Jennifer Fenwick

Midwives' perceptions of their role within the context of maternity service reform: An Appreciative Inquiry

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.

Māori and Pasifika perceptions of their local maternity care in Logan, Australia

Publisher: Elsevier BV

Date: 06-2019

DOI: 10.1016/J.WOMBI.2018.08.164

Abstract: Many childbearing women from Māori and Pasifika backgrounds living in the Logan region of Queensland, Australia experience poor health outcomes. Compared to the general population of childbearing women, Māori and Pasifika women are more likely to experience gestational diabetes mellitus and obesity, are less likely to attend recommended antenatal visits and present for initial antenatal visits at later gestations. To describe women's awareness of maternity service options, explore the barriers to participating in pregnancy care and identify possible enablers to improved uptake of services. Qualitative descriptive. Thirty-three women attended one of six culturally specific focus groups. Latent content analysis was used to analyse the data set. The key source of information for childbearing women was their families. Poor communication, lack of cultural safety and financial constraints were the major barriers to accessing services. Conversely, enablers were perceived to be continuity of midwifery care that was delivered in the community and was culturally safe. Strategies to increase uptake of maternity services and optimise services to better meet the needs of women from Māori and Pasifika backgrounds are needed. These should be partnership-based, engage women and families, incorporate cultural needs and preferences and provide services at accessible community locations. These findings may be relevant to other groups of women, such as women from culturally erse backgrounds and from communities experiencing poorer health outcomes.

Personal, professional and workplace factors that contribute to burnout in Australian midwives

Publisher: Wiley

Date: 27-11-2018

DOI: 10.1111/JAN.13491

Abstract: This study aimed to identify personal, professional and workplace factors that contribute to burnout in midwives. Burnout is prevalent in the midwifery workforce. Burnout adversely affects the well-being of midwives, diminishes the quality of care they provide and can shorten career duration. Self-administered online survey. The survey included the Copenhagen Burnout Inventory and personal and professional variables related to age, children, years of experience, role, model of care and satisfaction with work life. Midwives were invited to participate via an email sent from the Australian College of Midwives and through professional networks between June and July 2014. Variables associated with burnout were entered in a multinomial logistic regression. A total of 1,037 responses were received and 990 analysed. The prevalence of moderate to severe personal (N = 643 64.9%) and work-related burnout (N = 428 43.8%) were high. Having children, providing caseload midwifery care and working in a regional area were associated with low burnout. However, midwives registered for 5-10 years were more likely to report work and client-related burnout. Similarly, midwives reporting a lack of satisfaction with work-life balance were also more likely to report personal and work-related burnout. Family-friendly work environments that facilitate work-life balance can help to reduce the personal and organizational costs of burnout. Similarly, providing continuity of midwifery care in a caseload model can facilitate work-life balance and provide significant mental health benefits to participating midwives.

Developing reflective capacities in midwifery students: Enhancing learning through reflective writing

Publisher: Elsevier BV

Date: 08-2012

DOI: 10.1016/J.WOMBI.2018.06.004

Abstract: Practice-based or clinical placements are highly valued for linking theory to practice and enabling students to meet graduate outcomes and industry standards. Post-practicum, the period immediately following clinical experiences, is a time when students have an opportunity to share, compare and engage critically in considering how these experiences impact on their learning. Reflective practice has merit in facilitating this process. This project aimed to optimise the learning potential of practice-based experiences by enhancing midwifery students' capacity for reflective practice through writing. Design-based research was used to implement an educational intervention aimed at developing reflective practice skills and enhance reflective writing. The Bass Model of Holistic Reflection was introduced to promote the development of reflective capacity in midwifery students. Academics and midwifery students were provided with guidance and resources on how to apply the model to guide reflective writing. Students' written reflections completed before (n=130) and after the introduction of the intervention (n=96) were evaluated using a scoring framework designed to assess sequential development of reflective capacity. The pre-intervention scores ranked poorly as evidence of reflective capacity. All scores improved post-intervention. The introduction of a holistic structured model of reflection resulted in improved scores across all five components of reflective writing self-awareness, sources of knowledge, reflection and critical reflection, evidence informed practice and critical thinking. While further work is required the results show that the implementation process and use of the Bass Model enables students to demonstrate their capacity to reflect-on-practice through their writing.

Trauma and fear in Australian midwives

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.

Midwives' Experiences of Transitioning Into Private Practice With Visiting Access in Australia: A Qualitative Descriptive Study

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.

Royal Women's Hospital

Location: Australia

View Organisation

Charles Sturt University

Location: Australia

View Organisation

University Of Technology Sydney

Location: Australia

View Organisation

Flinders University

Location: Australia

View Organisation

Deakin University

Location: Australia

View Organisation

Royal North Shore Hospital

Location: Australia

View Organisation

University Of Technology Sydney

Location: No location found

View Organisation

Charles Sturt University

Location: No location found

View Organisation

Deakin University

Location: No location found

View Organisation

Linkage Projects - Grant ID: LP0882603

Start Date: 12-2007

End Date: 02-2011

Amount: $98,207.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0454943

Start Date: 11-2004

End Date: 12-2008

Amount: $370,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP110104108

Start Date: 2011

End Date: 12-2015

Amount: $277,992.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0991564

Start Date: 08-2009

End Date: 08-2012

Amount: $78,420.00

Funder: Australian Research Council