Lesley Barclay

Participative research in a remote Australian Aboriginal setting

Publisher: SAGE Publications

Date: 21-05-2009

DOI: 10.1177/1476750309103266

Abstract: This article describes the research process used to develop and evaluate an Internet-based resource aimed at improving access by health professionals to Australian Aboriginal cultural knowledge specific to pregnancy and childbirth. As a result of the research, women's stories from Maningrida were recorded and presented on the `Birthing Business in the Bush Website' which provided a platform for Aboriginal Australian women from Maningrida to present cultural and other information to maternity care practitioners. In particular, this article describes the development of the participatory action research combined with an Aboriginal research process, and how this was guided by the Aboriginal co-researchers and participants.

Barriers to developing midwifery as a primary health-care strategy: A Jordanian study

Publisher: Elsevier BV

Date: 02-2012

DOI: 10.1016/J.MIDW.2010.11.012

Abstract: To identify the current barriers to developing midwifery as a primary health-care strategy in Jordan and to explore the strategies to overcome these barriers. An exploratory design using an action research approach was undertaken. Workshop discussion groups and reflection were used to collect the data. A thematic approach was taken for the analysis. Data were collected from a convenience s le of 64 midwives and educators who attended workshops. The professional identity and image for midwifery has been confused within a medically dominated health system and has not been seen as a primary health strategy. Midwives are not able to practice to the full role and scope of the midwife. Key issues identified need to be addressed before midwifery can be part of a primary health-care strategy in Jordan.

Aboriginal women in rural Australia; a small study of infant feeding behaviour

Publisher: Elsevier BV

Date: 06-2015

DOI: 10.1016/J.WOMBI.2014.12.004

Abstract: Aboriginal women in rural areas have lower rates of breastfeeding than Australian averages. The reasons for this are poorly understood. Aboriginal people experience higher morbidity and increased rates of chronic disease throughout the life cycle. The protective effects of sustained breastfeeding could benefit rural Aboriginal communities. To explore the factors impacting upon infant feeding choices in a rural Aboriginal Community. Semi-structured interviews were conducted with eight Aboriginal rural dwelling first time mothers. These women received a continuity of midwife and Aboriginal Health Worker model of care. Interviews were also undertaken with five Aboriginal Health Workers and two Aboriginal community breastfeeding ch ions. The analysis was integrated with a conventional literature review and was further developed and illustrated with historical literature. Indigenist methodology guided the study design, analysis and the dissemination of results. Three key themes were identified. These were "I'm doing the best thing for..." which encompasses the motivations underpinning infant feeding decisions "this is what I know..." which explores in idual and community knowledge regarding infant feeding and "a safe place to feed" identifying the barriers that negative societal messages pose for women as they make infant feeding decisions. It appears loss of family and community breastfeeding knowledge resulting from colonisation still influences the Aboriginal women of today. Aboriginal women value and trust knowledge which is passed to them from extended family members and women within their Community. Cultural, historical and socioeconomic factors all strongly influence the infant feeding decisions of in iduals in this study. Efforts to normalise breastfeeding in the culture of rural dwelling Aboriginal women and their supporting community appear to be necessary and may promote breastfeeding more effectively than optimal professional care of in iduals can do.

Birth choices in Timor-Leste: A framework for understanding the use of maternal health services in low resource settings

Publisher: Elsevier BV

Date: 12-2010

DOI: 10.1016/J.SOCSCIMED.2010.09.012

Abstract: The high rate of maternal mortality in Timor-Leste is a persistent problem which has been exacerbated by the long history of military occupation and ongoing political crises since independence in 1999. It is similar to other developing countries where there have been slow declines in maternal mortality despite 20 years of Safe Motherhood interventions. The national Ministry of Health, United Nations (UN) agencies and non-government organisations (NGOs) have attempted to reduce maternal mortality by enacting policies and interventions to increase the number of births in health centres and hospitals. Despite considerable effort in promoting facility-based delivery, most Timorese women birth at home and the lack of midwives means few women have access to a skilled birth attendant. This paper investigates factors influencing access to and use of maternal health services in rural areas of Timor-Leste. It draws on 21 interviews and 11 group discussions with Timorese women and their families collected over two periods of fieldwork, one month in September 2006 and five months from July to December 2007. Theoretical concepts from anthropology and health social science are used to explore in idual, social, political and health system issues which affect the way in which maternal health services are utilised. In drawing together a range of theories this paper aims to extend explanations around access to maternal health services in developing countries. An empirically informed framework is proposed which illustrates the complex factors that influence women's birth choices. This framework can be used by policy-makers, practitioners, donors and researchers to think critically about policy decisions and where investments can have the most impact for improving maternal health in Timor-Leste and elsewhere.

Dear midwife colleagues

Publisher: Elsevier BV

Date: 06-1988

DOI: 10.1016/S1031-170X(88)80004-7

Sexuality and Pregnancy An Interview Study

Publisher: Wiley

Date: 02-1994

DOI: 10.1111/J.1479-828X.1994.TB01029.X

Abstract: This paper reports the interview research which formed the basis for a large recently completed study of sexuality and pregnancy by questionnaire. Semistructured interviews were conducted with 25 couples who presented at a large hospital antenatal clinic in the first trimester. Of these couples, 15 participated in second trimester interviews and 12 couples were interviewed between 38 and 40 weeks' gestation. The results showed a substantial decline in sexual interest amongst women that was not matched by their male partners but was reflected in a marked reduction in frequency of intercourse. The range of sexual activities also diminished during pregnancy. The majority (19 or 76%) regularly practised oral sex and 3 men (12%) regularly practised anal intercourse. A key observation is that 7 males (28%) did not always achieve orgasm during sexual intercourse per se.

Implementing Birthing on Country services for Aboriginal and Torres Strait Islander families: RISE Framework

Publisher: Elsevier BV

Date: 10-2019

DOI: 10.1016/J.WOMBI.2019.06.013

Abstract: Birthing on Country is an international movement to return maternity services to First Nations communities and community control for improved health and wellbeing. How can we implement Birthing on Country services for Aboriginal and/or Torres Strait Islander families across Australia? We have developed a framework from theoretical, policy and research literature on Birthing on Country Aboriginal and Torres Strait Islander voices from across Australia reviews exploring programs that have improved outcomes for Indigenous mothers and infants and the retrospective synthesis of learnings from two empirical studies that have redesigned maternal infant health services and improved outcomes for Aboriginal and Torres Strait Islander families. The RISE Framework has four pillars to drive important reform: (1) Redesign the health service (2) Invest in the workforce (3) Strengthen families and, (4) Embed Aboriginal and/or Torres Strait Islander community governance and control. We present the evidence base for each pillar and practical ex les of moving from the standard 'western' model of maternity care towards Birthing on Country services. Application of the RISE framework to plan, develop and monitor Birthing on Country services is likely to result in short and long-term health gains for Aboriginal and Torres Strait Islander families.

'Chatting': An important clinical tool in facilitating mothering in neonatal nurseries

Publisher: Wiley

Date: 13-03-2001

DOI: 10.1046/J.1365-2648.2001.01694.X

Abstract: This paper explores the use of 'chat' or 'social talk' as an important clinical tool that can assist nurses achieve family-centred care in neonatal nurseries. The study was undertaken to increase knowledge of women's experiences of mothering in the neonatal nursery and the relationship they share with nurses. The discussion presented is elicited from a grounded theory analysis of over 60 hours of interview data with 28 women, a thematic analysis of 50 hours of interviews with 20 nurses and a content analysis of 398 tape-recorded interactions between nurses and parents. The analysis identifies the importance of the nurse-mother relationship and demonstrates that it is both the context and method by which nursing care is delivered. We found the verbal exchanges that take place between nurse and mother influence a woman's confidence, her sense of control and her feelings of connection to her infant. It appears from the data that the nurse's ability to effectively 'engage' the mother is dependent on the use of language that expresses care, support and interest in parents. The data suggests that 'chatting' is the strategy and the process through which positive interactions are initiated, maintained and enhanced. This study confirms that nurses' language acts as a powerful clinical tool that can be used to assist parents in gaining confidence in caring for their infants and in becoming 'connected' to infants resident in nurseries.

Demographics, health literacy and health locus of control beliefs of Australian women who take complementary medicine products during pregnancy and breastfeeding: A cross‐sectional, online, national s

Publisher: Wiley

Date: 23-12-2021

DOI: 10.1111/HEX.13414

Abstract: Pregnant and breastfeeding women's use of complementary medicine products (CMPs) is common, and possibly associated with autonomous health care behaviours. However, the health literacy levels and health locus of control (HLOC) beliefs of women who use CMPs in pregnancy and lactation have not been previously assessed in a large Australian s le. The aim of this study is to determine the health literacy levels and HLOC beliefs of women who use CMPs in pregnancy and lactation and determine the types of CMPs used. A cross‐sectional, national, online survey of Australian pregnant or breastfeeding women aged 18 years and older, and currently using CMPs was conducted. A total of 810 completed surveys (354 pregnant and 456 breastfeeding women) were analysed. Most had adequate functional health literacy levels (93.3%). Health care practitioners (HCPs) HLOC mean scores were the highest for the s le, followed by Internal HLOC beliefs mean scores. Almost all ( n = 809) took at least one dietary supplement, the most popular being pregnancy and breastfeeding multivitamins, iron supplements and probiotics. Use was generally in line with clinical recommendations, except for low rates of iodine supplementation. Herbal medicine use was lower for the total s le (57.3%, n = 464), but significantly higher ( p .0001) for the breastfeeding cohort, with consumers taking one to four herbal medicines each. The most popular herbs were raspberry leaf, ginger, peppermint and chamomile (pregnant respondents) and chamomile, ginger and fenugreek (breastfeeding respondents). Respondents were health literate, with high scores for Internal and HCP HLOC scales, suggesting that they are likely to demonstrate self‐efficacy, positive health behaviours and work well in partnership with HCPs. HCPs can facilitate discussions with pregnant and breastfeeding women using CMPs, while considering women's health literacy levels, health beliefs and goals.

Women's business: the challenge of childbirth

Publisher: Elsevier BV

Date: 09-1989

DOI: 10.1016/S0266-6138(89)80026-9

Abstract: This paper was delivered as the opening address at the First National Conference of Childbirth Educators held in Melbourne, Australia, November, 1988. It is published with permission and support from the organisers. This paper develops and links insights available from anthropology, sociology, feminism and economics to the challenge facing childbirth educators. This challenge needs illumination from a number of directions before it can be understood, explained and met. The challenge described in the paper is that of re-establishing the importance and value of 'women's business'. This phrase, developed further at the beginning of the work, is from Aboriginal culture. It conveys the uniqueness of matters belonging to women. Childbirth is currently big business. Its management, whilst masquerading as scientific or medical, is clearly socio-economic. Until this is understood big business will continue to dominate women's business. The paper sets out to develop and defend these assertions and establish a role and responsibility for childbirth educators in relation to them.

Implementation of a childbirth preparation program in the maternal and child health centres in Jordan

Publisher: Elsevier BV

Date: 06-2018

DOI: 10.1016/J.MIDW.2018.02.010

Abstract: To investigate the feasibility and outcomes of introducing childbirth preparation programs in a s le of Maternal and Child Health centres in Jordan. An exploratory, descriptive design, and practice- research engagement was used to implement and evaluate the proposed childbirth preparation program. Face to face interviews and field notes were used to collect data. Outcomes of pregnancy and birth were collected from interviews with women using a structured format. Three Maternal and Child Health centres were randomly selected from the three main regions of Jordan. A convenience s le of 107 primigravid women was recruited for the implementation process. Six health staff (3 doctors and 3 midwives) also participated. The practice- research engagement approach assisted the researchers and care providers in dealing with problems that arose during the implementation of the program. Out of the 107 women initially recruited, only 36 women completed the implementation program, with attrition rate of 65%. The main reasons for poor attendance included: difficulty in keeping contact with participants, transportation difficulties, duration of the program, health problems, antenatal follow up at a private clinic, and not having permission from husbands to attend. The effectiveness of the program was noticed through some improved pregnancy outcomes for the participants and the high satisfaction of the health professionals and women who participated. The program was effective in increasing knowledge and understanding of women regarding the different aspects of pregnancy, birth, and postnatal periods. It helped promote a trusting relationship between health professionals and women and increased staff self confidence in providing specific and essential information to women. Women seemed to have an increased sense of control over the childbirth process, and it reinforced benefits and duration of breastfeeding and knowledge of family planning. Challenges identified by health professionals and women included: women's commitment and capacity to attend the scheduled sessions and shortage of qualified staff. Implementing a childbirth preparation program in a developing country appears possible, successful, and effective if logistical and cultural requirements can be better addressed. This was evidenced with a high rate of participants' satisfaction (women and health care providers), and suggestions of improved pregnancy outcomes. It is necessary to address some logistical issues of delivery and recognise the importance and limitations of current human resources. Policy makers in the Ministry of Health should consider implementation of a childbirth preparation program, as there are no existing programs. Clinical leaders, supported by researchers, should jointly consider reframing the program into a shorter more logistically acceptable delivery mode. This could be tested and evaluated.

A population-based investigation into inequalities amongst Indigenous mothers and newborns by place of residence in the Northern territory, Australia

Publisher: Springer Science and Business Media LLC

Date: 09-06-2012

DOI: 10.1186/1471-2393-12-44

‘Give us the full story’: Overcoming the challenges to achieving informed choice about fetal anomaly screening in Australian Aboriginal communities

Publisher: Elsevier BV

Date: 12-2013

DOI: 10.1016/J.SOCSCIMED.2012.10.031

Abstract: This cross-cultural qualitative study examined the ethical, language and cultural complexities around offering fetal anomaly screening in Australian Aboriginal communities. There were five study sites across the Northern Territory (NT), including urban and remote Aboriginal communities. In-depth interviews were conducted between October 2009 and August 2010, and included 35 interviews with 59 health providers and 33 interviews with 62 Aboriginal women. The findings show that while many providers espoused the importance of achieving equity in access to fetal anomaly screening, their actions were inconsistent with this ideal. Providers reported they often modified their practice depending on the characteristics of their client, including their English skills, the perception of the woman's interest in the tests and assumptions based on their risk profile and cultural background. Health providers were unsure whether it was better to tailor information to the specific needs of their client or to provide the same level of information to all clients. Very few Aboriginal women were aware of fetal anomaly screening. The research revealed they did want to be offered screening and wanted the 'full story' about all aspects of the tests. The communication processes advocated by Aboriginal women to improve understanding about screening included community discussions led by elders and educators. These processes promote culturally defined ways of sharing information, rather than the in idualised, biomedical approaches to information-giving in the clinical setting. A different and arguably more ethical approach to introducing fetal anomaly screening would be to initiate dialogue with appropriate groups of women in the community, particularly young women, build relationships and utilise Aboriginal health workers. This could accommodate in idual choice and broader cultural values and allow women to discuss the moral and philosophical debates surrounding fetal anomaly screening prior to the clinical encounter and within their own cultural space.

Challenges to achieving sustainable community health development within a donor aid business model

Publisher: Elsevier BV

Date: 06-2010

DOI: 10.1111/J.1753-6405.2010.00534.X

Abstract: This paper explores the paradox of donor aid being delivered through a business model through a case study in Papua New Guinea. A retrospective review of project implementation and an outcome evaluation provided an opportunity to examine the long-term results and sustainability of a large project. Analysis was informed by data collected from 175 interviews (national, provincial, district and village), 93 community discussions and observations across 10 provinces. Problems with the business model of delivering aid were evident from implementation data and in an evaluation conducted two years after project completion (2006). Compounding the business model effect were challenges of over-ambitious project goals with limited flexibility to adapt to changing circumstances, a donor payment system requiring short-term productivity and excessive reporting requirements. An overly ambitious project design, donor dominance within the business model and limited local counterpart capacity created problems in the community initiatives component of the project. Contractual pressures can negatively influence long-term outcomes that require development of local leadership and capacity. Future planning for donor project designs needs to be flexible, smaller in scope and have a longer timeframe of seven to 10 years. Donor-funded projects need to be sufficiently flexible to apply proven principles of community development, build local ownership and allow adequate time to build counterpart knowledge and skills.

Processing the first birth: Journeying into 'motherland'

Publisher: Wiley

Date: 14-06-2010

DOI: 10.1111/J.1365-2702.2009.03089.X

Abstract: Aims and objectives. To explore first‐time mothers’ experiences of birth at home and in hospital in Australia. Background. The first birth has unique physical and psychological impacts on women. With the first birth, women become mothers. Design. A grounded theory methodology was used. Data were generated from in‐depth interviews with women in their own homes. Methods. Nineteen women were interviewed in Sydney, Australia. The experiences of seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were contrasted with two mothers who gave birth for the first time in birth centres, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. Results. Following the birth, women ‘processed the birth’ by ‘remembering’, ‘talking (storytelling)’ and ‘feeling’. This activity appeared to help most women resolve their feelings about the birth and understand what it actually means to be a new mother. ‘Personal and social integration’ occurred for most women as they entered ‘motherland’. Conclusion. First‐time mothers appear to ‘process the birth’ to a greater extent than multiparous women because they are experiencing this for the first time. These women also have limited social networks in ‘motherland’, and these are facilitated through sharing the experiences of their labour or ‘processing the birth’. Relevance to clinical practice. Identifying the novice status of first‐time mothers and understanding the way they process the birth can help health providers to be sensitive to the specific needs of primiparous women. In particular, their need to tell their birth stories following birth understanding that these stories help women to process the birth and connect to other women.

Integration in a nurse practitioner-led mental health service in rural Australia

Publisher: Wiley

Date: 27-08-2016

DOI: 10.1111/AJR.12233

Abstract: Integration of mental health services is a prominent Australian mental health policy goal however, there is little detail in the literature of how integrated mental health services are established or function. This study aimed to describe a nurse practitioner-led primary healthcare rural mental health service and evidence of how the service was integrated with other services and the community. This pragmatic exploratory study used case study methodology and analysed documents, quantitative data and qualitative data from in idual and group semi-structured interviews and a 'stakeholder meeting'. The study was part of a formal evaluation of this nurse practitioner service. Rural New South Wales. Twenty-one service providers and stakeholders. Introduction of a nurse practitioner led mental health service. Not applicable. Purposely s led participants were interviewed. Documentary evidence included briefing notes, minutes and progress reports and provided important background information. Non-identifiable aggregated client data were analysed. Thematic analysis of the qualitative data produced a description of how and why the service was established, a description of the service and its impact and three analytic themes providing evidence of integration. Challenges to integrating this service are also discussed. The service was highly regarded. It addressed the drug and alcohol and mental health needs of a vulnerable rural community. The inception and implementation of the service were community driven, led by a number of agencies supported by a steering committee and underpinned by a Partnership Agreement. The service demonstrated key features of integration alongside experiencing challenges in optimising integration with acute mental health services.

It just forces hardship: Impacts of government financial penalties on non-vaccinating parents

Publisher: No publisher found

Date: 2018

DOI: 10.1057/S41271-017-0116-6

Abstract: Despite strong evidence confirming vaccination is safe and effective, some parents choose not to vaccinate their children. In 2016, the Australian Government introduced legislation strengthening links between vaccination compliance and some government payments. We interviewed thirty-one non-vaccinating parents about the impacts of this policy. Data analysis produced three key themes: 'questioning policy integrity', 'minimising impact' and 'holding my ground'. Affected parents offset reduced income by removing children from early childhood learning, reducing work commitments, moving residence to reduce living costs and accessing informal childcare arrangements. Parents reported a greater commitment to their decision not to vaccinate and an increased desire to maintain control over health choices for their children including an unprecedented willingness to become involved in protest action. Our study identifies why financial penalties have not been an effective policy measure for this s le of non-vaccinating parents, an understanding which may assist in the development of future legislation.

Local birthing services for rural women: Adaptation of a rural New South Wales maternity service.

Publisher: Wiley

Date: 06-07-2016

DOI: 10.1111/AJR.12310

The professionalising of breast feeding—Where are we a decade on?

Publisher: Elsevier BV

Date: 05-2013

DOI: 10.1016/J.MIDW.2012.11.007

Medication reviews are useful, but the model needs to be changed: Perspectives of Aboriginal Health Service health professionals on Home Medicines Reviews

Publisher: Springer Science and Business Media LLC

Date: 06-2015

DOI: 10.1186/S12913-015-1029-3

The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study

Publisher: Wiley

Date: 23-07-2014

DOI: 10.1111/HDI.12201

Hitting the white ceiling: Structural racism and Aboriginal and Torres Strait Islander university graduates

Publisher: SAGE Publications

Date: 10-07-2019

DOI: 10.1177/1440783319859656

Abstract: This article reports on a study that explored what it means to be a mature-age Aboriginal and Torres Strait Islander university graduate in the context of age, life-stage, history, culture, socioeconomic status, race and place. Using narrative interview data and fieldwork observation, we focus on the graduates’ workplace experiences and take a case study approach to lify their voices. We argue that the data challenges the ideological construct of Australia as a ‘post-racial’ society and illustrates how interrelated variants of structural racism function to sanction, silence and control educated Aboriginal and Torres Strait Islander people, ide communities into quasi-hierarchies, and sustain white power and privilege. We show how these variants are expressed as low expectations, shadeism, culturism and privilege protectionism, and argue that their enactment can erect an invisible barrier to Aboriginal and Torres Strait Islander professional progression: a ‘white ceiling’ above which many graduates struggle to ascend.

Randomised-controlled trial of two antenatal education programmes

Publisher: Elsevier BV

Date: 04-2009

DOI: 10.1016/J.MIDW.2006.12.012

Abstract: to determine whether a new antenatal education programme with increased parenting content could improve parenting outcomes for women compared with a regular antenatal education programme. a randomised-controlled trial. Data were collected through self-report surveys. specialist referral maternity hospital in Sydney, Australia. 170 women birthing at the hospital. Ninety-one women attended the new programme and 79 the regular programme. a new antenatal education programme ('Having a Baby' programme) developed from needs assessment data collected from expectant and new parents. One important feature of the programme was the recognition that pregnancy, labour, birth and early parenting were a microcosm of the childbearing experience, rather than separate topics. the primary outcome measure was perceived maternal parenting self-efficacy. Worry about the baby, and perceived parenting knowledge, were secondary outcome measures. They were measured before the programme and after birth. Birth outcomes were also recorded. the postnatal perceived maternal parenting self-efficacy scores of women who attended the 'Having a Baby' programme were significantly higher than those who attended the regular programme. Perceived parenting knowledge scores of women who attended the 'Having a Baby' programme were also significantly higher than those who attended the regular programme. Worry scores were lower but they did not reach statistical significant. Birth outcomes were similar. the 'Having a Baby' programme improved maternal self-efficacy and parenting knowledge. Parenting programmes that continue in the early postnatal period may be beneficial.

Complementary medicine products: Information sources, perceived benefits and maternal health literacy

Publisher: Elsevier BV

Date: 12-2019

DOI: 10.1016/J.WOMBI.2018.11.015

Abstract: Maternal health literacy plays an important role in women's decisions regarding health care during pregnancy and lactation. This systematic review aimed to investigate the use of complementary medicine products by pregnant and breastfeeding women information sources accessed, and the role health literacy plays in women's use of complementary medicine products. Seven databases were searched for peer-reviewed quantitative or mixed- methods studies (1995-2017). Thematic analysis identified key themes regarding women's use of complementary medicine products for perceived benefits to the mother, pregnancy, baby and/or breastfeeding process. 4574 papers were identified 56 met the inclusion criteria. Most (n=53) focused on the use of complementary medicine products during pregnancy six focused on use in lactation. Herbal medicines were the main complementary medicine product type discussed (n=46) for both pregnancy and breastfeeding. Women perceived complementary medicine products to be beneficial in supporting their own pre and postnatal health, their pregnancies, growing foetuses, labour and birth, and/or breastfeeding. Health care professionals, followed by other interpersonal relationships and the media were the most commonly reported information sources accessed. An interactive model of health literacy revealed that information sources within a woman's health literacy environment, combined with other information sources, influenced her decision making regarding complementary medicine product use. Pregnant and breastfeeding women use complementary medicine products for various self-perceived benefits related to their own, unborn or breastfeeding babies' health. Examining these with reference to an interactive health literacy model helps identify the decision-making process mothers undergo when choosing to use complementary medicine products.

Contemporary breast-feeding policy and practice: implications for midwives

Publisher: Elsevier BV

Date: 03-2001

DOI: 10.1054/MIDW.2000.0234

Maternal mortality surveillance in an inland Chinese province

Publisher: Wiley

Date: 19-11-2008

DOI: 10.1016/J.IJGO.2008.10.004

Abstract: To evaluate the Chinese maternal mortality surveillance system in an inland province and identify how it can be improved. The review process and Chinese Maternal Deaths Reporting Form were compared with standards recommended by the UK Confidential Enquiry into Maternal and Child Health using interviews with key personnel, field observations, and reports and audits from 2003-2005. The Chinese Maternal Deaths Reporting Form does not provide anonymity for the deceased woman, the health workers, or hospitals. The information collected is often insufficient to identify substandard care. The Review Committee was not multidisciplinary and the review was not confidential. The review findings were only available to the Review Committee. Confidentiality should be a requirement in the maternal mortality surveillance system. The anonymous findings should be available to health workers, and be used to improve the system and inform the community about performance.

'Big build': Hidden depression in men

Publisher: SAGE Publications

Date: 10-2005

DOI: 10.1111/J.1440-1614.2005.01665.X

Complementary medicine products used in pregnancy and lactation and an examination of the information sources accessed pertaining to maternal health literacy: A systematic review of qualitative studies

Publisher: Springer Science and Business Media LLC

Date: 31-07-2018

DOI: 10.1186/S12906-018-2283-9

The development of a caseload midwifery service in rural Australia

Publisher: Elsevier BV

Date: 08-2017

DOI: 10.1016/J.WOMBI.2016.11.010

Abstract: The past two decades have seen progressive decline in the number of rural birthing services across Australia. Despite health system pressures on small birthing units to close there have been ex les of resistance and survival. This descriptive study explored the evolution of a rural birthing service in a small town to offer insight into the process of transition which may be helpful to other small healthcare services in rural Australia. Quantitative data derived from birth registers on number and types of birth from 1993-2011 were analysed. Interviews were conducted between January and August 2012 with nine participants (GP obstetricians, midwives, a health service manager and a consumer representative). This rural maternity service developed gradually from a GP obstetrician-led service to a collaborative care team approach with midwifery leadership. This development was in response to a changing rural medical workforce, midwifery capacity and the needs and wants of women in the local community. Four major themes were developed from interview data: (1) development of the service (2) drivers of change (3) outcomes and (4) collaborative care and inter-professional practice. The success of this transition was reported to rest on strategic planning and implementation and respectful inter-professional practice and alignment of birth philosophy across the team. This team created a unified, progressive community-focused birthing service. The development of collaborative care models that embrace and build on established inter-professional relationships can maximise existing rural workforce potential and create a sustainable rural service into the future.

The professionalising of breast feeding—Where are we a decade on?

Publisher: Elsevier BV

Date: 06-2012

DOI: 10.1016/J.MIDW.2011.12.011

Abstract: This paper is an empirically informed opinion piece revisiting an argument published in Midwifery 10 years ago, that the increasing professionalisation of breast feeding was not supporting women in Australia in sustaining breast feeding. We present the last 10 years of primary research on the topic, explore major policy initiatives and the establishment and growth of lactation consultants in Australia to see if this has made a difference to sustained rates of breast feeding. We present an analysis of the only consistently collected national statistics on breast feeding and compare this with national and state level government data collections from the last decade. We have found that the considerable effort invested in trying to improve duration of breast feeding amongst women in Australia appears to have failed to improve sustained breast-feeding rates. We argue that this situation might be related to losing sight of the embodied nature of breast feeding and the relationships that must exist between the mother and baby, the knowledge and skills women quickly develop, and a loss of woman to woman support. We conclude that midwives have a major role in avoiding us reproducing similar, unintended, negative consequences to those resulting from increasing obstetrician managed normal birth. These include midwifery scrutiny and involvement in policy development and institutional practices and the design of services.

Improving maternity services for Indigenous women in Australia: moving from policy to practice

Publisher: AMPCo

Date: 10-2016

DOI: 10.5694/MJA16.00854

Abstract: The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce Culturally competent maternity care and Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

How participatory action research supported improvements to the postnatal discharge summary system used for remote dwelling Aboriginal mothers and infants in the Top End of Australia

Publisher: SAGE Publications

Date: 21-11-2012

DOI: 10.1177/1476750312467832

Abstract: This article describes and analyses the participatory action research (PAR) process used by researchers working with policy leaders and clinicians to facilitate health service improvement around postnatal discharge planning processes for remote-dwelling Aboriginal women and their newborn infants. The research presented here was a sub-study of a larger health system improvement investigation. Stringer’s (2007) working principles of PAR – participation, relationships, inclusion and communication – were used by researchers as a framework to describe a process of engagement for the research. Application of these principles prompted changes to the discharge planning process within the health system. The improvements included: redesign of discharge paperwork nomination of a designated health professional at the remote community to receive summaries training for hospital staff in the computer application that generated the discharge summaries and the development of a length of stay and discharge policy. Hospital service providers have formed a working group that meets to discuss issues around the discharge process and work continues to review and strengthen the discharge process. Hospital management reported that the changes resulted in improvements, with more likelihood that correct information is being received by the appropriate health professional in a timely manner.

Women's experiences of continuity of midwifery care in a randomised controlled trial in Australia

Publisher: Elsevier BV

Date: 06-2002

DOI: 10.1054/MIDW.2002.0298

Abstract: to compare the experiences of women who received a new model of continuity of midwifery care with those who received standard hospital care during pregnancy, labour, birth and the postnatal period. a randomised controlled trial was conducted. One thousand and eighty-nine women were randomly allocated to either the new model of care, the St George Outreach Maternity Project (STOMP), or standard care. Women completed a postal questionnaire eight to ten weeks after the birth. women in the trial were of mixed obstetric risk status and more than half the s le were born in a non-English speaking country. questionnaires were returned from 69% of consenting women. STOMP women were significantly more likely to have talked with their midwives and doctors about their personal preferences for childbirth and more likely to report that they knew enough about aspects of labour and birth, particularly induction of labour, pain relief and caesarean section. Almost 80% of women in the STOMP group experienced continuity of care, that is, one of their team midwives was present, during labour and birth. STOMP women reported a significantly higher 'sense of control during labour and birth'. Sixty-three per cent of STOMP women reported that they 'knew' the midwife who cared for them during labour compared with 21% of control women. In a secondary analysis, women who had a midwife during labour who they felt that they knew, had a significantly higher sense of 'control' and a more positive birth experience compared with women who reported an unknown midwife. Postnatal care elicited the greatest number of negative comments from women in both the STOMP and the control group. The reorganisation of maternity services to enable women to receive continuity of care has benefits for women. The benefits of a known labour midwife needs further research.

Women’s health literacy and the complex decision‐making process to use complementary medicine products in pregnancy and lactation

Publisher: Wiley

Date: 22-05-2019

DOI: 10.1111/HEX.12910

Legally binding midwives to doctors is not collaboration

Publisher: Elsevier BV

Date: 03-2010

DOI: 10.1016/J.WOMBI.2009.12.002

Craving closeness: A grounded theory analysis of women's experiences of mothering in the Special Care Nursery

Publisher: Elsevier BV

Date: 06-2008

DOI: 10.1016/J.WOMBI.2008.03.006

Abstract: The aim of the study was to increase knowledge and understanding of how women begin their roles as mothers when their infant is in the neonatal nursery. Research is limited into how women experience mothering in contexts such as the neonatal nursery. Consequently many nurses and midwives remain inadequately informed of parents' experiences which we know may have long-term family outcomes. This paper presents the overarching synthesis of a grounded theory analysis of data collected from 28 Australian women whose infants were in Special Care Nurseries. It draws together a number of previous publications that have described in detail the categories derived from the analysis that explain the actions, interactions and reactions women engage in as they seek to 'connect' with their infant. Data collection consisted of two in-depth interviews conducted with women, 333h of taped cot side recordings, field notes and interview data collected from 20 nursery staff, 19 of whom were midwives. Six major categories were identified that, when combined, explained the intense emotional, cognitive and worry 'work' women undertook with both their infants and the nursery staff in an effort to learn how to mother in the nursery. Four explained how women worked to get to know and connect with their infants. The first three were labelled 'just existing', 'striving to be the baby's mother' and 'trying to establish competence'. The fourth, 'learning and playing the game', overlays the first three and represents the reality of having to undertake these already difficult and unexpected activities of mothering in the nursery. Two categories 'becoming connected' and 'struggling to mother' were identified as the consequences of women's actions and interactions. A significant finding of the study was the impact of the interactions between nurses and mothers' mothering. The nurse-mother relationship had the potential to significantly affect how women perceived their connection to the infant and their confidence in caring for their infant which occurred through a three way interaction. It becomes clear that the intense work women undertake as mothers in the nursery is focused on not only the infant, which might have been expected, but also the nursery staff. It is driven by their desire to develop or re-establish some sense of competence in the eyes of the nurse and to achieve control over the situation. Achieving physical closeness with the baby was a major strategy through which women not only learned about and gained intimate knowledge of their infant, but also demonstrated authority and ownership. It appears that reorientating the delivery of services from the infant to the mother-infant dyad would improve the care women and families receive during their nursery experience.

Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives in Jordan

Publisher: Elsevier BV

Date: 03-2020

DOI: 10.1016/J.WOMBI.2019.03.007

Abstract: Episiotomy is still performed routinely by clinicians in many countries. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy practice among clinicians working in public hospitals in Jordan. A cross-sectional study, using a self-administered survey questionnaire, was conducted among midwives and obstetricians in three public hospitals in Jordan. 112 (87.5%) clinicians responded to the questionnaire. Low knowledge level of evidence about overuse and risk of episiotomy was identified among participants with a significant difference among obstetricians and midwives (P<0.05). Results revealed that both obstetricians and midwives have limited access to evidence which is not emphasised in their learning, practice, or hospital policy. The majority of obstetricians (80%) and midwives (79%) thought an episiotomy rate of 81% is about right. The most common reason for performing episiotomy identified by both obstetricians (83.1%) and midwives (75.5%) was to reduce the risk of 3rd and 4th degree perineal laceration. The most common obstacle to reducing episiotomy rate reported by obstetricians (78.0%) was lack of training on preventing perineal tears, while the most common obstacles reported by midwives were insufficient time to wait for the perineum to stretch (56.6%) and difficulty changing the conventional practices in the labour ward (52.8%). This study identifies that obstetricians and midwives in Jordan rely on non evidence-based beliefs to guide their practice on performing an episiotomy. Training, continuing education, and developing evidence based clinical policies and guidelines for surgical procedures, such as in an episiotomy, are needed.

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

Publisher: Elsevier BV

Date: 10-2017

DOI: 10.1016/J.WOMBI.2017.03.003

Abstract: To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.

A retrospective analysis of a community-based health program in Papua New Guinea

Publisher: Oxford University Press (OUP)

Date: 02-04-2009

DOI: 10.1093/HEAPRO/DAP009

Abstract: The Women and Children's Health Project was a large Australian funded aid Project that sought to improve the health of women and children in Papua New Guinea between 1998 and 2004. Community development and health promotion interventions aimed to increase community support for attended birth and children's health. Green and Kreuter's [Green, L. W. and Kreuter, M. W. (2005) Health Program Planning: An Educational and Ecological Approach, 4th edition. McGraw-Hill, New York] precede-proceed model of health program planning was applied retrospectively to critique the design, implementation and evaluation of the Project. An outcome evaluation (2006) provided data for this analysis and investigated long-term impact using a multi-methods approach. Application of the precede-proceed model was useful, but the model fails to sufficiently well identify 'inhibiting factors' as part of the educational and ecological assessment during the planning phase. Pre-defined objectives and contractually obligated outputs in a donor funded business model negatively influenced Project activity and outcomes. Despite this and the challenging context for implementation, Project interventions improved interaction between the community and health systems, and improved use of maternal child health services.

A comparison of labour and birth outcomes in Jordan with WHO guidelines: a descriptive study using a new birth record

Publisher: Elsevier BV

Date: 12-2009

DOI: 10.1016/J.MIDW.2007.10.007

Abstract: to examine data collected during the testing of a new birth record in Jordan from 1 July to 31 August 2004, and to compare these practices with guidelines from the World Health Organization (WHO) and evidence-based recommendations. This was part of a larger study that used an action research approach to engage practitioners in implementation of the new record. descriptive, comparative design. three Ministry of Health hospitals in Jordan. the birth records of 1254 mothers and babies were used. data on selected labour and birth practices were collected from the records. Comparisons were made using recognised evidence-based guidelines. the rates of a number of labour and birth practices were inappropriately high, and differed from WHO guidelines and evidence-based recommendations. The rates of augmentation of labour (46%) and episiotomy (53%) were particularly high, and seem to be in excess of the WHO recommendations, which state that neither of these practices should be undertaken routinely. information on labour and birth practices can assist clinicians working in these three hospitals to reflect upon their care and outcomes. Clinicians may be able to use this information to change practice to improve care for women and babies. Organisational support and clinical leadership are necessary in order to provide health professionals with time and resources to access research data and undertake comparisons that can lead to health service and system-level improvement.

None of Them Were Satisfactory: Women's Experiences with Contraception

Publisher: Informa UK Limited

Date: 06-2006

DOI: 10.1080/07399330600629468

Abstract: Seventy-two women, aged between 18 and 50 years, participated in focus groups to talk about their experiences with using contraception. There were both continuities and differences between women in each of the age groups. Younger women appeared to be more accepting of medical opinion, while many older women rejected medical interference in contraceptive decisions. Patterns of use were similar with the pill having been the contraceptive of first choice for the majority of women. The most persistent feature through the groups was a strong sense of dissatisfaction with contraception, in terms of both side effects and range of available methods.

Challenges to Providing Fetal Anomaly Testing in a Cross‐Cultural Environment: Experiences of Practitioners Caring for Aboriginal Women

Publisher: Wiley

Date: 07-08-2015

DOI: 10.1111/BIRT.12182

Abstract: Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation s ling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%) almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs.

An asset-based intervention with Tuberculosis groups in rural Indonesia villages: overview and lessons learned

Publisher: Oxford University Press (OUP)

Date: 13-09-2016

DOI: 10.1093/CDJ/BSW037

Complementary medicine products information-seeking by pregnant and breastfeeding women in Australia

Publisher: Elsevier BV

Date: 10-2019

DOI: 10.1016/J.MIDW.2019.06.011

Abstract: Complementary medicine product use in pregnancy and lactation is common but little is known about women's health literacy and information-seeking regarding this. The objectives of this study were to identify and explore pregnant or breastfeeding women's sources of, and rationale for seeking complementary medicine products information, the types of information sought, and how women felt their health care practitioners can help them receive information that meets their needs. A qualitative research design consisting of in-depth interviews and focus group discussions was conducted. Data were thematically analysed. Participants also completed two validated health literacy screening tools. Communities in regional and metropolitan settings in Sydney and Northern New South Wales, and South-East Queensland, Australia. Twenty-five women (n = 7 pregnant, n = 17 breastfeeding, n = 1 both pregnant and breastfeeding) who currently used complementary medicine products participated. Eleven women were pregnant with or breastfeeding their first child 14 had between one and four older children. Twenty-four participants had high health literacy according to the validated screening tools. Around half of the participants had used complementary medicine products for most of their lives and 17 had used complementary medicine products to resolve or manage complex health conditions in adulthood or childhood. Women sought complementary medicine products information from three main sources. 1) Practical and safety information on complementary medicine products was sought from health care practitioners and published research 2) health care practitioners were also sources of information on reasons for complementary medicine products recommendations and physiological actions and 3) sharing experiences of complementary medicine products use with other mothers appeared to help women understand what to expect when taking complementary medicine products, support social-emotional wellbeing and encourage participants to look after their own health. Participants strongly expressed the desire for their mainstream biomedical health care practitioners to be more informed in, and open to, complementary medicine product use in pregnancy and breastfeeding. Participants' high health literacy skills may have influenced them to seek comprehensive information on complementary medicine products from a variety of professional and lay sources. Their use of complementary medicine products in pregnancy and breastfeeding was a natural consequence from previous positive experiences with complementary medicine products and/or therapies. Maternity care practitioners can positively enhance their interactions with pregnant or breastfeeding women who use complementary medicine products by respectfully discussing use within the context of these women's values and health goals, and by furthering their own education in complementary medicine products' safety, efficacy and indications in pregnancy and breastfeeding.

A feminist history of Australian midwifery from colonisation until the 1980s

Publisher: Elsevier BV

Date: 03-2008

DOI: 10.1016/J.WOMBI.2007.12.001

Abstract: This paper uses a feminist interpretation and secondary sources to describe the history of Australian midwifery from colonisation until the 1980s. There have been too few midwife scholars who have had access to or used primary data collections to describe the role and place of midwives in the colonising community. I draw on a range of biography, medical literature and work by sociologists and economic historians to produce a limited picture of the history of professional midwifery. This helps to explain the position of midwives today and the problematic relationship we often have with medicine.

Making pregnancy safer in Australia: The importance of maternal death review

Publisher: Wiley

Date: 26-03-2008

DOI: 10.1111/J.1479-828X.2008.00846.X

Attitudes of pharmacists to provision of Home Medicines Review for Indigenous Australians

Publisher: Springer Science and Business Media LLC

Date: 17-10-2014

DOI: 10.1007/S11096-014-0030-Y

Abstract: Home Medicines Reviews could improve the quality use of medicines and medicines adherence among Aboriginal people. Despite high level of chronic disease very few Home Medicines Review are currently being conducted for Aboriginal and Torres Strait Islander people. The aim of this research was to explore the barriers and facilitators from the pharmacists' perspective for the provision of Home Medicines Review to Aboriginal people attending Aboriginal Health Services. A cross sectional survey was used to gather demographic, qualitative and quantitative data from 945 Australian pharmacists accredited to undertake Home Medicines Review. The survey consisted of 39 items which included both closed, open ended and Likert scale questions. Data was extracted from the online survey tool and analysed. Descriptive statistics were used to explore the quantitative data while qualitative data was thematically analysed and coded for emergent themes. Number of Home Medicines Review conducted for Aboriginal and Torres Strait Islander patients. A total of 187 accredited pharmacists responded to the survey. They reported that barriers to Home Medicines Review to Aboriginal patients may include lack of understanding of cultural issues by pharmacists lack of awareness of Home Medicines Review program by Aboriginal Health Service staff difficulties in implementation of Home Medicine Review processes burdensome program rules the lack of patient-pharmacist relationship, and the lack of pharmacist-Aboriginal Health Service relationship. Changes to the medication review processes and rules are needed to improve the accessibility of the Home Medicine Review program for Aboriginal and Torres Strait Islander people. Improved relationships between pharmacists and Aboriginal health service staff, would increase the likelihood of more Home Medicines Reviews being conducted with Aboriginal and Torres Strait Islander patients.

Improving knowledge and behaviours related to the cause, transmission and prevention of Tuberculosis and early case detection: a descriptive study of community led Tuberculosis program in Flores, Indo

Publisher: Springer Science and Business Media LLC

Date: 08-08-2016

DOI: 10.1186/S12889-016-3448-4

Exploring the Process of Women’s Infant Feeding Decisions in the Early Postbirth Period

Publisher: SAGE Publications

Date: 09-05-2013

DOI: 10.1177/1049732313490075

Abstract: Research indicates that multiple factors are associated with decisions women make about infant feeding, yet few studies have explored the decision-making process. In this article, we present the analysis that produced the core category “deconstructing best,” previously reported as part of a grounded theory exploring 37 Australian women’s infant feeding experiences and decisions in the first 6 weeks postbirth. We expand on the previous article by detailing and discussing the phases of the infant feeding decision-making process in relation to decision-making theory. Analysis demonstrates the importance of these early weeks in shaping women’s infant feeding trajectories. Findings illustrate that information gathering encompassing multiple factors occurred at this time, and that complex and often competing goals were involved in the women’s decisions. We suggest that acknowledging and assisting women to meet alternate goals in the postbirth period might help them meet their breastfeeding goals.

A cost-consequences analysis of a Midwifery Group Practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia

Publisher: Elsevier BV

Date: 04-2014

DOI: 10.1016/J.MIDW.2013.04.004

Abstract: to compare the cost-effectiveness of two models of service delivery: Midwifery Group Practice (MGP) and baseline cohort. a retrospective and prospective cohort study. a regional hospital in Northern Territory (NT), Australia. baseline cohort included all Aboriginal mothers (n=412), and their infants (n=416), from two remote communities who gave birth between 2004 and 2006. The MGP cohort included all Aboriginal mothers (n=310), and their infants (n=315), from seven communities who gave birth between 2009 and 2011. The baseline cohort mothers and infant's medical records were retrospectively audited and the MGP cohort data were prospectively collected. All the direct costs, from the Department of Health (DH) perspective, occurred from the first antenatal presentation to six weeks post partum for mothers and up to 28 days post births for infants were included for analysis. analysis was performed with SPSS 19.0 and Stata 12.1. Independent s le of t-tests and χ2 were conducted. women receiving MGP care had significantly more antenatal care, more ultrasounds, were more likely to be admitted to hospital antenatally, and had more postnatal care in town. The MGP cohort had significantly reduced average length of stay for infants admitted to Special Care Nursery (SCN). There was no significant difference between the two cohorts for major birth outcomes such as mode of birth, preterm birth rate and low birth weight. Costs savings (mean A$703) were found, although these were not statistically significant, for women and their infants receiving MGP care compared to the baseline cohort. for remote dwelling Aboriginal women of all risk who travelled to town for birth, MGP was likely to be cost effective, and women received better care and resulting in equivalent birth outcomes compared with the baseline maternity care.

The novice birthing: theorising first-time mothers' experiences of birth at home and in hospital in Australia

Publisher: Elsevier BV

Date: 02-2010

DOI: 10.1016/J.MIDW.2008.01.012

Abstract: to explore first-time mothers' experiences of birth at home and in hospital in Australia. a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Sydney, Australia. 19 women were interviewed. Seven women who gave in a public hospital and seven women who gave birth for the first time at home were interviewed and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. three categories emerged from the analysis: preparing for birth, the novice birthing and processing the birth. These women shared a common core experience of seeing that they gave birth as 'novices'. The basic social process running through their experience of birth, regardless of birth setting, was that, as novices, they were all 'reacting to the unknown'. The mediating factors that influenced the birth experiences of these first-time mothers were preparation, choice and control, information and communication, and support. The quality of midwifery care both facilitated and hindered these needs, contributing to the women's perceptions of being 'honoured'. The women who gave birth at home seemed to have more positive birth experiences. identifying the novice status of first-time mothers and understanding the way in which they experience birth better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing. It demonstrates how midwives can contribute to positive birth experiences by being aware that first-time mothers, irrespective of birth setting, are essentially reacting to the unknown as they negotiate the experience of birth.

Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care

Publisher: Elsevier BV

Date: 2001

DOI: 10.1016/S0306-5456(00)00022-X

Understanding non-vaccinating parents' views to inform and improve clinical encounters: A qualitative study in an Australian community

Publisher: BMJ

Date: 05-2019

DOI: 10.1136/BMJOPEN-2018-026299

Abstract: To explain vaccination refusal in a s le of Australian parents. Qualitative design, purposive s ling in a defined population. A geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal. Semi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive s ling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment via local advertising then snowballing. Thematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents’ accounts included: perceived deterioration in health in Western societies a personal experience introducing doubt about vaccine safety concerns regarding consent varied encounters with health professionals (dismissive, hindering and helpful) a quest for ‘the real truth’ reactance to system inflexibilities and ongoing risk assessment. We suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group.

The Lived Experience of Jordanian Women who Received Family Support During Labor

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 2010

DOI: 10.1097/01.NMC.0000366810.52208.B6

Midwives in China: 'jie sheng po' to 'zhu chan shi'

Publisher: Elsevier BV

Date: 04-2009

DOI: 10.1016/J.MIDW.2007.01.015

Abstract: We explore the position of midwifery in contemporary China, and draw on fieldwork conducted in Shanxi and Sichuan Provinces during 2005 and 2006, the available literature in English and to a lesser extent in Mandarin. We also explore the historical antecedents to the present-day professional status, practices and position within the health-care system of midwifery in China. We consider the effect on midwifery of the place of biomedicine in the modernising project of the post-reform State, the shift of birth from the private to the public domain, the rise of the medical profession, the medicalisation of birth and the increasing use of technology, and trace changes in the nature of relations between midwives, doctors and the State from Imperial China to the present day. In particular, we examine the changes that have occurred as midwifery has moved from the arena of the lay practitioner ('jie sheng po') to the professional ('zhu chan shi'). We draw out and critique some ways that midwives act to differentiate themselves and lay claim to a variant body of practice-based knowledge, yet question the capacity of midwifery in China today to assert, in any substantial way, a professional identity that distinguishes it from medical obstetric practice.

Women's perceptions of emotional support following childbirth: A qualitative investigation

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.

Consequences of Birth Policies and Practices in Post-Reform China

Publisher: Informa UK Limited

Date: 2007

DOI: 10.1016/S0968-8080(07)30315-7

They've given me that many tablets, I'm bushed. I don't know where I'm going

Publisher: Wiley

Date: 09-2013

DOI: 10.1111/AJR.12053

Abstract: To explore Aboriginal and Torres Strait Islander patients' experiences with medicines and the barriers and facilitators to their effective use of medicines. A descriptive, qualitative study, using 18 semi-structured focus groups with 101 Aboriginal and Torres Strait participants. Groups were conducted at 11 Aboriginal health services. These were recorded, transcribed and a thematic analysis was performed. Participants were Aboriginal and Torres Strait Islander patients, taking multiple medicines, who attended Aboriginal health services (AHSs) and who spoke English. AHSs varied in governance, size and service delivery models as well as their locations which were across urban, regional, rural and remote settings. Major themes identified were consistent across all settings and patients. These were confusion over medicines, perceived lack of advice from health professionals to patients about medicines and challenges in having effective interactions with medical practitioners and pharmacists. Participants wanted more information about medicine, indications for medicine, how they should be used, potential side effects, drug interactions and duration of therapy. They also reported an absence of appropriate medication labelling and written information. Many Aboriginal and Torres Strait Islander patients take multiple medicines and often find managing their medicines difficult and worrying. These patients require more comprehensive information, verbal and written, and more effective communications from doctors and pharmacists about medication indications, mechanisms, side effects, drug interactions and duration of treatment. Pharmacists have an opportunity to play a greater role in improving understanding of medicines and treatment choices.

Availability and quality of emergency obstetric care in Shanxi Province, China

Publisher: Wiley

Date: 08-06-2010

DOI: 10.1016/J.IJGO.2010.05.001

Abstract: To investigate the availability and quality of emergency obstetric care (EmOC) received by women in a rural Chinese province. The study was conducted in 7 rural counties and townships in Shanxi Province, China. Data sources included interviews with 7 hospital leaders, 5 maternal and child health workers, and 7 obstetricians 118 records of complicated delivery were audited, 21 Maternal and Child Health Annual Reports analyzed, and observations conducted of facilities and advanced labor care. The number of comprehensive EmOC facilities was adequate in all counties. Three counties had fewer basic EmOC facilities than recommended and only 4 counties reached the recommended level. Most of the existing township hospitals did not provide birthing services. All the county hospitals could perform cesarean deliveries with rates from 6.8%-40.8%. The management of complications was not evidence-based. For ex le, women with pre-ecl sia and ecl sia were given too little magnesium sulfate women were not closely monitored for hemorrhage after birth and the partograph was used incorrectly with consequences for obstructed labor. Basic EmOC facilities are not adequate and township hospitals should be upgraded to provide birthing services. The quality of EmOC is poor and needs improvement.

Caring behaviours by midwives: Jordanian women's perceptions during childbirth

Publisher: Elsevier BV

Date: 07-2019

DOI: 10.1016/J.MIDW.2019.03.006

Abstract: It is agreed internationally that caring is a central part of nursing and midwifery. There is a growing concern about the lack of caring in childbirth settings in developing countries including Jordan. The aim of this study was to explore women's perceptions of midwives' caring behaviours during childbirth to assist develop strategies for improvement. An exploratory and qualitative design utilizing semi-structured interviews was used to explore women's perceptions of midwives' caring behaviours during childbirth. Interviews were digitally recorded and transcribed verbatim. Data were analysed by using thematic coding. Repetitive themes that described commonalties between the women's perceptions were identified and described. Twenty-one women participated in the interviews. Three main themes were identified: (1) Women's feelings during childbirth: they felt frightened, humiliated, ignored, and disrespected. Negative actions in term of tangible or physical non-caring behaviours and emotional behaviours were reported. (2) Women's perceptions of the caring behaviours of midwives during childbirth: women had negative experiences during childbirth, they reported disrespectful manners and physical and empathetic abandonment by midwives during childbirth. (3) Women's preferred caring behaviours: women wanted the midwives to listen to what they say, to demonstrate respect for them, and be truly 'present' for women when they needed them. The absence of caring behaviours from a group of Jordanian midwives' elicited negative responses from women in labour, who found this distressing. Devising strategies, informed by the study, focused on the preferred caring behaviours identified by women, could improve the standard of care provided by midwives currently working in labour wards in public hospitals in Jordan. These strategies should recognise that core competencies for midwifery care must go beyond skills training alone and highlight the importance of the psychosocial and emotional components of caring as well as routine procedural activities.

The closure of rural and remote maternity services: Where are the midwives?

Publisher: Elsevier BV

Date: 07-2016

DOI: 10.1016/J.MIDW.2016.03.007

Abstract: Decisions to close small maternity units in rural and remote communities have often precipitated a community response as women and families rally to save local services. But where are the midwives? We argue here that professional bodies such as colleges of midwives have a responsibility to advocate more strongly at a political level for evidence-based decisionmaking regarding the allocation of rural services. We suggest that adopting a comprehensive definition of maternity services risk that considers both social and health services risks and their impact on clinical risk, could provide a solid basis for effective advocacy by professional bodies.

Alliances and evidence: Building the capacity and effectiveness of rural health advocacy in Australia

Publisher: Wiley

Date: 10-2018

DOI: 10.1111/AJR.12455

Developing a best practice pathway to support improvements in Indigenous Australians’ mental health and well-being: a qualitative study: Figure 1

Publisher: BMJ

Date: 08-2015

DOI: 10.1136/BMJOPEN-2015-007938

Complex decisions: theorizing women’s infant feeding decisions in the first 6 weeks after birth

Publisher: Wiley

Date: 02-2010

DOI: 10.1111/J.1365-2648.2009.05194.X

Abstract: This paper is a report of a grounded theory study of woman's infant feeding experiences and decisions in the first 6 weeks after birth. Breastfeeding is considered the optimum method of infant feeding. Studies have identified numerous factors associated with infant feeding decisions. What remains unexplored are the mechanisms by which socio-demographic, biomedical and psychosocial factors influence infant feeding decisions. Research highlights the need for further investigation of the experiences and decision-making processes of both breastfeeding and formula-feeding women. A constructionist grounded theory approach to data collection and analysis was used. Data for this study were collected and analysed between 2003 and 2004. Further data, collected in a previous study in 2000, were theoretically s led and analysed in 2005. In-depth interviews with 37 women from various socio-demographic areas in New South Wales, Australia provided data. The core category was 'deconstructing best'. 'Deconstructing best' was the infant feeding decision-making process in the first 6 weeks after birth. The process of 'deconstructing best' involved seven phases: planning, expecting, realizing, questioning, getting on with it, defending and qualifying. Four main categories -'it's really best to breastfeed', 'it's the unknown', 'it's not the only thing going on', and 'everybody's best is different'- comprised the context within which deconstructing best occurred. Woman's infant feeding decisions cannot be viewed in isolation from other post-natal experiences and needs. Infant feeding decisions will only be understood and appropriately supported when they are seen in relation to the circumstances of a woman's life, her immediate sociocultural context and in idual experience.

Women's experiences of infant feeding support in the first 6 weeks post‐birth

Publisher: Wiley

Date: 10-03-2009

DOI: 10.1111/J.1740-8709.2008.00163.X

'When I was transgender'

Publisher: Edinburgh University Library

Date: 06-11-2020

DOI: 10.17157/MAT.4.2.399

Abstract: This think piece reflects on the ways in which the category ‘transgender’ is used by waria – Indonesia’s ‘national transvestite’ (Boellstorff 2007) – based on ethnographic data collected from informants aged forty years or older in Yogyakarta and Jakarta. I was struck by how this group used the category ‘transgender’ with reference to a particular time in life that stretched from mid-teens to late twenties, a period marked by national and transnational migration for intensive sex work and other labor. Their use of ‘transgender’ to describe certain times of their lives but not others validates scholarly calls to question the privileging of gender and sexuality in analyses of subjectivity. It also troubles the basis of Western assumptions about aging and its relationship to the self, which presumes an experience of time as an orderly chronological progression. Finally, their use of ‘transgender’ demands closer attention to why the use of categories of gender and sexuality might shift across the life course. My informants’ narratives invite us to consider how people in different locations draw upon globalized categories to make meaning. Greater ethnographic attention towards how categories are drawn upon to produce and reflect subjectivity in erse ways may produce a reflexive understanding of the relationship between categories and the context of entrenched structural inequalities in which they are used.

'Reacting to the unknown': Experiencing the first birth at home or in hospital in Australia

Publisher: Elsevier BV

Date: 08-2010

DOI: 10.1016/J.MIDW.2008.07.009

Abstract: to explore the experiences of a small group of first-time mothers giving birth at home or in hospital. a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Sydney, Australia. 19 women were interviewed. Seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were interviewed, and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. these women shared common experiences of giving birth as 'novices'. Regardless of birth setting, they were all 'reacting to the unknown'. As they entered labour, the women chose different levels of responsibility for their birth. They also readjusted their expectations when the reality of labour occurred, reacted to the 'force' of labour, and connected or disconnected from the labour and eventually the baby. knowing that first-time mothers, irrespective of birth setting, are essentially 'reacting to the unknown' as they negotiate the experience of birth, could alter the way in which care is provided and increase the sensitivity of midwives to women's needs. Most importantly, midwives need to be aware of the need to help women adjust their expectations during labour and birth. Identifying the 'novice' status of first-time mothers also better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing.

Service providers’ perspectives, attitudes and beliefs on health services delivery for Aboriginal people receiving haemodialysis in rural Australia: a qualitative study

Publisher: BMJ

Date: 10-2013

DOI: 10.1136/BMJOPEN-2013-003581

Barriers to increasing hospital birth rates in rural Shanxi Province, China

Publisher: Informa UK Limited

Date: 2010

DOI: 10.1016/S0968-8080(10)36523-2

Erratum

Publisher: Oxford University Press (OUP)

Date: 06-03-2018

DOI: 10.1093/CDJ/BSY004

Frequent hospital admission of older people with chronic disease: a cross-sectional survey with telephone follow-up and data linkage

Publisher: Springer Science and Business Media LLC

Date: 30-10-2012

DOI: 10.1186/1472-6963-12-373

PRIME: impact of previous mental health problems on health-related quality of life in women with childbirth trauma

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.

Australian primary maternity units: Past, present and future

Publisher: Elsevier BV

Date: 09-2013

DOI: 10.1016/J.WOMBI.2013.06.001

Abstract: Primary maternity units are commonly those run by midwives who provide care to women with low-risk pregnancies with no obstetric, anaesthetic, laboratory or paediatric support available on-site. In some other countries, primary level maternity units play an important role in offering equitable and accessible maternity care to women with low-risk pregnancies, particularly in rural and remote areas. However there are very few primary maternity units in Australia, largely due to the fact that over the past 200 years, the concept of safety has become inherently linked with the immediate on-site availability of specialist medical support. The purpose if this paper is to explore the various drivers and barriers to the sustainability of primary maternity units in Australia. It firstly looks at the historical antecedents that shaped primary level maternity services in Australia, from the time of colonisation to now. During this period the space and management of childbirth moved from home and midwifery-led settings to obstetric-led hospitals. Following on from this an analysis of recent political events shows how Australian government policy both supports and undermines the potential of primary maternity units. It is important that researchers, clinicians and policy makers understand the past in order to manage the challenges facing the development and maintenance of midwifery-led maternity services, in particular primary maternity units, in Australia today.

Rural and remote health research: Does the investment match the need?

Publisher: Wiley

Date: 04-2018

DOI: 10.1111/AJR.12429

Challenges to maternal health care utilization among ethnic minority women in a resource-poor region of Sichuan Province, China.

Publisher: Oxford University Press (OUP)

Date: 25-01-2010

DOI: 10.1093/HEAPOL/CZP062

Abstract: We present a simple descriptive study of maternal health care utilization among ethnic minority women in a remote region of China. Factors that affect women obtaining care and their decision-making are explored. Results show that utilization of maternal health care services is associated with a range of social, economic, cultural and geographic factors as well as the policies of the state and the delivery of services. Utilization is not necessarily increased through easy access to a health facility. We identify potential for improving utilization through developing the role of village-based health care workers, expanding mobile antenatal care clinics and changing the way township hospital services are provided and funded. This would include modifications to rural health insurance schemes. Several of these changes are achievable at the township or county level. The findings of this study provide insights that can be used by local health providers, planners and decision-makers to improve the provision of maternal health care services to ethnic minority women.

Midwifery in Australia and surrounding reions: Dilemmas, debates and Development

Publisher: Informa UK Limited

Date: 1998

DOI: 10.1016/S0968-8080(98)90110-0

Defining social support in context: A necessary step in improving research, intervention, and practice

Publisher: SAGE Publications

Date: 09-2004

DOI: 10.1177/1049732304266997

Abstract: A substantial body of work on the concept of social support has resulted in many definitions, but none have been accepted as definitive. The lack of consensus about the definition of social support has resulted in a lack of consistency and comparability among studies. More important, the validity of any study attempting to measure or influence social support is undermined by the use of generic definitions, which lack contextual sensitivity. In this article concept analysis is used to evaluate definitions of social support to ascertain their utility for research. The authors argue that a contextualized approach to the definition of social support is necessary to improve clarity in research, and results in interventions or practices that are useful. They also assert that the development of a contextualized definition of social support requires qualitative methods to explore the meaning of social support with groups of people for whom intervention research is ultimately intended.

How is the midwife's training and practice defined in policies and regulations in Australia today?

Publisher: Elsevier BV

Date: 1985

DOI: 10.1016/0168-8510(85)90026-0

Abstract: This paper describes the current definitions of a midwife found in Australian State policies and regulations. It examines these for internal consistency and external comparability. It also discusses the links between nursing and midwifery in Australia and their influence on the midwife's practice. The basis on which midwifery training programmes are established is examined, particularly in the light of characteristics and career plans of midwifery students and the questionable cost-effectiveness of current training. The assumption that nursing leadership is necessarily satisfactory, fitting or appropriate for midwifery is challenged.

Implementation of a new birth record in three hospitals in Jordan: a study of health system improvement

Publisher: Oxford University Press (OUP)

Date: 13-11-2007

DOI: 10.1093/HEAPOL/CZM039

Abstract: This study tested the introduction of a new integrated clinical record in Jordan where currently no clinical report links antenatal, birth and postnatal care for women. As a result, no continuity of information is provided to clinicians nor are there national statistics on trends, or performance of hospitals around birth. Our study was conducted in the Jordanian Ministry of Health, the maternity wards and registration departments of three hospitals in Jordan and in the Maternal and Child Health Centres located near these hospitals. We used an exploratory, descriptive design and practice-research engagement to investigate and report on the process of change to improve and implement the new birth record. Through engaging practitioners in research, care improved, the quality of reporting changed, managers developed more effective measures of hospital performance and policy makers were provided with information that could form the basis of a national maternity data monitoring system. Quantitative and qualitative audit data demonstrated improved clinical reporting, organizational development and sustained commitment to the new record from clinicians, managers and policy leaders.

The effect of a postnatal education and support program on breastfeeding among primiparous women: A randomized controlled trial

Publisher: Elsevier BV

Date: 09-2011

DOI: 10.1016/J.IJNURSTU.2011.02.001

Abstract: Women's traditional way of breastfeeding has altered in Jordan with rates declining in recent years. The objectives of this study were to test whether the introduction of an educational program supporting breastfeeding would increase the proportion of women who breastfed fully to six months, improve the women's level of breastfeeding knowledge, and decrease the proportion of infants admitted to hospitals due to gastrointestinal illnesses. A randomized controlled trial was conducted in 90 primiparous women who had given birth to a healthy, full term, singleton baby at two hospitals in the southern region of Jordan. Women were randomly allocated to either the intervention group (n=45), in which they were offered a one-to-one postnatal educational session and follow-up phone calls at two months and four months postpartum, or the control group (n=45), in which they received routine postnatal care. The primary outcomes were the proportion of women fully breastfeeding their babies at six months and the women's level of breastfeeding knowledge at six months postpartum. The postnatal education and support program significantly improved breastfeeding knowledge measured by differences between mean pre- and post-test scores. This was statistically significant for the intervention group (p 0.05). Although the postnatal education and support program improved breastfeeding knowledge among women in the study, this increase in knowledge did not translate to an increase in the duration of full breastfeeding to six months.

Evidence: making an impact

Publisher: Ovid Technologies (Wolters Kluwer Health)

Date: 03-2012

DOI: 10.1111/J.1744-1609.2012.00258.X

Woman and midwives: position, problems and potential

Publisher: Elsevier BV

Date: 03-2008

DOI: 10.1016/J.MIDW.2006.07.003

Abstract: to describe and analyse birthing models in a number of countries, particularly Samoa and China, that have been the focus of my recent research to discuss how cultural frameworks, colonisation and ideas of what is 'modern' influence the nature, place of birth and its attendant. midwives need to reflect on their practice and consider broader health policy and how it affects health systems. They also need to understand the social, economic, historical and cultural context of practice, including the influence of gender inequality and attitudes to women and themselves as midwives.

The experiences of new fatherhood: A socio-cultural analysis

Publisher: Wiley

Date: 04-1999

DOI: 10.1046/J.1365-2648.1999.00978.X

Abstract: For most men, first-time fatherhood involves significant changes in self-identity and their relationship with their female partner. This paper presents some findings from a longitudinal, qualitative study into the first 6 months of new fatherhood for a group of 15 Australian men. The discussion draws on a series of semistructured interviews undertaken on a minimum of four occasions from a few days before the child was born until 5-6 months after birth. We found that first-time fathering in contemporary western society requires men to be simultaneously provider, guide, household help and nurturer. The demands of these roles, and the tensions they sometimes produce, challenge men's relationships with their female partners, the meaning and place of work in their lives and their sense of self as competent adults. Almost all the men we interviewed found the early weeks and months of fatherhood more uncomfortable than rewarding, despite looking forward to fatherhood very positively. Their experience appeared more closely aligned to their difficulties with meeting social expectations and roles rather than in idual deficits.

Community based service providers' perspectives on frequent and/or avoidable admission of older people with chronic disease in rural NSW: a qualitative study

Publisher: Springer Science and Business Media LLC

Date: 12-10-2011

DOI: 10.1186/1472-6963-11-265

Integrating treatment for mental and physical disorders and substance misuse in Indigenous primary care settings

Publisher: SAGE Publications

Date: 07-2011

DOI: 10.3109/10398562.2011.583070

Abstract: Objective: Australian Indigenous peoples in remote and rural settings continue to have limited access to treatment for mental illness. Comorbid disorders complicate presentations in primary care where Indigenous youths and perinatal women are at particular risk. Despite this high comorbidity there are few ex les of successful models of integrated treatment. This paper outlines these challenges and provides recommendations for practice that derive from recent developments in the Northern Territory. Conclusions: There is a strong need to develop evidence for the effectiveness of integrated and culturally informed in idual and service level interventions. We describe the Best practice in Early intervention Assessment and Treatment of depression and substance misuse study which seeks to address this need.

Australian midwifery training & practice

Publisher: Elsevier BV

Date: 06-1985

DOI: 10.1016/S0266-6138(85)80003-6

Securing a rural health workforce for the next generation of rural Australians

Publisher: AMPCo

Date: 05-2015

DOI: 10.5694/MJA15.00449

'Beats the alternative but it messes up your life': Aboriginal people's experience of haemodialysis in rural Australia

Publisher: BMJ

Date: 17-09-2014

DOI: 10.1136/BMJOPEN-2014-005945

Pragmatic indicators for remote Aboriginal maternal and infant health care: why it matters and where to start

Publisher: Elsevier BV

Date: 07-2010

DOI: 10.1111/J.1753-6405.2010.00545.X

Abstract: There are challenges in delivering maternal and infant health (MIH) care to remote Northern Territory (NT) communities. These include fragmented care with birthing in regional hospitals resulting in cultural and geographical dislocation for Aboriginal women. Many NT initiatives are aimed at improving care. Indicators for evaluating these for remote Aboriginal mothers and infants need to be clearer. We reviewed existing indicators to inform a set of pragmatic indicators for reporting improvement in remote MIH care. Scientific databases and grey literature (organisational websites and Google Scholar) were searched using the terms 'Aboriginal/maternal/infant/remote health/monitoring performance'. Key stakeholders identified omitted indicators sets. Relevant sets were reviewed and organised by indicator type, stage of patient journey, topic and theme. Forty-two indicators sets were found. Seven focused on Aboriginal health, 23 on reproductive/maternal health, eight on child/infant health and four on other aspects, e.g. remote health. We identified more than 1,000 in idual indicators. Of these, 656 were relevant for our purpose and were subsequently organised into 300 topics and 16 themes for antenatal, birth and postpartum, and infant care by indicator type. There are many measures for monitoring health care delivery to mothers and infants. Few are framed around remote MIH services, despite poorer health outcomes of remote mothers and infants and the specific challenges with providing care in this setting. Establishing relevant indicators is vital to support relevant data collection and the development of appropriate policy for remote Aboriginal maternal and infant care.

The tyranny of distance: Maternity waiting homes and access to birthing facilities in rural Timor-Leste

Publisher: WHO Press

Date: 02-11-2012

DOI: 10.2471/BLT.11.088955

From hospital to home: The quality and safety of a postnatal discharge system used for remote dwelling Aboriginal mothers and infants in the top end of Australia

Publisher: Elsevier BV

Date: 06-2012

DOI: 10.1016/J.MIDW.2011.04.010

Abstract: to examine the transition of care in the postnatal period from a regional hospital to a remote health service and describe the quality and safety implications for remote dwelling Aboriginal mothers and infants. a retrospective cohort study of maternal health service utilisation and birth outcomes, key informant interviews with health service providers and participant observation in a hospital and two remote health centres. Data were analysed using descriptive statistics and content analysis. a maternity unit in a regional public hospital and two remote health centres within large Aboriginal communities in the Top End of the Northern Territory, Australia. poor discharge documentation, communication and co-ordination between hospital and remote health centre staff occurred. In addition, the lack of clinical governance and a specific position holding responsibility for the postnatal discharge planning process in the hospital system were identified as serious risks to the safety of the mother and infant. the quality and safety of discharge practices for remote dwelling mothers and their infants in the transition from hospital to their remote health service following birth need to be improved. The discharge process and service delivery model must be restructured to reduce the adverse effects of poor standards of care on mothers and infants.

Emeritus Professor Sydney University

Location: Australia

View Organisation

Research Networks - Grant ID: RN0460314

Start Date: 12-2004

End Date: 12-2010

Amount: $1,750,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP100100693

Start Date: 08-2010

End Date: 02-2014

Amount: $240,000.00

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

Special Research Initiatives - Grant ID: SR0354508

Start Date: 02-2004

End Date: 03-2005

Amount: $10,000.00

Funder: Australian Research Council

Special Research Initiatives - Grant ID: SR0354698

Start Date: 2004

End Date: 11-2004

Amount: $40,000.00

Funder: Australian Research Council