of health care with respect to infection prevention and control.
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.WOMBI.2007.05.003
Abstract: Examining women's preferences for maternity care is overdue. Understanding women's preferences and re-orienting services to meet their expectations is critical to improving health outcomes. A self-report survey of a convenience community s le of 63 women visiting a Maternity Coalition/Association for Improvements in Maternity Services stall at a Mother and Baby Expo in 2003. Over 95% of women ranked birth safety, bonding with the baby, feeling in control during birth, and postnatal care as "very important". Over 85% of women rated educational preparation for birth, the relationship with their caregiver, prenatal care, and breastfeeding successfully as "very important". Avoiding labour pain was considered less important by more women than any other item. Around half the respondents preferred their birth care to be from a chosen midwife with access to medical backup (57.9%, n=37). Some women identified a lack of choice of care options with 45.9% (n=17) reporting "little" or "no" choice in birth care for their previous birth. Poor quality care was also identified with 57.9% (n=22) rating their postnatal care as "mediocre". Given assurance of equal safety and free care, 50% (n=31) of participants would prefer to give birth at a birth centre and 24.2% (15 out of 63) would prefer a homebirth. Factors associated with safety, control, continuity of care and successful mothering are perceived as important for many women. Some women perceived limited birth choices. More needs be done to align the provision of maternity services with women's preferred care options. Given the small self-select, non-representative s le, results should be interpreted with caution.
Publisher: Wiley
Date: 12-2000
DOI: 10.1046/J.1523-536X.2000.00256.X
Abstract: The consistently high cesarean section rate in most developed Western countries has been attributed in part to maternal request. This controversial view demands critical analysis. This paper provides a critique of published research relating to women's request for cesarean delivery. A search of the major databases was undertaken using the search term "cesarean section" with "maternal request," "decision-making," "patient-participation," "decision-making-patient," "patient-satisfaction," "patient-preference," and "maternal-choice." Ten research articles examining women's preferred mode of birth were retrieved, nine of which focused on women's preference for cesarean delivery. The methodology of some studies may result in overreporting women's request for a cesarean delivery. The role of the woman's caregiver in the generation, collection, and entry of data, and the occurrence of post hoc rationalization, recall bias, and women's tendency to be less critical of their care immediately after birth are possible areas of concern. Due consideration is rarely given to the influence of obstetric risk for women who may be requesting a cesarean section or to the information women used in making their decision. Women's perceptions of their involvement in decision-making regarding cesarean section are used to draw conclusions regarding women's request. Few women request a cesarean section in the absence of current or previous obstetric complications. The focus on women's request for cesarean section may ert attention away from physician-led influences on the continuing high cesarean section rates.
Publisher: Springer Science and Business Media LLC
Date: 11-01-2015
DOI: 10.1007/S00737-014-0495-7
Abstract: This cohort study compared 262 women with high childbirth distress to 138 non-distressed women. At 12 months, high distress women had lower health-related quality of life compared to non-distressed women (EuroQol five-dimensional (EQ-5D) scale 0.90 vs. 0.93, p = 0.008), more visits to general practitioners (3.5 vs. 2.6, p = 0.002) and utilized more additional services (e.g. maternal health clinics), with no differences for infants. Childbirth distress has lasting adverse health effects for mothers and increases health-care utilization.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.MIDW.2013.03.001
Abstract: for some women childbirth is physically and psychologically traumatic and meets Criterion A1 (threat) and A2 (intense emotional response) for Posttraumatic Stress Disorder of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV).This study differentiates Criterion A1 and A2 to explore their in idual relationship to prevalence rates for posttraumatic stress, each other, and associated factors for childbirth trauma. women were recruited at three hospitals from October 2008 to October 2009. Questionnaires were completed at recruitment and at 14 days post partum. women in the third trimester of pregnancy (n=890) were recruited by a research midwife while waiting for their antenatal clinic appointment. Participants were over 17 years of age, expected to give birth to a live infant, not undergoing psychological treatment, and able to complete questionnaires in English. this study found 14.3% of women met criteria for a traumatic childbirth. When the condition of A2 was removed, the prevalence rate doubled to 29.4%. Approximately half the women who perceived threat in childbirth did not have an intense negative emotional response. Predictors of finding childbirth traumatic were pre-existing psychiatric morbidity, being a first time mother and experiencing an emergency caesarean section. the fear response is an important diagnostic criterion for assessing psychologically traumatic childbirth. The identification of risk factors may inform maternity service delivery to prevent traumatic birth and postpartum approaches to care to address long-term negative consequences. prevention and treatment of traumatic childbirth are improved through knowledge of potential risk factors and understanding the woman's subjective experience.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.WOMBI.2019.09.002
Abstract: Continuity of midwifery care is the best maternity care model for women at any risk level, and there is a global imperative to improve access to midwifery-led care. However, erse perspectives about how best to prepare graduates for working in midwifery continuity of care models persist. The continuity of care experience standard in Australia was anticipated to address this. To challenge the dearth of published information about the structures and processes in midwifery education programs by identifying: the educational value and pedagogical intent of the continuity of care experience issues with the implementation, completion and assessment of learning associated with continuity of care experience and discuss curriculum models that facilitate optimal learning outcomes associated with this experience. We discuss the primacy of continuity of care experience in midwifery education programs in Australia. The inclusion of continuity of care experience in midwifery programs in Australia became mandatory in 2010 requiring 20, however this number was reduced to 10 in 2014. Research has shown the beneficial outcomes of continuity of care experience to both students and women. Continuity of care experience builds mutual support and nurturing between women and students, fosters clinical confidence, resilience, and influences career goals. We require curriculum coherence with both structural and conceptual elements focusing on continuity of care experience. Education standards that preference continuity of care experience as the optimal clinical education model with measurable learning outcomes, and alignment to a whole of program philosophy and program learning outcomes is required.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.MIDW.2011.12.008
Abstract: to describe perceptions of participating in a study testing the effectiveness of a perinatal emotional support intervention (Promoting Resilience in Mothers Emotions PRIME) by women identified as experiencing emotional distress after birth. qualitative descriptive approach. Semi-structured telephone interviews with 33 women recruited as part of a larger RCT to test the efficacy of a counselling intervention (PRIME). Women who received either (1) the intervention (counselling (or PRIME)) (n=16), (2) active control (Parenting support) (n=12), or (3) matched control (standard care) (n=5), were interviewed at 12 months postpartum. Thematic analysis of data was used. 'promoting reflection' and 'feeling cared for', were phrases that all participants used to describe their experience in the project regardless of group allocation. Women receiving PRIME reported 'getting in touch with (their) feelings' and 'moving on' as beneficial outcomes. Two women who received counselling reported 'having things left unresolved' indicating that their needs had not been met. Some women in both the active control and intervention identified that contact was 'nice but not hugely helpful or needed'. positive outcomes of PRIME were evident and most participants desired postpartum contact. Some women needed additional follow up and targeted assistance. Findings support the importance of providing personalised postnatal care that addresses women's emotional health needs.
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.MIDW.2013.07.009
Abstract: this paper describes midwives' experiences of learning new counselling skills and delivering a counselling intervention entitled 'Promoting Resilience on Mothers Emotions' (PRIME). a descriptive exploratory approach was used. Data collected included semi-structured interviews (n=42), midwife diary entries (18 pages) and web based postings (169 pages). Data were analysed using manual thematic method. the intervention study was conducted in two tertiary maternity hospitals in the Australian states of Queensland (QLD) and Western Australia (WA) during a 17 month period, from August 2008 to December 2009. midwives were employed as research assistants and trained to deliver a counselling intervention to women reporting a traumatic birth experience. Eighteen of a possible 20 Australian midwives participated in this study. PRIME is a midwife-led counselling intervention based on cognitive-behavioural principles and designed to ameliorate trauma symptoms. It is offered face-to-face within 72 hours of childbirth and by phone around six weeks post partum. participating midwives felt confronted by the level of emotional distress some women suffered as a consequence of their birth experience. Four major themes were extracted: The challenges of learning to change Working with women in a different way Making a difference to women and me and A challenge not about to be overcome. the advanced counselling skills the midwives acquired improved their confidence to care for women distressed by their birthing experience and to personally manage stressful situations they encountered in practice.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.WOMBI.2021.05.006
Abstract: Central fetal monitoring systems transmit cardiotocograph data to a central site in a maternity service. Despite a paucity of evidence of safety, the installation of central fetal monitoring systems is common. This qualitative research sought to explore whether, and how, clinicians modified their clinical safety related behaviours following the introduction of a central monitoring system. An Institutional Ethnographic enquiry was conducted at an Australian hospital where a central fetal monitoring system had been installed in 2016. Informants (n=50) were midwifery and obstetric staff. Data collection consisted of interviews and observations that were analysed to understand whether and how clinicians modified their clinical safety related behaviours. The introduction of the central monitoring system was associated with clinical decision making without complete clinical information. Midwives' work was disrupted. Higher levels of anxiety were described for midwives and birthing women. Midwives reported higher rates of intervention in response to the visibility of the cardiotocograph at the central monitoring station. Midwives described a shift in focus away from the birthing woman towards documenting in the central monitoring system. The introduction of central fetal monitoring prompted new behaviours among midwifery and obstetric staff that may potentially undermine clinical safety. This research raises concerns that central fetal monitoring systems may not promote safe intrapartum care. We argue that research examining the safety of central fetal monitoring systems is required.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.MIDW.2016.12.001
Abstract: to develop a comprehensive model of personal, trauma event-related and workplace-related risk factors for posttraumatic stress subsequent to witnessing birth trauma among Australian midwives. a descriptive, cross-sectional design was used. members of the Australian College of Midwives were invited to complete an online survey. the survey included items about witnessing a traumatic birth event and previous experiences of life trauma. Trauma symptoms were assessed with the Posttraumatic Stress Disorder Symptom Scale Self-Report measure. Empathy was assessed with the Interpersonal Reactivity Index. Decision authority and psychological demand in the workplace were measured with the Job Content Questionnaire. Variables that showed a significant univariate association with probable posttraumatic stress disorder were entered into a multivariate logistic regression model. 601 completed survey responses were analysed. The multivariable model was statistically significant and explained 27.7% (Nagelkerke R square) of the variance in posttraumatic stress symptoms and correctly classified 84.1% of cases. Odds ratios indicated that intention to leave the profession, a peritraumatic reaction of horror, peritraumatic feelings of guilt, and a personal traumatic birth experience were strongly associated with probable Posttraumatic Stress Disorder. risk factors for posttraumatic stress following professional exposure to traumatic birth events among midwives are complex and multi-factorial. Posttraumatic stress may contribute to attrition in midwifery. Trauma-informed care and practice may reduce the incidence of traumatic births and subsequent posttraumatic stress reactions in women and midwives providing care.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.MIDW.2022.103386
Abstract: Whether women's preferences for maternity care are informed remains unclear, suggesting that maternal preferences may not accurately represent what women truly want. The aim of this study was to understand and critique research on women's maternity care preferences published since 2010. Systematic mixed studies review. CINHAL, EMBASE, MEDLINE, and ProQuest Nursing and Allied Health electronic databases were searched from January 2010 to April 2022. Thirty-five articles were included. Models of care and mode of birth were the most frequently investigated preference topics. Roughly three-quarters of included studies employed a quantitative design. Few studies assessed women's baseline knowledge regarding the aspects of maternity care investigated, and three provided information to help inform women's maternity care preferences. Over 85% of studies involved women who were either pregnant at the time of investigation or had previously given birth, and 71% employed study designs where women were required to select from pre-determined response options to describe their preferences. Two studies asked women about their preferences in the face of unlimited access and availability to specific maternity care services. Limited provision of supporting information, the predominant inclusion of women with experience using maternity care services, and limited use of mixed methods may have hindered the collection of accurate information from women about their preferences. Women's maternity care preferences research since 2010 may only present a limited version of what they want.
Publisher: Elsevier BV
Date: 06-2013
DOI: 10.1016/J.WOMBI.2013.01.002
Abstract: The aim of the study was to describe the level of burnout in midwives working at a maternity unit in South East Queensland, Australia. A self-administered questionnaire was distributed to all registered midwives (N=110) working at the study site during November 2011. The questionnaire included a demographic survey and the Copenhagen Burnout Inventory. Fifty-eight (52.7%) staff completed the package. Data was entered into SPSS database version 19 and descriptive statistics were used to determine means, ranges and frequencies. Almost 30% of the s le experienced moderate to high levels of burnout some 50% of participants scored moderate to high for personal burnout with a similar number scoring high for work-related burnout. In comparison, burnout related to working with clients was very low. Differences between participants were associated with years of experience, area of work and employment position (FT/PT, level of position and work area). Participants aged 35years or younger and with less than 10years midwifery experience scored highest on the personal and work-related domains whereas participants over 35years scored highest within the client-related domain. Midwives at level 1 (lowest pay group) scored highest for work-related burnout and client-related burnout. Midwives in more senior positions (level 2 and above) scored highest for personal burnout. Personal and work-related burnout was high in this group of midwives while burnout related to caring for women was low. These results provide insight into the emotional health of midwives in one maternity unit. While more work is needed, strategies to decrease and/or prevent burnout may include clinical mentorship and reorganising models of maternity care to increase work satisfaction and autonomy and strengthen relationships between midwives and women.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.NEPR.2015.01.013
Abstract: Collaborative partnerships between health care providers and academics are essential in the provision of quality undergraduate midwifery programs. While health care providers often contribute to clinical assessment and teaching in midwifery programs, they are rarely involved in assessment design and evaluation. This paper describes the evaluation of an assessment task designed to develop critical thinking skills in final year undergraduate midwifery students. Health care providers' involvement sought to confirm the authenticity and validity of the assessment task and facilitate further engagement. A mixed method descriptive study design was used. After reviewing a s le of student work, health care providers completed a 20 item survey and participated in a focus group. Survey items were based on the domains of Educational Acceptability, Educational Impact and Preparation for Practice. Participants gave high scores for each domain and commented positively on the innovative nature of the assessment, students' ability to undertake in-depth analysis of complex cases, and development of student's critical thinking skills. Participants also reported greater confidence in students' competence and the program. Involving health care providers in evaluation of an assessment task validated the assessment, contributed to clinicians' perceptions of student credibility, and fostered strong links between the program and industry.
Publisher: CSIRO Publishing
Date: 15-07-2019
DOI: 10.1071/AH18209
Abstract: Objective This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies. Methods A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services. Results The mean unadjusted cost for each woman and her baby (n = 134 910) was A$17406 in the first 1000 days. After adjusting for clinical and demographic factors and birth type, women and their babies who birthed in the Cairns Hospital and Health Service (HHS) had costs 19% lower than those who birthed in Gold Coast HHS (95% confidence interval (CI) –32%, –4%) women and their babies who birthed at the Mater public hospitals had costs 28% higher than those who birthed at Gold Coast HHS (95% CI 8, 51). Conclusions There was considerable variation in costs between hospital and health services in Queensland for the costs of delivering maternity care. Cost needs to be considered as an important additional element of monitoring programs. What is known about the topic? The Australian maternal care system delivers high-quality, safe care to Australian mothers. However, this comes at a considerable financial cost to the Australian public health system. It is known that there are variations in the cost of care depending upon the model of care a woman receives, and the type of delivery she has, with higher-cost treatment not necessarily being safer or producing better outcomes. What does this paper add? This paper compares the cost of delivering a full cycle of maternity care to a woman at different HHSs across Queensland. It demonstrates that there is considerable variation in cost across HHSs, even after adjusting for clinical and demographic factors. What are the implications for practitioners? Reporting of cost should be an ongoing part of performance monitoring in public hospital maternity care alongside clinical outcomes to ensure the sustainability of the high-quality maternal health care Australian public hospitals deliver.
Publisher: Elsevier BV
Date: 03-2023
Publisher: Frontiers Media SA
Date: 07-02-2022
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.WOMBI.2017.06.004
Abstract: Psychoeducation counselling delivered by midwives has been demonstrated to reduce maternal fear and improve women's confidence for birth. Translating the evidence in practice presents challenges. A systematic approach to the implementation of evidence and evaluation of this process can improve knowledge translation. To implement and evaluate the translation of psychoeducation counselling on (1) midwives' knowledge, skills and confidence to provide the counselling (2) perceived barriers and enablers to embedding the psychoeducation counselling in practice and (3) pregnant women's levels of fear. Using a mixed methods approach, data were collected using a pre (n=22) and post (n=21) training survey, recorded interviews (n=17), diaries (n=6), and retrospective audit of fear of birth scores. Data were analysed using descriptive statistics, independent s le t-tests, and chi-square tests. Latent content analysis was used to analyse the qualitative data. Training in the counselling framework significantly improved midwives' knowledge, skills and confidence to counsel women on psychosocial issues and reduce fear scores for women reporting high childbirth fear. The main barriers to midwives introducing counselling into routine care related to the fragmentation of care delivery during pregnancy. Conversely continuity of care by a known midwife was considered an enabler. Psychoeducation provided by midwives is of benefit to women experiencing high levels of birth fear. While psychoeducation training was successful in enhancing midwives' knowledge, skills and confidence embedding the counselling framework in everyday practice was challenging. Counselling is more easily implemented within midwifery caseload models which enable midwives to build relationships with women across their pregnancy.
Publisher: Wiley
Date: 09-10-2014
DOI: 10.1111/BIRT.12136
Publisher: Informa UK Limited
Date: 20-04-2011
Publisher: Springer Science and Business Media LLC
Date: 20-10-2013
Publisher: Elsevier BV
Date: 02-2021
Publisher: Wiley
Date: 11-12-2019
DOI: 10.1111/AJO.13107
Abstract: Traumatic stress can adversely affect obstetricians' mental health and may affect care provision. Little is known about the impact of traumatic birth on the Australasian obstetric workforce. To assess the feasibility of conducting a binational survey of Australia and New Zealand obstetricians, trainees, and general practitioner obstetricians, to determine the prevalence of trauma exposure and associated factors. Feasibility was assessed using a convergent mixed-methods design. The pilot online survey assessed traumatic exposure and included the Posttraumatic Diagnostic Scale, Copenhagen Burnout Inventory (work subscale), and Posttraumatic Growth Inventory (short form). Qualitative data were generated from survey comments and telephone interviews and thematically analysed. Using various recruitment strategies, 32 participants completed the survey, and eight completed interviews. Most participants were consultant obstetricians. Nearly all (n = 31, 96.9%) had been exposed to traumatic birth(s). Three-quarters had current symptoms of traumatic stress, one-quarter had symptoms of work-related burnout, but over two-fifths reported significant post-traumatic growth. Thematic analysis revealed perceptions that 'obstetricians experience substantial trauma', there is a 'culture of blame in obstetrics', and only 'in some workplaces it's supportive and safe'. Feasibility issues included the need to identify the respondent's level of training at the time when their most traumatic birth occurred, ensure anonymity of responses, and use a different tool to assess traumatic stress symptoms. Conducting a full study of this important topic appeared feasible. Standardised measures were acceptable. Revision of some questions is required. Anonymity needs to be promoted.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2014
Publisher: Cambridge University Press (CUP)
Date: 18-05-2019
DOI: 10.1017/S1463423618000336
Abstract: Screening women for depression and psychosocial risk during the perinatal period is recognised best practice. Screening by current pen and paper methods can be time consuming, and prone to scorer error. The lack of readily available translated versions of screening tools also excludes many women from different cultures. To evaluate a perinatal mental health digital screening platform, iCOPE. The trial was conducted in a community maternal and child health setting in Melbourne, Australia. A descriptive, cohort design was used. All women attending the urban clinic were invited to complete their routine perinatal screening on the digital platform, designed to automate score calculations and produce instant clinical and client reports whilst collecting data in real time. Screening included the Edinburgh Postnatal Depression Scale (EPDS) and psychosocial risk questions in line with current national clinical guidelines. Functionality of iCOPE was assessed according to duration of screening, completion rates, accuracy of reporting and level of engagement by women. During the trial, 144 screens were performed. The mean screening time was 6.7 min (SD=3.78). Most (65.7% n =94) women took between 3 and 6 min. Mean EPDS score was 7.2 with 16% ( n =23) scoring 13 or more. The accuracy of reports was 100% and screening completion rate was 99.3%. Many women (81.3%) requested a copy of their personal report. The iCOPE platform was efficient in terms of screening time, scoring accuracy, and engagement of women. The automated production of tailored client and clinical reports enabled screening outcomes to be instantly communicated to women and health professionals. The collection of data in real time facilitated the monitoring of screening rates and evaluation of outcomes by clinicians and service managers.
Publisher: Elsevier BV
Date: 12-2002
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH13044
Abstract: Introduction For women with a lower uterine incision without indication for repeat Caesarean section (CS), vaginal birth for their next pregnancy is a safe option. Although these women should be encouraged to consider vaginal birth after a Caesarean section (VBAC) it is not consistently supported in practice. There is relatively little information on the extent to which maternal preference, birthing decisions and outcomes match best available evidence. Aim To describe current VBAC rates for women in Queensland, Australia and compare this to safe, achievable VBAC rates reported in national and international studies. Method Perinatal data from 2004 to 2011 were reviewed to determine current VBAC rates following a primary CS for women birthing in Queensland. These were compared with VBAC rates reported in the literature. Results Queensland has a high overall CS rate and high repeat CS rate compared with the national average. In 2010, Queensland VBAC rates for next birth following primary CS were 14% (range 13–21% public sector, 7–11% private hospitals). This is substantially lower than achievable Australian rates of 24% and international rates. Conclusion Low VBAC rates reflect low numbers of women commencing labour in a pregnancy subsequent to a primary CS. There is unexplained variation in VBAC rates between maternity facilities. Clinical reviews to support evidence-based practice are warranted. What is known about the topic? Repeat CS is a major contributor to high CS rates in industrialised countries. What does this paper add? Following a primary CS, women in Queensland are less likely to commence labour and achieve a vaginal birth compared with rates reported in national and international VBAC studies. What are the implications for practitioners? Maternity clinicians need to be aware of best practice and contextualise the evidence for in idual women to improve VBAC rates.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Mark Allen Group
Date: 02-06-2019
DOI: 10.12968/BJOM.2019.27.6.362
Abstract: Postnatal anxiety is relatively common when transitioning to parenthood however, there are relatively few studies assessing postnatal anxiety in Middle Eastern women. To identify the prevalence of postnatal anxiety among Jordanian women and associated sociocultural factors. A descriptive cross-sectional design was used with 324 women. Participants completed the Depression, Anxiety, and Stress Scale (DASS) and Maternity Social Support Scale at 6-8 weeks postpartum in addition to a sociodemographic data form. Some 45.4% of women scored above ‘mild’ on the DASS scale. Postnatal anxiety was significantly associated with low levels of support, giving birth to a female baby, financial difficulties, and having four or more children. Findings revealed a high level of postnatal anxiety among Jordanian women. There is a need for routine assessment, ongoing support, counselling and emotional care, which are important to enhance maternal satisfaction and psychological wellbeing.
Publisher: MDPI AG
Date: 28-05-2022
Abstract: Background: Although undergoing an abortion is stressful for most women, little attention has been given to their psychological wellbeing. This protocol aims to assess the feasibility, acceptability, and primary effects of a complex intervention to promote positive coping behaviors and alleviate depression symptoms among Chinese women who have undergone an abortion. Methods: A two-arm randomized controlled trial design will be used. Participants will be recruited at their first appointment with the abortion clinic and randomly allocated to receive either the Stress-And-Coping suppoRT (START) intervention (in addition to standard abortion care) or standard care only. All participants will be followed-up at two- and six-weeks post-abortion. Approval has been granted by local and university ethics committees. This research was supported by an Australian Government Research Training Program Scholarship. Discussion: The results will assist refinement and further evaluations of the START intervention, contribute to improved abortion care practices in China, and enrich the evidence on improving women’s psychological well-being following abortion in China. Trial registration: Registered at the Chinese Clinical Trials.gov: ChiCTR2100046101. Date of registration: 4 May 2021.
Publisher: Springer Publishing Company
Date: 09-2019
DOI: 10.1891/IJCBIRTH-D-19-00031
Abstract: A national review of maternity services in Australia in 2009 resulted in legislative changes which provided midwives with an unprecedented opportunity to offer continuity of care as a private practitioner with visiting access to a public maternity hospital. However, very few midwives have taken up this opportunity. To explore the experiences of midwives who transitioned into private practice with visiting access to a public hospital. Using a qualitative descriptive approach, six midwives participated in digitally recorded in-depth interviews. Data was analyzed using thematic analysis. Transitioning to private practice enabled midwives to align their core midwifery values with their practice. Midwives reported taking “a leap of faith” by venturing into private practice. Although seeking visiting access and running a small business was initially daunting, midwives were rewarded by being able to practice autonomously and provide continuity of woman centered care within a caseload model. The legislative restrictions, especially around employing other midwives posed significant challenges. Private practice with visiting access provided midwives with a service model that aligned their core midwifery values with their clinical practice. The model facilitated their ability to work as lead care professionals, provide woman centered care, and access a collaborative network of healthcare professions. However, the midwives continued to experience structural barriers that threaten the scalability and sustainability of the model. Structural barriers to midwives working to their full scope of practice and in alignment with a midwifery philosophy are a global issue. Further reforms are needed.
Publisher: Springer Science and Business Media LLC
Date: 09-01-2017
Publisher: Elsevier BV
Date: 03-2020
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.MIDW.2018.10.016
Abstract: Negative birth experiences may have adverse effects on the wellbeing of women and babies. Knowledge about useful interventions to assist women in processing and resolving negative birth experiences is limited. To explore women's experience and preferences of reviewing their birth experience at a special midwifery clinic. The study is a qualitative content analysis of women's written text responses to semi-structured questions, included in a retrospective study. A special counselling clinic, 'Ljáðu mér eyra', at Landspitali University Hospital in Reykjavik, provides women with an opportunity to review their birth experience and discuss their fears about an upcoming birth with a midwife. A questionnaire was sent to all women attending the clinic from 2006-2011 (n = 301). Of the 131 women completing and returning the questionnaire, 125 provided written responses to the open-ended questions. The questionnaire consisted of demographic and reproductive characteristics of women, questions about why they attended the clinic, whether their expectations were fulfilled, helpful components of the interview and open-ended questions about women's views of the process. Data on participant characteristics, the reason for attending the clinic, whether the interview fulfilled their expectations and helpful components were analysed using quantitative descriptive data, while written responses to semi-structured questions were analysed using content analysis. The main reasons for attending the clinic were a previous negative birth experience, anxiety about the upcoming birth, and/or loss of control during a prior birth. Two themes and three subthemes were identified. The overarching theme was 'on my terms' with the subthemes of 'being recognised', 'listening is paramount' and 'mapping the unknown'. The final theme was 'moving on'. Women want to be recognised and invited to review their birth experience in a tailored conversation on their terms. By fulfilling their expectations of reviewing the birth experience, they regained control and strength to move on. Findings support the importance of recognising women's need to review their birth experiences and offer an intervention to reflect on their perceptions. A discussion of the birth experience should be a routine part of maternity services.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.NEDT.2022.105405
Abstract: Childbearing women's relationship with maternity care providers enhance childbirth outcomes. Students need to understand and offer respectful care. Evaluate effectiveness and impact of an online education intervention on nursing students' perceptions towards respectful maternity care during labour and childbirth in Nepal. A quasi-experimental pre-post design was used. A total of 89 Third Year Bachelor of Nursing students (intervention n = 40 control n = 49) from three participating colleges. Students completed online pre and post-test surveys using the Students' Perceptions of Respectful Maternity Care scale and questions about impact of the intervention. The intervention group received six hours of education delivered online (three sessions x three weeks). ANCOVA and non-parametric Wilcoxon signed-rank tests measured effects. Compared to controls, students in the intervention group reported a significant increase in perceptions towards respectful maternity care (F (1, 86) = 28.19, p < 0.001, η Relatively few intervention studies to promote respectful maternity care in students have been published. This brief online intervention improved students' perceptions. The intervention package can be integrated into nursing or midwifery curricula and in-service training. A larger study with longer follow-up is needed to support current findings.
Publisher: Wiley
Date: 06-2001
DOI: 10.1046/J.1523-536X.2001.00101.X
Abstract: Few studies have examined women's preferences for birth. The object of this study was to determine the incidence of women's preferred type of birth, and the reasons and factors associated with their preference. Three hundred and ten women between 36 and 40 weeks' gestation were recruited from the antenatal clinic of a major metropolitan teaching hospital and the consulting rooms of six private obstetricians in Brisbane, Australia. Participants completed a questionnaire asking about their preferred type of birth, reasons for their preference, preparation for childbirth, level of anxiety and concerns, and the influence of the primary caregiver. Two hundred and ninety women (93.5%) preferred a spontaneous vaginal birth 20 women (6.4%) preferred a cesarean section. Of the latter group, most had a current obstetric complication or experienced a previously complicated delivery (p <0.001) 1 woman (0.3%) preferred a cesarean section in the absence of any known current or previous obstetric complication. Women who preferred a cesarean section were more anxious, were generally poorly informed of the risks of this procedure, and/or overestimated the safety of the procedure. Women who preferred a cesarean section were more likely to have experienced this type of birth previously and to have negative feelings about it. To decrease women's preference for a cesarean section, practitioners should reduce the primary cesarean delivery rate and improve the quality of emotional care for women who require a cesarean section. Caregivers should engage in a sensitive discussion of the risks and benefits of various birth options, including a vaginal birth after cesarean, with women who have previously experienced a cesarean birth before they make decisions about mode of delivery in a subsequent pregnancy.
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.WOMBI.2014.12.006
Abstract: In 2010 Australian Government reform of maternity services enabled midwives to access Medicare. This significant change provides midwives with new opportunities to engage in patterns of working that provide continuity of care to childbearing women. There remains limited evidence, however, on midwives perceptions of how the reforms impact them both personally and professionally. This research examined midwives' perceptions of their role and how, in light of the reform agenda, they might conceptualise a change in working patterns and environment to provide greater levels of continuity of care. A qualitative descriptive approach was employed using the four-stage Appreciative Inquiry model. Twenty-three midwives from three maternity units within south-east Queensland participated in one of six focus groups. Thematic iterative analysis was employed to identify empirical codes and examine relationships within and across the data. Midwives endorsed the reforms and considered the concept of continuity of midwifery care as fundamental to achieving a woman centred maternity system. Most participants, however, found it difficult to conceptualise how they might contribute to any level of system change. In addition the majority passively accepted the status quo of their employing organisation and believed they were powerless to effect change. In order to promote the growth of evidence based continuity of care models midwives need to work to their full scope of practice. Strong midwifery leadership is required to enable midwives to re-conceptualise roles and work patterns and identify how they can engage with and contribute to reform of maternity services.
Publisher: Elsevier BV
Date: 04-2009
DOI: 10.1016/J.MIDW.2007.04.004
Abstract: to describe the development and application of a brief counselling intervention for women who have experienced a traumatic birth. the birthing trauma counselling model reflecting women's need to establish a therapeutic connection with a midwife, talk about their birth experience and have their feelings validated. Gaps in understanding of events need explanation and explicit connections made between the event and subsequent emotions and behaviours. Developing a rational understanding of birthing events and how labour may have been managed differently assists women to revise their assumptions about maternity care and gain a sense of control. Fostering social support, reinforcing positive approaches to coping and exploring solutions to restoring self-confidence and reducing anxiety may help re-establish psychological equilibrium. the counselling intervention is consistent with trauma theory and draws on cognitive behavioural therapy principles. Midwives are well placed to provide counselling support to women experiencing birth-related distress. Further testing of the intervention in the clinical setting with a large s le is required.
Publisher: Springer Publishing Company
Date: 06-2019
Abstract: To understand the experiences and contextual factors that influence the ability of midwives to provide appropriate support to women regarding alcohol and other drug (AOD)e use during pregnancy, in the Queensland context. Using a qualitative approach underpinned by critical realism, we explored the experiences of eleven midwives using semi-structured interviews. Thematic analysis was utilized, which was inductive and deductive, as it aimed to explicate different contextual factors at play, based on the experiences of the current s le of midwives. Experiences of midwives in the current study were influenced by five overarching contextual factors: (a) patient-level factors (complexities experienced by women and lack of knowledge regarding maternity care options) (b) provider atient-level factors (importance of midwives building relationships with women and importance of continuity of care) (c) provider-level factors (importance of taking a supportive approach, midwife confidence, engagement in AOD screening, variable attitudes and knowledge) (d) organizational-level factors (lack of support and training, concerns regarding communication, time constraints and organizations that limited midwife involvement) (e) broader system-level factors (lack of effective services and inconsistent messages regarding AOD use during pregnancy). The current study has highlighted a range of practice areas and potential implementation strategies across a number of contextual levels that could be beneficial in the Queensland context to improve maternity care provision for women who are experiencing AOD use challenges during pregnancy.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.WOMBI.2017.06.013
Abstract: Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included Copenhagen Burnout Inventory (CBI) Depression, Anxiety and Stress Scale-21 and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The s le (n=862) was ided into two groups midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002 CBI Work p<.001 CBI Client p<.001) and Anxiety (p=.007) and Depression (p=.004) sub-scales. Midwives providing continuity reported significantly higher scores on the PEMs Autonomy/Empowerment subscale (p<.001) and the Skills and Resources subscale (p=.002). There was no difference between the groups in terms of satisfaction with time off and work-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.WOMBI.2017.04.003
Abstract: Several risk factors for negative birth experience have been identified, but little is known regarding the influence of social and midwifery support on the birth experience over time. The aim of this study was to describe women's birth experience up to two years after birth and to detect the predictive role of satisfaction with social and midwifery support in the birth experience. A longitudinal cohort study was conducted with a convenience s le of pregnant women from 26 community health care centres. Data was gathered using questionnaires at 11-16 weeks of pregnancy (T1, n=1111), at five to six months (T2, n=765), and at 18-24 months after birth (T3, n=657). Data about sociodemographic factors, reproductive history, birth outcomes, social and midwifery support, depressive symptoms, and birth experience were collected. The predictive role of midwifery support in the birth experience was examined using binary logistic regression. The prevalence of negative birth experience was 5% at T2 and 5.7% at T3. Women who were not satisfied with midwifery support during pregnancy and birth were more likely to have negative birth experience at T2 than women who were satisfied with midwifery support. Operative birth, perception of prolonged birth and being a student predicted negative birth experience at both T2 and T3. Perception of negative birth experience was relatively consistent during the study period and the role of support from midwives during pregnancy and birth had a significant impact on women's perception of birth experience.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.MIDW.2014.09.003
Abstract: around 20% of women suffer childbirth fear causing them significant distress and often leading to requests for caesarean section. In Sweden, fearful pregnant women are offered counselling however, in Australia, no dedicated service caters for the specific needs of these women. Indeed scant research has been conducted in Australia and little is known about women's concerns and if these align to those reported in the international literature. to describe the sources, responses and moderators of childbirth fear in a group of pregnant women assessed as having high levels of childbirth fear. comparative analysis was used to identify common concepts and generate themes that represented women's perspectives of childbirth fear. Data consisted of 43 tape recorded telephone conversations with highly fearful pregnant women who were participating in a large randomised controlled trial known as BELIEF (Birth Emotions, Looking to Improve Expectant Fear). women's fears were conceptualised into three themes: fear stimuli fear responses and fear moderators. Lack of confidence to birth, fear of the unknown, internalising other women's negative stories, perineal tearing and labour pain were common concerns for first time mothers. For multiparous women, not having had personal feelings resolved following their previous birth and negative experiences of last birth influenced current expectations for their upcoming birth. Themes common to both groups were: unmet information and support needs, feelings of loss of control and lack of input in to decision-making. Some women however, chose to avoid birth planning in order to cope during pregnancy. Australian women had similar childbirth concerns to those reported in the international literature. However unique to this study was finding two opposing discourses one of preoccupation with negative events and the other avoidance of planning for labour and birth. Provision of woman centred maternity models that minimise obstetric intervention, offer personalised conversations following birth, and are sensitive to identifying listening and assisting women to modify their fears in early pregnancy are required to promote positive anticipation and preparation for birth.
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.WOMBI.2018.04.003
Abstract: Relatively little is known about the extent of trauma and birth-related fear in midwives and how this might affect practice. (1) Determine prevalence of birth related trauma and fear in midwives and associations with midwives' confidence to advise women during pregnancy of their birth options and to provide care in labour. (2) Describe midwives' experiences of birth related trauma and/or fear. A mixed methods design. A convenience s le of midwives (n=249) completed an anonymous online survey. Descriptive and inferential statistics were used to analyse the quantitative data. Latent content analysis was used to extrapolate meaning from the 170 midwives who wrote about their experiences of personal and/or professional trauma. The majority of midwives (93.6%) reported professional (n=199, 85.4%) and/or personal (n=97, 41.6%) traumatic birth experiences. Eight percent (n=20) reported being highly fearful of birth. Trauma was not associated with practice concerns but fear was. Midwives categorised as having 'high fear' reported more practice concerns (Med 23.5, n=20) than midwives with 'low fear' (Med 8, n=212) (U=1396, z=-3.79, p<0.001, r=0.24). Reasons for personal trauma included experiencing assault, intervention and stillbirth. Professional trauma related to both witnessing and experiencing disrespectful care and subsequently feeling complicit in the provision of poor care. Feeling unsupported in the workplace and fearing litigation intensified trauma. High fear was associated with lower confidence to support childbearing women. Fear and trauma in midwives warrants further investigation to better understand the impact on professional practice.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.WOMBI.2016.02.001
Abstract: Midwifery prescribing was introduced in Australia in 2010 and is available to those notated as Medicare Eligible. Only 59% of Medicare Eligible midwives are endorsed prescribers. To explore and describe Australian midwives views of prescribing including the barriers and enablers to prescribing. Online survey. Eligible participants were Australian midwives who had completed an educational programme required for endorsement as a midwifery prescriber (n=131). Descriptive statistics and content analysis were used to analyse the data set. Sixty-six midwives entered data (50% response rate). Twelve midwives (18%) had commenced prescribing. Prescribers agreed that being able to prescribe enhanced women's access to medicines and role satisfaction. The most common barriers to initiating prescribing were regulatory issues and processes, and no pathway to support midwifery prescribing in the public sector. The enabling factors most commonly reported were supportive relationships, education and personal factors such as motivation, knowledge and confidence. Prescribing was viewed positively by midwives, but only a small proportion of suitably educated midwives were able to translate this into prescribing. Prolonged and complicated registration processes, restrictive drug formularies, and a lack of prescribing roles for public sector midwives were clear barriers. Supportive professional relationships, quality education and personal motivation and confidence assisted midwives in overcoming these barriers. Offering mentoring may help midwives to move into prescribing practice and use it in a manner that best meets the health needs of women and infants in midwifery care.
Publisher: Elsevier BV
Date: 09-2020
DOI: 10.1016/J.WOMBI.2019.10.002
Abstract: Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring. Intrapartum cardiotocograph monitoring is considered to be indicated for women at risk for poor perinatal outcome. This systematic literature review with meta-analysis examined randomised controlled trials and non-experimental research to determine whether cardiotocograph monitoring rather than intermittent auscultation during labour was associated with changes in perinatal mortality or cerebral palsy rates for high-risk women. A systematic search for research published up to 2019 was conducted using PubMed, CINAHL, Cochrane, and Web of Science databases. Non-experimental and randomised controlled trial research in populations of women at risk which compared intrapartum cardiotocography with intermittent auscultation and reported on stillbirth, neonatal mortality, perinatal mortality and/or cerebral palsy were included. Relative risks were calculated from extracted data, and meta-analysis of randomised controlled trials was undertaken. Nine randomised controlled trials and 26 non-experimental studies were included. Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy. Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome. There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.
Publisher: Wiley
Date: 16-09-2020
DOI: 10.1111/NHS.12756
Abstract: This systematic review aimed to critique the process of development and psychometric properties of tools measuring respectful or disrespectful maternity care experienced by women during labor and birth in low‐ and middle‐income countries. The MEDLINE, Embase, CINAHL, Web of Science, PubMed, and Cochrane Library electronic databases were systematically searched from their inception to February 2020. Methodological quality was assessed using the COnsensus‐based Standards for the selection of health Measurement INstruments checklist. Six tools measuring respectful maternity care during the intrapartum period were identified. Measurement error, cross‐cultural validity, and responsiveness were not evaluated by any tool developers, while structural validity, internal consistency, and hypothesis testing were the most frequently assessed measurement properties. Interestingly, this review could not identify any measures of disrespectful care even though most included measures focused on disrespect and abuse. No measure was of sufficient quality to determine women's experiences of disrespectful and respectful maternity care in low‐ and middle‐income countries. New valid and reliable measures using rigorous approaches to tool development are required.
Publisher: Mark Allen Group
Date: 02-08-2023
DOI: 10.12968/BJOM.2023.31.8.445
Abstract: Childbirth is an important and unique event for mothers and families, but can cause fear and anxiety. All mothers have the right to adequate support for labour and a respectful birth. This study aimed to investigate the impact of supportive intrapartum care on women's perceptions of fear, pain and control during childbirth, as compared to routine care. A quasi-experimental study was conducted at the Jordan University Hospital with 134 pregnant women between August 2019 and January 2020. Participants were assigned to either the intervention (n=65) or control group (n=69). Data were collected using a sociodemographic form, a visual analogue scale for pain, the Wijma delivery expectancy questionnaire (B) for fear during birth, and the perceived support and control in birth scale. Women receiving supportive care reported lower pain scores during the latent (t=4.15, P .001), active (t=4.64, P .001) and transition (t=2.34, P .05) phases of labour, less fear (t=8.66, P .001), and higher perceived control (t=12.46, P .001) and support (t=10.54, P .001), and had a shorter labour (t=10.367, P .001) compared to women receiving routine care. Low control (β=-0.35), high levels of pain (β=0.20) and low support (β=-0.19) contributed to fear during childbirth. Supportive intrapartum care decreased women's perceptions of pain and fear and improved perceptions of control and support. Training and support for midwives could be translated to similar settings in middle-income countries. Policies directed at routine implementation of supportive intrapartum care are essential to decrease pain and fear of childbirth.
Publisher: Wiley
Date: 08-2014
DOI: 10.1111/INR.12120
Abstract: Birth weight is a good indicator of mothers' and neonates' nutritional status, and it contributes to the newborn baby's survival, health, growth and development. This study identified social factors associated with differences in the mean birth weight of newborn babies in Jordan. This retrospective study analysed medical records to determine possible risk factors associated with differences in newborn BW in the Irbid governorate of Jordan. All full-term singleton births during the year 2010 were reviewed. Abstracted data included mother's age, educational level, and monthly family income. Newborn information included birth weight, gender and birth order. A total of 5414 full-term singleton births were included. Of these, 15.1% were low birth weight, 73.6% were normal birth weight, and 11.3% were high birth weight. Bivariate analysis of variance revealed that low mean birth weight was associated with female gender, first-born babies, higher maternal age (>35 years), lower educational level and lower income (<500 JD). Multivariate analysis of variance revealed that mean birth weight was lower in female infants, first-born infants, infants of less educated mothers, higher age and low monthly income. The findings can be generalized to full-term singleton pregnancies in countries who share similar cultural and traditional values. Education of mothers is a modifiable variable that can positively influence birth weight, particularly in the case of female and first-born infants. The findings inform our understanding of some social factors affecting birth weights of neonates in Jordan and development of effective public health interventions that could reduce the adverse effects of such factors on newborn birth weight. Preconception and antenatal care is also important for early detection of such possible risk and targeting mothers who require early interventions and support.
Publisher: Elsevier BV
Date: 09-2020
DOI: 10.1016/J.WOMBI.2019.10.005
Abstract: Graduating midwives unsuccessful in gaining employment in their preferred model/location or finding a job within a year of graduation are more likely to leave the profession. Obtaining post-graduate midwifery employment is competitive with midwifery students needing to confidently sell themselves to potential employers. Whilst midwifery students may be prepared with the requisite midwifery skills and knowledge, there is no guarantee of attaining a midwifery position upon graduation. Increasingly employers are requiring 'soft skills' including communication, teamwork, reflexivity and personal attributes of the in idual to be able to effectively respond within different contexts. Demonstrating these skills within an employment interview requires confidence and knowledge in how to prepare. Designed with health service partners, simulated employment interviews were introduced into the final year of a Bachelor of Midwifery program as part of a suite of employability strategies connected to the student lifecycle. An exploratory evaluation study of students 'experiences of a simulated employment interview was undertaken. The simulated interview emulated real employment interviews with students receiving immediate written and oral feedback. Evaluation through surveys, focus groups and in idual interviews provided rich data around the effectiveness of this approach. Students, health service partners and academics found the simulated employment interview provided a valuable learning experience, assisting students to reflect, explore and further develop skills sought by employers. Collaboration with health service partners created an authentic process enabling students to receive feedback relevant to the real world of practice. Students were able to work through anxiety, gain confidence and exposure to employers in preparation for employment interviews.
Publisher: Springer Science and Business Media LLC
Date: 14-04-2020
DOI: 10.1186/S12884-020-02891-2
Abstract: Variation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum. A prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for ‘ at least probable minor depression ’ during pregnancy (≥ 13) and postpartum (≥ 10) and for ‘ probable major depression ’ during pregnancy (≥ 15) and postpartum (≥ 13). PHQ-2 was analysed using two methods: [1] scored (cut-points ≥ 2 and ≥ 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy. Probable major depression: Over four timepoints PHQ-2 ≥ 3 revealed lowest sensitivity (36–79%) but highest specificity (94–98%). An alternative case-identification method revealed high sensitivity (93–100%), but lowest specificity (58–71%). Minor depression: PHQ-2 ≥ 3 revealed the lowest sensitivity (19–50%) but highest specificity (95–98%). An alternative case-identification method revealed the highest sensitivity (81–100%) and moderate specificity (60–74%). Recommended method of case-identification (PHQ-2 ≥ 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and erse maternity populations is recommended.
Publisher: Springer Science and Business Media LLC
Date: 11-07-2017
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.MIDW.2011.10.012
Abstract: to compare cost-effectiveness of two models of maternity service delivery: Midwifery Group Practice (MGP) at a birth centre and standard care (SC). a prospective non-randomised trial. an Australian metropolitan hospital. women at 36 weeks gestation were approached in the birth centre or hospital antenatal clinics between March and December 2008. Of 170 consecutive women who met birth centre eligibility criteria, 70% (n=119) were recruited to the study. Women (MGP n=52 or standard care n=50) were followed through to 6 weeks postpartum. Publically funded care costs were collected from women's diaries, handheld pregnancy health records, medical records and the hospital accounting system. health-care costs to the hospital and government. generalised linear models with covariates of age, nulliparity, private health insurance (yes/no) and household income category. women receiving MGP care were less likely to experience induction of labour, required fewer antenatal visits, received more postnatal care, and neonates were less likely to be admitted to special care nursery than those receiving standard care. Statistically significant lower costs were found for women and babies receiving MGP care compared with women receiving standard care during pregnancy, labour and birth and postpartum to 6 weeks. MGP resulted in lower costs for the hospital ($AUD4,696 vs. $AUD5,521 p<0.001) and the government ($AUD4,722 vs. $AUD5,641 p<0.001). When baby costs were excluded MGP care remained statistically significantly cheaper than standard care. for women at low-risk of birth complications, Midwifery Group Practice was cost effective, and women experienced fewer obstetric interventions compared with standard maternity care. The evidence suggests Midwifery Group Practice is safe and economically viable.
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.WOMBI.2014.10.002
Abstract: Unexplained late gestation stillbirth is a significant health issue. Antenatal information about foetal movements has been demonstrated to reduce the stillbirth rate in women with decreased foetal movements. Midwives are ideally placed to provide this information to women. To investigate pregnant women's perceptions of information about foetal movements and preferences for receiving information. This prospective, descriptive study was conducted in the antenatal clinic of a large metropolitan maternity hospital. Pregnant women (n=526) at 34 weeks gestation or later were recruited. Only 67% of women reported receiving information about foetal movements. Women reported that midwives (80%), family (57%), friends (48%) and own mother (48%) provided this information. Midwives were the most preferred source of information. Around half (52%) of the women used the internet for information but only 11% nominated the web as their preferred information source. Women prefer to be given as much information about foetal movements as possible. Women favour information from health professionals, mainly from a midwife. Midwives are well-placed to partner with pregnant women and give them unbiased and evidenced based information enabling them to make decisions and choices regarding their health and well-being. While the internet is a prevalent information source, women want to be reassured that it is trustworthy and want direction to reliable pregnancy related websites.
Publisher: Wiley
Date: 20-09-2008
DOI: 10.1111/J.1365-2648.2008.04757.X
Abstract: This paper is a report on the examination of demographic, birthing and social correlates of maternal role development in childbearing women. Successful adaptation to the maternal role provides a mother with confidence and satisfaction in her ability to nurture and care for her infant. Despite the importance of this developmental process for maternal well-being, little attention has been given to social and demographic predictors of positive role development in recent years. A prospective study was undertaken at three publicly-funded metropolitan antenatal clinics in Queensland, Australia between March and November 2003. A total of 605 women completed a survey at 36 weeks gestation and 12 weeks postpartum, with a response rate of 78% (n = 473). A self-report questionnaire was used to collect data about personal and birth variables, domestic violence, social support and maternal role development. The majority of women (81%) were of White ethnic background, modal age was 30-45 years (40%, n = 189) and 66 percent (n = 312) were in paid employment. Bivariate analysis identified age, marital status, length of relationship and social support to be statistically significantly associated with maternal role development. Optimal scaling showed social support to be the most important factor in maternal role development. Maternal role development following childbirth is complex and can be adversely affected by older maternal age, married status, inadequate social support and short partner relationships. A deeper understanding of this process is needed if healthcare professionals are to assist mothers in making a smooth transition to motherhood.
Publisher: Elsevier BV
Date: 05-2023
DOI: 10.1016/J.WOMBI.2022.09.004
Abstract: International guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women's decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors. To examine impacts of policy and research texts on midwives' and obstetricians' work with labouring women related to intrapartum fetal monitoring decision-making. We used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives' and obstetricians' work with the fetal monitoring system. Textual mapping was used to explain how midwives' and obstetricians' work was organised to happen the way it was. CTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour. Guidelines structured midwives' and obstetricians' work in a manner that undermined women's participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.NEPR.2018.07.008
Abstract: Capstone experiences facilitate consolidation and application of previous learning, strengthening professional identity and competency. This study evaluates the effectiveness and acceptability of a capstone assessment item, in the form of an e-portfolio, designed to identify and demonstrate preparedness for professional midwifery practice. A sequential explanatory strategy occurred within a mixed method research design. Final year Bachelor of Midwifery students at an Australian university, having completed the e-portfolio assessment, participated in two phases of data collection an initial online-survey, followed by in-depth exploration of emergent concepts within a focus group. Analysis of the quantitative data identified completing the e-portfolio assessment increased students' skills, knowledge and confidence and promoted reflection and critical thinking. Three themes emerged from the qualitative data acknowledging growth and development transitioning to practice, and knowing 'who I am and where I am going'. The e-portfolio assessment meets the aims of a capstone assessment and provides an appropriate framework and authentic opportunity for students to identify and demonstrate their level of preparedness for professional practice, determine their ongoing learning needs and develop strategies for achieving them. The assessment item provides an opportunity to develop and articulate a personal practice philosophy and embeds the principles of lifelong learning.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.WOMBI.2016.06.006
Abstract: Midwives frequently witness traumatic birth events. Little is known about responses to birth trauma and prevalence of posttraumatic stress among Australian midwives. To assess exposure to different types of birth trauma, peritraumatic reactions and prevalence of posttraumatic stress. Members of the Australian College of Midwives completed an online survey. A standardised measure assessed posttraumatic stress symptoms. More than two-thirds of midwives (67.2%) reported having witnessed a traumatic birth event that included interpersonal care-related trauma features. Midwives recalled strong emotions during or shortly after witnessing the traumatic birth event, such as feelings of horror (74.8%) and guilt (65.3%) about what happened to the woman. Midwives who witnessed birth trauma that included care-related features were significantly more likely to recall peritraumatic distress including feelings of horror (OR=3.89, 95% CI [2.71, 5.59]) and guilt (OR=1.90, 95% CI [1.36, 2.65]) than midwives who witnessed non-interpersonal birth trauma. 17% of midwives met criteria for probable posttraumatic stress disorder (95% CI [14.2, 20.0]). Witnessing abusive care was associated with more severe posttraumatic stress than other types of trauma. Witnessing care-related birth trauma was common. Midwives experience strong emotional reactions in response to witnessing birth trauma, in particular, care-related birth trauma. Almost one-fifth of midwives met criteria for probable posttraumatic stress disorder. Midwives carry a high psychological burden related to witnessing birth trauma. Posttraumatic stress should be acknowledged as an occupational stress for midwives. The incidence of traumatic birth events experienced by women and witnessed by midwives needs to be reduced.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.WOMBI.2014.06.002
Abstract: Marked differences exist between the maternal and neonatal outcomes of Australian Aboriginal and Torres Strait Islander women and their babies compared with the outcomes for other Australian women and their babies. Australian government policies underline the need to increase the number of practising Aboriginal and Torres Strait Islander midwives and nurses as a strategy for delivering culturally appropriate healthcare to improve health outcomes for Aboriginal and Torres Strait Islander families. Additional challenges are experienced by Aboriginal and/or Torres Strait Islander midwifery students providing Continuity of Care (COC) to Australian Aboriginal and/or Torres Strait Islander childbearing women. One such ex le is the challenge presented due to the close connections and relationships that exist within some Aboriginal and/or Torres Strait Islander cultures in terms of the maintenance of a professional relationship, in particular, the maintenance of professional boundaries. Whilst there is a growing body of evidence on the benefits to women of continuity of midwifery care models, little is known about the experiences of Aboriginal and Torres Strait Islander women who receive COC from Aboriginal and Torres Strait Islander midwifery students. To explore the experiences of Australian Aboriginal and Torres Strait Islander childbearing women who participated in a Continuity of Care journey with an Aboriginal and/or Torres Strait Islander Bachelor of Midwifery student. Exploratory, descriptive study using semi-structured interviews informed by an Indigenous Research Methodology. Thematic analysis identified four major themes: (i) communicating our way, (ii) the role of relationships, (iii) support and assistance and (iv) challenges of the system. The findings illustrated the benefits Aboriginal women experience as a result of having Aboriginal and/or Torres Strait Islander midwifery students provide Continuity of Care. Increasing the number of Australian Aboriginal and/or Torres Strait Islander midwives is essential to improving health outcomes for Australian Aboriginal and Torres Strait Islander childbearing women and their families. Caseload midwifery models with Aboriginal and Torres Strait Islander midwives across Australia are needed. Health services, in partnership with Universities and Aboriginal and Torres Strait Islander communities, have a vital role to play in the development and expansion of these models.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.NEDT.2013.10.020
Abstract: Midwives require well developed critical thinking to practice autonomously. However, multiple factors impinge on students' deep learning in the clinical context. Analysis of actual case scenarios using root cause analysis may foster students' critical thinking and application of 'best practice' principles in complex clinical situations. To examine the effectiveness of an innovative teaching strategy involving root cause analysis to develop students' perceptions of their critical thinking abilities. A descriptive, mixed methods design was used. Final 3rd year undergraduate midwifery students (n=22) worked in teams to complete and present an assessment item based on root cause analysis. The cases were adapted from coroners' reports. After graduation, 17 (77%) students evaluated the course using a standard university assessment tool. In addition 12 (54%) students provided specific feedback on the teaching strategy using a 16-item survey tool based on the domain concepts of Educational Acceptability, Educational Impact, and Preparation for Practice. Survey responses were on a 5-point Likert scale and analysed using descriptive statistics. Open-ended responses were analysed using content analysis. The majority of students perceived the course and this teaching strategy positively. The domain mean scores were high for Educational Acceptability (mean=4.3, SD=.49) and Educational Impact (mean=4.19, SD=.75) but slightly lower for Preparation for Practice (mean=3.7, SD=.77). Overall student responses to each item were positive with no item mean less than 3.42. Students found the root cause analysis challenging and time consuming but reported development of critical thinking skills about the complexity of practice, clinical governance and risk management principles. Analysing complex real life clinical cases to determine a root cause enhanced midwifery students' perceptions of their critical thinking. Teaching and assessment strategies to promote critical thinking need to be made explicit to students in order to foster ongoing development.
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.MIDW.2016.04.010
Abstract: undergraduate midwifery programmes offer opportunities for school leavers and young people (aged less than 21 years) to enter the profession. There is limited research exploring this age groups experience of their Bachelor of Midwifery programme. In order to retain these students we need to ensure that their experiences of undertaking a Bachelor of Midwifery program are positive and barriers and challenges are minimised. this study explored young midwifery students' experience of their Bachelor of Midwifery program. a descriptive exploratory qualitative approach was used to explore the experiences of eleven students aged 20 years or less on enrolment. Data was collected using face-to-face or telephone-recorded interviews. Thematic analysis was used to analysis the data set. three major themes described the young students' experiences. The first labelled 'The challenges of being young' presented a number of age related challenges including transport issues with on-call commitments as some students had not gained a driver's license. Students experienced some degree of prejudice relating to their age from their older student peers and some clinical staff during placements. 'Finding your way' was the second theme and described the strategies students used to build confidence and competence both in the university and clinical environment. The young students reported a strong commitment to the profession. They demonstrated high levels of connection with women and found the continuity of care experiences invaluable to their learning. The final theme 'Making the transition from teenager to midwife' demonstrated some unique insights into how studying to become a midwife impacted upon their personal and professional growth. the young students in this study encountered some unique issues related to their age. However as they progressed through the program they developed confidence in themselves and visualised themselves as having a long midwifery career. They were strongly motivated towards providing woman-centred maternity care and considered their continuity of care experiences fundamental to them developing a strong sense of themselves as midwives. Attracting and retaining young students is essential if the profession is to realise its goal of ensuring all women have access to a known midwife.
Publisher: Elsevier BV
Date: 03-2002
Publisher: Elsevier BV
Date: 11-2019
Publisher: Springer Science and Business Media LLC
Date: 13-02-2015
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.SRHC.2016.08.003
Abstract: The rate of caesarean section continues to increase, and there is evidence that childbirth fear is a contributing factor. Insufficient evidence is available on the impact of reducing childbirth fear on health-related quality of life and health service use. We undertook an economic evaluation of a psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia. Pregnant women (n = 339) with high childbirth fear were randomised to a midwife-led psycho-education intervention for childbirth fear or to usual care. This paper presents the economic evaluation of the intervention based on health-related quality of life and health service use from recruitment to six weeks postpartum (n = 184). The changes in health-related quality of life after birth (EQ-5D-3L: 0.016 vs. 0.010, p = 0.833, for usual care and intervention) and total health care use cost (AUS$10,110 vs. AUS$9980, p = 0.819) were similar between groups. The intervention did not increase costs however, in a post hoc analysis, the interventions might be cost-effective for those women with very high childbirth fear. This brief psycho-education intervention by midwives did not improve the health-related quality of life of women, and had no impact on overall cost.
Publisher: Elsevier BV
Date: 12-2011
DOI: 10.1016/J.MIDW.2010.10.008
Abstract: To investigate the prevalence of depression during pregnancy and postpartum period for Jordanian women and identify associated risk factors and maternity service delivery issues. A prospective cross-sectional study. Participants were recruited during the last trimester of pregnancy, provided personal, social and obstetric information, and completed the Edinburgh Postnatal Depression Scale (EPDS), Depression Anxiety and Stress Scale (DASS-21), the Maternity Social Support Scale (MSSS), the Cambridge Worry Scale (CWS), Perceived Self-Efficacy Scale (PSES) and Perceived Knowledge Scale (PKS). All participants were contacted again at six-eight weeks and six months post partum to complete a telephone or face-to-face interview. The postnatal questionnaire included the EPDS, MSSS, and DASS-21. A teaching hospital and five health centres in Irbid city in northern Jordan. Arabic speaking women (n = 353) between the ages of 18 and 45 years, in their last trimester of pregnancy, at low risk for obstetric complications and receiving antenatal care between November 2005 and August 2006. High rates of antenatal (19%) and postnatal depression (22%) were reported. A regression analysis revealed that stress, anxiety, financial problems, perceived lack of parenting knowledge, difficult relationship with the mother-in-law, unplanned pregnancy, and low self-efficacy were associated with antenatal depression. These seven factors accounted for 83% (r(2) = 0.834) of variance in the development of probable antenatal depression. At six-eight weeks post partum, a regression analysis revealed that antenatal depression, unplanned pregnancy, difficult relationship with mother-in-law, dissatisfaction with overall care, stress, lack of social support, giving birth to a female baby, feeling pressured to birth the baby quickly, and perceived low parenting knowledge were associated with postnatal depression. These nine variables accounted for 82% (r(2) = 0.819) of variance in the development of probable PND. Three intrapartum and postpartum variables associated with PND at six-eight weeks (postpartum haemorrhage, unhelpful doctors during labour and birth, and anxiety) were no longer associated with PND at six months. Jordanian women need support to prepare for labour and birth. Postpartum emotional support and assessment of symptoms of depression needs to be incorporated into routine practice. The opportunity for open discussion along with increased awareness and clarification of common misconceptions about antenatal and postnatal depression are necessary. Quality assurance systems would help reduce the rate of invasive obstetric procedures, and give greater emphasis to emotional care provided to women during the perinatal period.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 12-2000
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.WOMBI.2010.08.004
Abstract: This small qualitative study aimed to explore pregnant women's experiences of participating in a pregnancy program designed around the use of creative activities. Increasingly childbirth, in resource rich countries, is considered a medical event with limited attention paid to the emotional aspects of pregnancy. However, the use of the creative arts to promote physical and emotional health and well-being has also gained increasing acknowledgement and recognition. Based on this latter literature, a program of activities including singing, dancing, storytelling and weaving was developed for pregnant women. A qualitative descriptive approach was employed. Seven pregnant women participated in six 2-h creative activity sessions. Data were collected using diaries, interviews, field notes and a brief questionnaire. Thematic analysis was used to analyse the qualitative data. Four themes, labelled 'Seeking support', 'Connecting with each other, myself and the baby', 'Finding a place to share, learn and grow,' and 'Finding balance' were identified. The findings suggest that participating in the program afforded women social support, a sense of connection with each other and enhanced perceptions of emotional well-being during pregnancy. The findings provide preliminary evidence that engaging in creative activities during pregnancy may enhance women's sense of emotional well-being. In addition, the findings confirm the growing body of literature that suggests that when childbearing women come together in a supportive sharing environment an opportunity is created whereby women learn or regain their cultural knowledge about birth and feel confident to make the decisions that best meet their own in idual needs and preferences. Although the creative activities program was not designed to prepare women for birth it facilitated the sharing of information which appeared to increase the women's confidence and sense of competence to give birth and transition into motherhood. While the number of women attending the program was small, the positive experiences expressed by participants warrant further development, implementation and investigation of similar approaches to childbirth preparation. Based on this study, it would seem that such a program is indeed feasible and that women would attend.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2015
Publisher: Wiley
Date: 15-11-2018
DOI: 10.1002/NUR.21919
Abstract: Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6% n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.SRHC.2015.05.002
Abstract: The WDEQ-A is the most widely used measure of childbirth fear in pregnant women however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice. To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women. Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics. 1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean. This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.MIDW.2013.12.015
Abstract: This study examined midwives' perceptions of organisational structures and processes of care when working in a caseload model (Midwifery Group Practice MGP) for socially disadvantaged and vulnerable childbearing women. This study used Donabedian's theoretical framework for evaluating the quality of health care provision. Of the 17 eligible midwives, 15 participated in focus group discussions and two others provided written comments. Thematic analysis was guided by three headings clinical outcomes, processes of care and organisational structure. Midwives believed they provided an excellent service to socially disadvantaged and vulnerable childbearing women. Midwives gained satisfaction from working in partnership with women, working across their full scope of practice, and making a difference to the women. However the midwives perceived the MGP was situated within an organisation that was hostile to the caseload model of care. Midwives felt frustrated and distressed by a lack of organisational support for the model and a culture of blame dominated by medicine. A lack of material resources and no identified office space created feelings akin to 'homelessness'. Together these challenges threatened the cohesiveness of the MGP and undermined midwives' ability to advocate for women and keep birth normal. If access to caseload midwifery care for women with erse backgrounds and circumstances is to be enhanced, then mechanisms need to be implemented to ensure organisational structures and processes are developed to sustain midwives in the provision of 'best practice' maternity care. Women accessing midwifery caseload care have excellent maternal and newborn outcomes. However there remains limited understanding of the impact of organisational structures and processes of care on clinical outcomes.
Publisher: Wiley
Date: 02-2003
Publisher: Elsevier BV
Date: 03-2021
DOI: 10.1016/J.WOMBI.2021.04.004
Abstract: Pre-registration midwifery students in Australia are required to engage in a minimum of ten continuity of care experiences (CoCE). Students recruit and gain consent of each woman to provide CoCE under direct supervision of a registered health professional, usually a midwife. Clinical outcomes for women who had CoCE with a midwifery student placed in a continuity of midwifery care (CMC) or fragmented models are rarely reported. 1. analyse clinical outcomes for women experiencing CMC with CoCE by students 2. analyse clinical outcomes for women in a fragmented care model with CoCE by students and 3. compare clinical outcomes according to women's primary model of care. Students undertaking a Bachelor of Midwifery program at one Australian university recorded clinical outcomes for women experiencing CoCE during pregnancy [n=5972] and labour and birth [n=3933] in an e-portfolio. A retrospective, cohort design compared student recorded maternal data with National Core Maternity Indicators and Queensland Perinatal Data. Midwifery students providing CoCE reported better or equal clinical outcomes for women compared to population data. Women receiving CoCE had reduced likelihood of tobacco smoking after 20 weeks of pregnancy, episiotomy, and third and fourth degree tears. Clinical outcomes for women in fragmented models of care and receiving CoCE by undergraduate, pre-registration midwifery students are equal to or better than State data across 12 variables. CoCE should be offered to all women early in their pregnancy to ensure optimal benefits. Acknowledging midwifery students' potential to make positive impacts on women's clinical outcomes may prompt more health services to reconceptualise and foster CoCE.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.WOMBI.2021.04.008
Abstract: Little is known about what midwifery leaders need to effectively contribute to maternity services reform. Despite evidence establishing midwifery continuity of care as the gold standard of maternity care, implementation of these models has been slow. Midwives in health service leadership roles are in an ideal position to re-orientate maternity services to midwifery continuity of care. What do midwives in leadership positions need in order to be effective in contributing to the reform of maternity services in Australia? This qualitative descriptive study used purposive s ling to recruit 13 midwifery leaders from across Australia. In idual telephone interviews were conducted and analysed through line-by-line coding and identification of themes. Five main themes emerged from the data: 'core leadership skills and education are essential' 'motivation and commitment to implementing evidence-based maternity care' 'ability to create and sustain strategic relationships' 'bringing the vision to life' which contained two sub-themes of 'changing the culture' and 'reaching midwifery's full potential' and, 'organisational support and commitment are key to maternity reform'. This study echoes findings from previous research emphasising the importance of leadership attributes and development opportunities for midwifery leaders. Additional needs of midwifery leaders were also revealed, which have not yet been extensively explored in the literature, including a strong commitment to continuity of care, effective relationships with key stakeholders and support from healthcare executives. Midwifery leaders need to be equipped to contribute to maternity care reform through leadership development opportunities, effective relationships and support from healthcare executives.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
DOI: 10.1097/JNR.0000000000000137
Abstract: An increasing number of women from other countries, mostly Mainland China and Southeast Asia, are marrying Taiwanese husbands and settling in Taiwan. Immigration, marriage abroad, and pregnancy may be stressful and adversely affect maternal health. Relatively little research has compared the life stress and depressive symptoms of pregnant women of different ethnic groups living in nonmetropolitan areas in Taiwan. This study investigates the levels of life stress and depressive symptoms in pregnant Taiwanese women and Vietnamese “foreign brides” currently living in southern Taiwan. Eligible women in their last trimester of pregnancy who attended their local antenatal clinic were recruited for the study. Participants completed standardized measures, including the Difficult Life Circumstances Scale, Social Support APGAR Scale, and Edinburgh Postnatal Depression Scale. Two hundred thirty-six Taiwanese women and 44 Vietnamese women participated. Major life difficulties for both groups of women were related to their marital relationship, housing, or health problems. Taiwanese participants reported perceiving financial strain more often than their Vietnamese peers, whereas Vietnamese participants reported perceiving greater concerns regarding their children’s development and about recent physical abuse than their Taiwanese peers. Furthermore, the Vietnamese participants reported less social support and higher rates of antenatal depression than Taiwanese participants. Clinical nurses and midwives should be sensitive to the particular difficulties and insufficient social support faced by pregnant women from different backgrounds in Taiwan. Women from foreign countries or those under unique challenging circumstances may face a particular risk of adverse outcomes. Identifying stresses informs the development of effective nursing interventions and support activities for new mothers and their families.
Publisher: Wiley
Date: 29-12-2019
DOI: 10.1111/PPE.12621
Abstract: Clinical interventions known to reduce the risk of caesarean delivery include routine induction of labour at 39 weeks, caseload midwifery and chart audit, but they have not been compared for cost-effectiveness. To assesses the cost-effectiveness of three different interventions known to reduce caesarean delivery rates compared to standard care and conduct a budget impact analysis. A Markov microsimulation model was constructed to compare the costs and outcomes produced by the different interventions. Costs included all costs to the health system, and outcomes were quality-adjusted life years (QALY) gained. A budget impact analysis was undertaken using this model to quantify the costs (in Australian dollars) over three years for government health system funders. All interventions, plus standard care, produced similar health outcomes (mean of 1.84 QALYs gained over 105 weeks). Caseload midwifery was the lowest cost option at $15 587 (95% confidence interval [CI] 15 269, 15 905), followed by routine induction of labour ($16 257, 95% CI 15 989, 16 536), and chart audit ($16 325, 95% CI 15 979, 16 671). All produced lower costs on average than standard care ($16 905, 95% CI 16 551, 17 259). Caseload midwifery would produce the greatest savings of $172.6 million over three years if implemented for all low-risk nulliparous women in Australia. Caseload midwifery presents the best value for reducing caesarean delivery rates of the options considered. Routine induction of labour at 39 weeks and chart audit would also reduce costs compared to standard care.
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.MIDW.2022.103508
Abstract: Complications during pregnancy and birth are known risk factors for negative birth experience. Women value the opportunity to review their birth experiences, but limited knowledge exists about appropriate interventions and the feasibility of providing this care for women following high-risk pregnancies. To describe the construction and evaluate the feasibility and acceptability of a postpartum midwifery counselling intervention for women following high-risk pregnancies. A mixed-method study. A high-risk antenatal outpatient clinic at Landspítali University Hospital in Reykjavík, Iceland. Thirty women who experienced high-risk pregnancies were invited to write about and review their birth experience with a known midwife 4-6 weeks postpartum. Eight midwives working in a high-risk antenatal clinic provided the intervention after a special training. Data including birth outcomes, birth experience and experience of the intervention were collected by questionnaires from women at two time points before and after the counselling intervention. Midwives providing the intervention completed diaries and participated in focus group interview to explore their experiences of the process. Descriptive and content analysis. Women and midwives perceived the intervention positively and feasible in this context. Midwives evaluated the pre-training program as helpful. Most women would like to review their birth experience with a midwife they know, 4-6 weeks postpartum. Almost half of the women wrote about their birth experiences. The findings indicate that women experiencing high-risk pregnancies might benefit from a follow up by a midwife they know. Women and midwives perceived the counselling intervention as an acceptable and feasible option in maternity care. The training program sufficiently prepared the midwives to provide the counselling intervention. The findings provide an opportunity to offer the intervention on a larger scale to explore the effects further and subsequently implement into routine care after birth for high-risk women.
Publisher: Informa UK Limited
Date: 12-2005
Abstract: Registered nurse Papanicolaou (Pap) smear providers (RN PSPs) were introduced to improve women's accessibility to Pap smear services through the National Cervical Screening Program. This pilot study assessed women's attitudes towards RNs as providers. One hundred women attending a Family Planning Queensland (FPQ) centre for a routine appointment with a doctor or registered nurse were recruited. Participants completed an anonymous questionnaire. A response rate of 86% (n = 100) was achieved. Only 15% of participants indicated they had seen a RN for a Pap test prior to this visit and 67% were unaware that registered nurses provided Pap smear services. Participants reported positive attitudes toward RN PSPs (M = 44.53, SD = 7.85, range 13 - 60). The majority of participants considered RN PSPs would be responsive to their needs (92%) and well-qualified to perform Pap smears (70%). The majority (79%) would not hesitate to see a RN PSP for a Pap smear. Some uncertainty existed about the competence of nurses to provide this service (25% of respondents were uncertain). Older women were more likely to report less positive attitudes toward RN PSP (r = -.267, p <.05). Women reporting previous awareness of the role of nurses as Pap smear providers were more likely to report positive attitudes (Chi-square = 12.96, p < .0001) compared to women with no awareness of this role. While women are positive about RN PSPs, there is a need for promotion and community education about the role of RNs in providing cervical screening services.
Publisher: Wiley
Date: 19-06-2015
DOI: 10.1111/NHS.12143
Abstract: This study investigated the health and well-being of Vietnamese foreign brides recently immigrated to southern Taiwan. Forty-four participants were recruited during pregnancy and 23 were followed-up at six weeks post-partum. Standardized measures completed during face-to-face interviews revealed high levels of life stress, poor general health, low social support, and difficulty caring for their infant amongst participants. Estimated prevalence of probable antenatal depression was 32%, and 26% for probable post-partum depression using Edinburgh Postnatal Depression Scale (EPDS) scores of ≥ 13. Probable antenatal depression predicted postnatal depression. Pregnant immigrant women experienced a high level of difficult life circumstances and were significantly more likely to develop depressive symptoms after birth. Immigrant women with low social support during pregnancy were also more likely to report higher EPDS scores than well-supported women. Given these results, prevention and intervention activities are needed to promote maternal psychological well-being in disadvantaged women, especially immigrant brides.
Publisher: Wiley
Date: 11-09-2015
DOI: 10.1111/IJN.12335
Abstract: Prevention is important to reduce the prevalence of preterm births. Although prematurity has been well studied in developed countries, data from developing countries, such as Jordan, are still limited. This retrospective study analysed medical records to determine possible risk factors leading to preterm birth in the Irbid governorate of Jordan. All preterm births during the year 2011 were reviewed. Abstracted data included mother's age and gravidity. Newborn information included gender, birthweight and gestational age at birth. A total of 647 singleton births were included. There were more females than males (54.9% vs. 45.1%), with 75.6% being the second child or more. Half the mothers (50.2%) were 25-35 years of age. Factors associated with preterm birth were male gender (P = 0.008), maternal age > 35 years (P = 0.005) and first birth (P = 0.003). Nurses need to provide support and education to mothers with potential risk about reproductive health and family planning.
Publisher: Wiley
Date: 16-07-2018
DOI: 10.1002/ACP.3438
Publisher: Elsevier BV
Date: 11-2023
Publisher: Wiley
Date: 26-10-2020
DOI: 10.1111/NHS.12779
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-065720
Abstract: To examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations. Systematic review. Original studies of tool development and validation related to health engagement, with abstract available in English, published between 2000 and 2022, s ling people receiving outpatient healthcare including pregnant women. CINAHL Complete, Medline, EMBASE and PubMed were searched in April 2022. Study quality was independently assessed by two reviewers using an adapted COSMIN risk of bias quality appraisal checklist. Tools were also mapped against the Synergistic Health Engagement model, which centres on women’s buy-in to maternity care. Nineteen studies were included from Canada, Germany, Italy, the Netherlands, Sweden, the UK and the USA. Four tools were used with pregnant populations, two tools with vulnerable non-pregnant populations, six tools measured patient–provider relationship, four measured patient activation, and three tools measured both relationship and activation. Tools that measured engagement in maternity care assessed some of the following constructs: communication or information sharing, woman-centred care, health guidance, shared decision-making, sufficient time, availability, provider attributes, discriminatory or respectful care. None of the maternity engagement tools assessed the key construct of buy-in. While non-maternity health engagement tools measured some elements of buy-in (self-care, feeling hopeful about treatment), other elements (disclosing risks to healthcare providers and acting on health advice), which are significant for vulnerable populations, were rarely measured. Health engagement is hypothesised as the mechanism by which midwifery-led care reduces the risk of perinatal morbidity for vulnerable women. To test this hypothesis, a new assessment tool is required that addresses all the relevant constructs of the Synergistic Health Engagement model, developed for and psychometrically assessed in the target group. CRD42020214102.
Publisher: Wiley
Date: 20-09-2012
DOI: 10.1111/J.1545-5300.2012.01420.X
Abstract: This study evaluated if the transition to parenthood is a window of opportunity to provide couple relationship education (CRE) to new parents at high risk for future relationship problems. Fifty-three percent of eligible couples approached agreed to participate in CRE and of these 80% had not previously accessed CRE. Couples were a broad representative of Australian couples having their first child, but minority couples were underrepresented. A third of couples had three or more risk factors for future relationship distress (e.g., cohabiting, interpartner violence, elevated psychological distress, unplanned pregnancy). Low education was the only risk factor that predicted drop out. The transition to parenthood is a window of opportunity to recruit certain types of high-risk couples to CRE.
Publisher: Wiley
Date: 06-08-2019
DOI: 10.1002/NAU.24121
Abstract: The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Wexner Scale have been included in the International Consortium for Health Outcomes Measurement core outcome set during pregnancy and childbirth, to measure urinary and anal incontinence. The reliability and validity of these instruments have not been fully evaluated in maternity populations. The aim of this study was to conduct a psychometric evaluation of the ICIQ-UI SF and Wexner Scale. Consecutive pregnant women (n = 309) who booked for care at one Australian birth facility between August 2017 and April 2018 completed the online surveys. Women who screened positive for urinary and/or anal incontinence were administered the ICIQ-UI SF and/or Wexner Scale during pregnancy ( <27 and 36-weeks) and postpartum (6 and 26-weeks). Scale internal consistency, construct validity, and responsiveness were evaluated. In women with urinary incontinence, the ICIQ-UI SF demonstrated good internal consistency during pregnancy (baseline and 36 weeks) and 6-weeks postpartum (mean inter-item correlation: 0.47, 0.39, and 0.46, respectively), recorded significant change across three time-points, and was sensitive to group differences in age and obesity during pregnancy. Wexner Scale was unsuitable for psychometric analysis due to insufficient numbers of women with anal incontinence. The ICIQ-UI SF is a valid and reliable instrument to measure urinary incontinence during pregnancy and postpartum. The findings support the inclusion of the ICIQ-UI SF in the International Consortium for Health Outcomes Measurement core outcome set for use during the perinatal period. Psychometric analysis of the Wexner Scale in larger maternity populations is recommended.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.MIDW.2010.12.008
Abstract: to assess Australian midwives' attitudes towards caring for women with emotional distress and their perceptions of the extent to which workplace policies and processes hindered such care. a postal survey. members of the Australian College of Midwives. 815 Australian midwives completed the survey. a modified version of the 17-item REASON questionnaire (McCall et al., 2002) that was originally developed for used by General Practitioners to measure their attitudes towards their role in the management of patients with mental health disorders. An exploratory factor analysis with Varimax rotation identified four factors that reflected midwives' (1) perceptions of systemic problems that hindered emotional care, (2) attitudes towards working with women experiencing emotional health problems, (3) perceived competence in using treatment techniques and (4) attitudes and perceived competence towards the referral of women with depression and anxiety to other health professionals. participating midwives indicated their willingness to offer assistance and acknowledged the importance of providing emotional care to women. In practice, emotional care by midwives is impeded by perceived lack of competency rather than a lack of interest. Midwives' competency in the assessment and care of women with conditions such as depression and anxiety may be enhanced through continuing professional education.
Publisher: MDPI AG
Date: 07-07-2022
DOI: 10.3390/NU14142799
Abstract: Preterm birth is a leading cause of neonatal and child mortality and morbidity worldwide. The aim of this study was to investigate associations between attending a brief antenatal lifestyle education seminar and preterm birth, and whether education timing modifies outcomes. A retrospective cohort study was conducted in a hospital-based antenatal care center in Beijing, China, where a free, 2 h, optional, face-to-face, midwife-led group seminar on healthy lifestyle choices during pregnancy was provided. Among the 3008 eligible women, 1107 (36.8%) attended the seminar during the first trimester, 515 (17.1%) attended during the second trimester or later, and 1386 (46.1%) did not attend. Multiparous women were more likely to not attend or to attend at a later stage. The overall prevalence of preterm birth was 8.7%, but it was higher for women who did not attend the antenatal seminar (11.5%). The risk of preterm birth for first trimester attendees decreased by 53%, and it decreased by 41% for later attendees. Estimates persisted after adjusting pre-existing and gestational covariates. Attending a brief antenatal lifestyle education seminar was associated with lower preterm birth risk, and attending during the first trimester had a better impact than later attendance. The results can inform the development of tailored preterm birth prevention strategies.
Publisher: BMJ
Date: 29-10-2016
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.MIDW.2022.103456
Abstract: To investigate the prevalence of depression, anxiety, and stress symptoms in Jordanian midwives and identify associated factors. Setting and participants: This descriptive, cross-sectional study was conducted with a s le of 321 registered midwives from 18 public hospitals in Jordan that provide antepartum, intrapartum, postpartum care, and family planning services. The survey included the Depression, Anxiety, and Stress Scale (DASS-21) and demographic and professional data forms. High rates of depression (76.2%) anxiety (85.3%) and stress (66.8%) symptoms were reported among midwives in Jordan. Midwives aged between 22 - 30 years reported more depression, anxiety, and stress symptoms than midwives in the other age groups. Married midwives had higher depression symptoms than single midwives. Midwives with 10 women per shift had higher anxiety and stress symptoms than midwives caring for five or less women per shift. Midwives who rotated between shifts had higher depression and stress symptoms than midwives who did not rotate. Rates of depression, anxiety, and stress symptoms reported by Jordanian midwives were higher than rates reported by midwives in other countries. The high rates of distress highlight the urgent need for national strategies to support the emotional wellbeing and retention of midwives within Jordanian settings.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Springer Science and Business Media LLC
Date: 29-10-2022
DOI: 10.1186/S40352-022-00196-4
Abstract: Maternal imprisonment negatively impacts mothers and their children and is likely to have lifelong and intergenerational sequelae. In many jurisdictions nationally and internationally, young children (usually those less than 5 years) can reside with their mothers in prison. However, there is considerable debate regarding the impact of prison environments on incarcerated mothers and their children who are born, and/or raised in prison. Research to date on the pregnancy and mothering experiences of imprisoned mothers and their preferences for care arrangements for their babies and young children is limited. This study was part of the Transforming Corrections to Transform Lives project, in which workshops were conducted with imprisoned mothers to understand their needs while in custody and post-release, and the kind of supports and system changes that are required to meet those needs. Incarcerated mothers ( n = 75) participated in seven workshops conducted across four Queensland prisons. Themes were generated through reflexive thematic analysis. Three themes characterised mothers’ experiences of being pregnant and undertaking a mothering role of a young child while in prison. First, for most mothers, imprisonment adds vulnerability and isolation during pregnancy and childbirth. Second, although mothers felt that residing together with their children in prison motivated them to change for a better future, they were concerned about the potential negative impact of the prison environment on the child’s development. Lastly, most mothers voiced losing autonomy and agency to practice motherhood independently within custodial settings. Mothers expressed a need for the correctional system to be adapted, so it is better equipped to address the unique and additional needs of mothers with young children. Mothers’ experiences indicated that the correctional system and policies, which were predominantly designed for men, do not adequately address the varied and complex needs of pregnant women, mothers, and their young children. Imprisonment of pregnant women and mothers with young children should be the last resort, and they should be provided with holistic, in idually tailored support, most preferably in community settings, to address their multiple intersecting needs.
Publisher: Wiley
Date: 14-11-2007
Publisher: Springer Science and Business Media LLC
Date: 04-10-2013
DOI: 10.1007/S00737-013-0384-5
Abstract: We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions n = 137) or parenting support (n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.
Publisher: Elsevier BV
Date: 07-2020
Publisher: Springer Science and Business Media LLC
Date: 30-10-2015
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.NEDT.2022.105476
Abstract: ePortfolios are increasingly used in health professional clinical education. However, the nature of ePortfolios varies greatly amongst programs, as does the software, purpose, and institutional cost. An integrative review of the literature was conducted to determine how ePortfolios are being used in pre-registration health programs to enhance clinical learning. A systematic search of relevant databases (Cumulative Index of Nursing and Allied Health Literature, Education Resources Information Center, Cochrane, Medline, ProQuest, PubMed, Turning Research Into Practice, and Web of Science) was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Retrieved papers were assessed using the Critical Appraisal Skills Programme tool and findings were analysed. A total of 272 records were identified. Thirty papers were assessed in detail. Five themes were identified by content analysis feedback and communication student-centred learning experiences and competencies access, attitudes, and digital literacy and technological support. ePortfolios offer a range of pedagogical benefits. Clinical learning is enhanced by student-focused ePortfolio design which includes clear learning outcomes development of relationships with peers and instructors via ongoing communication and feedback use of templates links to time-saving applications and guided, assessed reflections. Poor technological support, negative attitudes by clinical supervisors, unreliable access, instructor-focused design, and excessive or repetitive documentation in ePortfolio design hindered clinical learning.
Publisher: Informa UK Limited
Date: 18-10-2016
DOI: 10.1080/01443615.2016.1234443
Abstract: The aims of this study were to explore the vitamin D status among a s le of Jordanian postpartum women and identify factors associated with vitamin D deficiency. A total of 171 postpartum women agreed to participate. Participants completed a questionnaire on factors related to vitamin D deficiency and provided a blood s le to assess their plasma vitamin D (25(OH)D) levels using DIA source Immuno-Assays S.A. The majority of women (76%, n = 130) had vitamin D deficiency and 24% (n = 41) of participants had vitamin D insufficiency. Factors associated with vitamin D deficiency were younger age (< 30 years), low education level, unemployment, multiparity, lactation, dress style, limited sunlight exposure, high BMI, dark skin colour and lack of multivitamin use. Vitamin D supplementation must be considered during pregnancy and lactation to prevent hypovitaminosis in both mother and baby.
Publisher: Wiley
Date: 12-02-2009
DOI: 10.1111/J.1365-2702.2008.02568.X
Abstract: To investigate pre- and postpartum levels of childbirth fear in a cohort of childbearing women and explore the relationship to birth outcomes. While results are mixed, there is evidence that fear of childbirth is associated with mode of birth. Limited theoretical work around childbirth fear has been undertaken with Australian women. A prospective correlation design. Method. Women (n = 401) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A at 36 weeks gestation, with 243 (61%) women also completing version B at six weeks postpartum. Scores were summarised with means and standard deviations. Content analysis of the free statements identified nine issues of concern. Twenty-six per cent of pregnant women reported low levels of childbirth fear, 48% were moderately fearful and 26% were highly fearful. Fear decreased after birth for those women in the high antenatal fear group, however surgical intervention at birth (n = 238, anova, F(1,230) = 12.39, p = 0.001) and suspected fetal compromise (F(1,230) = 4.33, p = 0.039) increased levels of postpartum fear. Univariately, high antenatal fear was associated with emergency caesarean delivery (n = 324, Wald 5.05, p = 0.025) however after adjustment for nulliparity and fetal compromise the association disappeared. Australian-born women were more likely to report higher levels of fear and experience higher rates of caesarean section than participants of non-Australian origin. Results support those from earlier studies in showing that nulliparous women experience more fear than parous women before birth and that there is no difference in levels of postpartum fear between these two groups. Fear levels were higher in Australian women when compared to a Swedish s le. The results of this study add to our preliminary understanding of the phenomena of childbirth fear within an Australian context and are particularly useful in profiling women for whom secondary fear of childbirth is more likely to occur.
Publisher: Elsevier BV
Date: 2021
DOI: 10.1016/J.NEDT.2021.105174
Abstract: Quantitative feedback from students about their clinical learning experiences is used to inform program quality, but the extent to which tools are reliable, valid and refined receives less attention. To evaluate the psychometric properties of the Midwifery Student Evaluation of Practice (MidSTEP) tool using Rasch analysis. The Midwifery Student Evaluation of Practice tool was completed by Bachelor of Midwifery students (n = 901) attending seven universities in Australia and New Zealand. The tool consists of the Clinical Learning Environment Scale (16 items) and Impact of the Midwifery Preceptor Scale (10 items), each with two subscales. Rasch analysis was conducted on all subscales separately using the partial credit model of RUMM2030. Response format, item fit, dimensionality of the scale and its targeting were assessed. Rasch analysis confirmed the internal construct validity of the Clinical Learning Environment and Impact of the Midwifery Preceptor subscales, with no evidence of mis-fitting items, local dependency or multidimensionality. The 4-point response scale was found to be appropriate, and internal consistency reliability of each subscale was good. Results provide support for the reliability and validity of the Midwifery Student Evaluation of Practice tool. The four subscales can confidently be used in undergraduate midwifery clinical education. The use of Rasch analysis is consistent with growing awareness in health and education of the need to apply more advanced, sophisticated psychometric techniques to ensure measures are suitable for their intended use. Midwifery students clinical learning experiences should be measured using robust tools. MidSTEP is reliable and valid.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 08-2021
Publisher: Elsevier BV
Date: 11-2020
Publisher: Therapeutic Guidelines Limited
Date: 05-12-2016
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.WOMBI.2015.10.012
Abstract: Within the context of an ageing health workforce it is important to gain a greater understanding of the motivations of young people (aged less than 21 years) to choose a career in midwifery. To explore the reasons why young students decided to study midwifery and enrol in one Australian Bachelor of Midwifery program. A descriptive exploratory qualitative design was used. Eleven midwifery students aged less than 21 years on enrollment participated in a semi-structured tape-recorded interview. The transcribed interviews were analysed using thematic analysis. Direct and indirect exposure to positive constructions of childbirth as well as the midwives role fuelled young student's fascination with midwifery and drove their desire to enrol. While some young students entered midwifery studies as a result of their 'love of babies' others took a more pragmatic 'wait and see' approach about their career choice. Many young students however clearly distinguished midwifery from nursing demonstrating an intention to be a midwife rather than a nurse. This decision often took place within the context of opposition from within their family, school and social networks where the public discourse continued to reinforce nursing as the preferred pathway to midwifery. Creating opportunities for young people to be exposed to positive constructions of childbirth as well as midwifery role models may increase the number of young students entering midwifery. There is also a need for information to be provided to school careers officers to assist them to understand the distinction between midwifery and nursing.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.MIDW.2015.05.006
Abstract: recent legislative changes in Australia have enabled eligible midwives to provide private primary maternity care with fee rebates through Medicare. This paper (1) discusses these changes affecting midwifery practice (2) describes Australia's first private midwifery service with visiting rights to hospital for labour and birth care since Medicare funding for midwives was introduced in 2010 and (3) compares outcomes with National Core Maternity Indicators. an audit of all client records (n=323) for the survey period from September 2012 to February 2014 was undertaken. Data were extracted and compared with the 10 perinatal indicators using Chi square statistics. this convenience s le of all-risk women was similar to the national birthing population for age and parity. Compared to national indicators, women were significantly more likely to have spontaneous commencement of labour (79.6% versus 54.8%) (χ(2)=79.88, p<.001), lower rates of induction (10.2% versus 26%) (χ(2)=79.88, p<.001), and not require pharmacological pain relief (54.8% versus 23.9%) (χ(2)=152.2, p<.001). The majority of women had a normal vaginal birth (70.3% versus 55.1%) (χ(2)=28.13, p<.001). The caesarean section rate (22% versus 32.3%) was significantly lower (χ(2)=15.64, p<.001) than the national rate. Average gestation of neonates was 39.3 weeks average birth weight was 3525 gms, and fewer required transfer to the special care nursery (8.4% versus 15.3%) (χ(2)=11.89, p<.001). this is the first report of maternal and neonatal outcomes for a private midwifery service in Australia since the introduction of access to Medicare for midwives. Maternal and newborn outcomes were statistically better than national rates. Routinely reporting and publishing clinical outcomes needs to become the norm for private maternity care. this private midwifery caseload model has been instrumental in the ground-breaking change to primary maternity services that extends women׳s access to safe midwifery care in Australia. The potential impact of private practicing midwives to align maternity care with the best available evidence is significant.
Publisher: Springer Science and Business Media LLC
Date: 22-10-2019
DOI: 10.1186/S12884-019-2546-6
Abstract: Health related quality of life is a critical concept during the perinatal period but remains under-researched. The International Consortium for Health Outcomes Measurement have included the Patient Reported Outcomes Measurement Information System (PROMIS®) Global Short Form (GSF) in their core outcome set for pregnancy and childbirth to measure health related quality of life. The PROMIS GSF has not been fully evaluated as a valid and reliable instrument in this population. This study assessed the psychometric properties of the PROMIS GSF during pregnancy and postpartum period. PROMIS GSF was administered to a s le of 309 pregnant women at four time-points during pregnancy (≤ 27 and 36-weeks) and postpartum (6- and 26-weeks). The structural validity, internal consistency reliability, construct validity, and responsiveness of the PROMIS GSF were evaluated. The internal structure of the PROMIS GSF was explored using Rasch Measurement Theory. Response format, item fit, differential item functioning (item bias), dimensionality of the scale and its targeting were assessed. Two revised subscales (Mental Health: four items and Physical Health: five items) showed good fit to the Rasch model. The revised mental health subscale demonstrated good internal consistency reliability during pregnancy and postpartum period (α = .88 and .87, respectively). The internal consistency reliability of the physical health subscale was adequate (α = .76 and .75, respectively). The revised mental health subscale was sensitive to group differences according to a history of mental health disorder, income, smoking status, drug use, stress levels and planned versus unplanned pregnancy. Differences in scores on the revised physical subscale were detected for groups based on obesity, income, drug use, smoking status, stress, and history of mental health disorders. Scores on both subscales recorded significant changes across the four time-points, spanning pregnancy and postpartum period. The revised version of the PROMIS GSF was better able to measure mental and physical health during pregnancy and postpartum period compared to the original version. Findings support the clinical and research application of the PROMIS GSF within the International Consortium for Health Outcomes Measurement Standard Set of Outcome Measures for Pregnancy and Childbirth. Ongoing psychometric analysis of the PROMIS GSF is recommended in other maternity populations.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.MIDW.2019.03.019
Abstract: Emotional care underpins women's positive experiences during labour andbirth but is under-researched. Applying an attachment theory approach may inform the measurement of emotional aspects of maternity care. To develop and validate a self - report measure for midwives to assess their emotionally attuned intrapartum care. A staged approach to tool development was followed. Item generation was informed by a critical review of the literature and expert review. Following a pilot test, the draft scale was psychometrically assessed. Principal component analysis with varimax rotation was used to establish construct validity. Cronbach's alpha determined internal reliability. Concurrent validity was tested with the 'empathic concern' and the 'personal distress' subscales on the Interpersonal Reactivity Index. The study was conducted with midwives (n = 705) who are members of the Australian College of Midwives. The Cronbach's alpha for the scale was 0.88. Principal component analysis revealed a one- factor solution. Significant but low correlations with Interpersonal Reactivity Index subscales of 'empathic concern' (rho = .256, p <.001) and 'personal distress' (rho = -.249, p<.001) confirmed concurrent validity. The Emotional Availability and Responsiveness in Intrapartum Care Scale appears to be a valid and reliable measure of emotional aspects of midwives' caregiving. An Attachment Theory approach validates women's perspectives and elucidates our understanding of the importance of emotional labour support.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2015
End Date: 2016
Funder: Griffith University
View Funded ActivityStart Date: 2015
End Date: 2017
Funder: Department of Health, Queensland
View Funded ActivityStart Date: 2012
End Date: 2014
Funder: National Health and Medical Research Council
View Funded Activity