ORCID Profile
0000-0003-0626-3365
Current Organisations
University of California Davis
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The University of Newcastle
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Publisher: Elsevier BV
Date: 10-2018
Publisher: Elsevier BV
Date: 03-2023
Publisher: Public Library of Science (PLoS)
Date: 23-02-2021
Publisher: Elsevier BV
Date: 08-2023
Publisher: Elsevier BV
Date: 06-2018
Publisher: Elsevier BV
Date: 09-2019
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.NEPR.2017.12.002
Abstract: An innovative blended learning resource for undergraduate nursing and midwifery students was developed in a large urban Australian university, following a number of concerning reports by students on their experiences of bullying and aggression in clinical settings. The blended learning resource included interactive online learning modules, comprising film clips of realistic clinical scenarios, related readings, and reflective questions, followed by in-class role-play practice of effective responses to bullying and aggression. On completion of the blended learning resource 210 participants completed an anonymous survey (65.2% response rate). Qualitative data was collected and a thematic analysis of the participants' responses revealed the following themes: 'Engaging with the blended learning resource' 'Responding to bullying' and 'Responding to aggression'. We assert that developing nursing and midwifery students' capacity to effectively respond to aggression and bullying, using a self-paced blended learning resource, provides a solution to managing some of the demands of the clinical setting. The blended learning resource, whereby nursing and midwifery students were introduced to realistic portrayals of bullying and aggression in clinical settings, developed their repertoire of effective responding and coping skills for use in their professional practice.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Wiley
Date: 10-12-2020
DOI: 10.1111/JEP.13335
Abstract: The psychological and emotional impact of a traumatic birth experience on clinicians is well-established. It is also known that emotions can generally influence decisions. However, it is not clear whether experiencing a birth trauma can affect the professional behaviour and decision-making of clinicians. This study explores the impact of birth trauma on clinical decision-making of midwives. Four databases (Medline, Scopus, CINAHL and ProQuest) were searched to identify English language studies published from 1990 to 2018. Due to the lack of studies with specific focus on clinical decision-making after birth trauma, we defined two main domains for our literature search. To be included, studies had to focus on either traumatic birth experience or clinical decision-making in midwifery. The findings of the two domains were then integrated. Of a total 2104 studies identified, 70 received full-text screening with 40 included in the review. Twenty-two articles were about traumatic birth events and 18 examined decision-making in midwifery. Information were extracted on each article's purpose, study design, data collection, participants, definitions of birth trauma and the context in which clinical decisions were made. Thematic analysis was conducted. The impact of birth trauma on midwives could be categorized into the following themes: psychological issues professional concerns changes in practice and positive impact. Review of literature indicated that clinical decision-making could be influenced through all these themes. Decision-making can be impacted by the midwife's affective state related to previous experience of birth trauma. The continuum of impact may vary from increased defensiveness to increased personal and professional growth. Being aware of this impact can help midwives to better manage their emotions while making decision after traumatic birth experiences.
Publisher: Elsevier BV
Date: 03-2016
DOI: 10.1016/J.NEPR.2015.12.003
Abstract: Simulated teaching methods enable a safe learning environment that are structured, constructive and reflective. We prepared a 2-day simulation project to help prepare students for their first clinical practice. A quasi-experimental pre-test - post-test design was conducted. Qualitative data from the open-ended survey questions were analysed using content analysis. Confidence intervals and p-values were calculated to demonstrate the changes in participants' levels of understanding/ability or confidence in clinical midwifery skills included in the simulation. 71 midwifery students participated. Students rated their understanding, confidence, and abilities as higher after the simulation workshop, and higher still after their clinical experience. There were five main themes arising from the qualitative data: having a learning experience, building confidence, identifying learning needs, developing communication skills and putting skills into practise. First year midwifery students felt well prepared for the clinical workplace following the simulation workshops. Self-rated understanding, confidence and abilities in clinical midwifery skills were significantly higher following consolidation during clinical placement. Longitudinal studies on the relationship between simulation activities and student's overall clinical experience, their intentions to remain in midwifery, and facility feedback, would be desirable.
Publisher: Elsevier BV
Date: 10-2013
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 09-2022
Publisher: Elsevier BV
Date: 10-2013
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.WOMBI.2019.03.013
Abstract: Midwifery-led continuity of care has well documented evidence of benefits for mothers and babies, however uptake of these models by Australian maternity services has been slow. It is estimated that only 10% of women have access to midwifery-led continuity of care in Australia. The Quality Maternal Newborn Care (QMNC) Framework has been developed as a way to implement and upscale health systems that meet the needs of childbearing women and their infants. The Framework can be used to explore the qualities of existing maternity services. We aimed to use the QMNC Framework to explore the qualities of midwifery-led continuity of care in two distinct settings in Australia with recommendations for replication of the model in similar settings. Data were collected from services users and service providers via focus groups. Thematic analysis was used to develop initial findings that were then mapped back to the QMNC Framework. Good quality care was facilitated by Fostering connection, Providing flexibility for women and midwives and Having a sense of choice and control. Barriers to the provision of quality care were: Contested care and Needing more preparation for unexpected outcomes. Midwifery-led continuity of carer models shift the power dynamic from a hierarchical one, to one of equality between women and midwives facilitating informed decision making. There are ongoing issues with collaboration between general practice, obstetrics and midwifery. Organisations have a responsibility to address the challenges of contested care and to prepare women for all possible outcomes to ensure women experience the best quality care as described in the framework. The QMNC Framework is a useful tool for exploring the facilitators and barriers to the widespread provision of midwifery-led continuity of care.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Cambridge Media
Date: 06-2022
Publisher: Elsevier BV
Date: 09-2019
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.EJOGRB.2018.08.016
Abstract: Shoulder dystocia (SD) is an obstetric emergency which if not carefully diagnosed and managed, can contribute to lifelong neonatal morbidities. Despite current guidelines on the definition of SD (impaction of the fetal shoulder behind the maternal symphysis pubis and need for ancillary manoeuvres or head-body delivery interval (HBDI) >60 s) its accurate diagnosis requires clinical expertise as well as overall consideration of feto-maternal condition. Based on the literature available, our study aims to determine (1) the range of HBDI as an indicator of SD and (2) the neonatal complications occurring following prolonged HBDI in normal or SD-complicated births. A comprehensive literature search will be conducted in the following databases MEDLINE, CINAHL and Scopus (Elsevier) as well as international obstetric guidelines to find English language published data since 1970 that evaluate HBDI, prolonged HBDI and associated neonatal outcomes. Retrospective rospective observational studies and randomized controlled trials will be recruited. As heterogeneity in definitions of SD among studies is expected, we will categorize our results according to the following two definitions: 1-Bony obstruction of fetal shoulder behind the maternal symphysis pubis or less commonly, posterior shoulder on sacral promontory and need for ancillary manoeuvres or 2- Head-body delivery interval (HBDI)> 60 s). Two reviewers will independently identify eligible studies, assess risk of bias and extract data based on predefined checklists. Outcomes of interest will be the HBDI in normal and SD-complicated births and associated neonatal consequences. Findings of this systematic review will provide reliable information regarding (1) the interval between birth of the head and birth of the shoulders and (2) neonatal outcomes attributed to either true SD or prolonged HBDI. Our findings will add to the knowledge of whether prolonged HBDI is an appropriate definition for SD and whether/what level of prolongation of HBDI results in adverse neonatal outcomes. This increased understanding will better inform the clinical practice of midwives and obstetricians.
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.WOMBI.2014.06.009
Abstract: Many Bachelor of Midwifery students have not had any exposure to the hospital setting prior to their clinical placement. Students have reported their placements are foreign to them, with a specialised confusing 'language'. It is important to provide support to students to prevent culture shock that may lead to them leaving the course. To assist first year midwifery students with the transition into clinical practice by providing a preparatory workshop. An action research project developed resources for a workshop held prior to students' first clinical placement. Four phases were held: Phase one involved holding discussion groups with students returning from clinical practice Phase two was the creation of vodcasts Phase three was integration of resources into the clinical subject and phase four was the evaluation and reflection on the action research project. Evaluations of the workshops were undertaken through surveying the students after they returned from their clinical placement. A descriptive analysis of the evaluations was performed. Students rated the workshop, vodcasts and the simulated handover positively. Further recommendations were that complications of labour and birth be included in their first semester as students were unexpectedly exposed to this in their first clinical placement. The students evaluated the workshop positively in reducing the amount of culture shock experienced on the first clinical placement. In addition the students provided further recommendations of strategies that would assist with clinical placement.
Publisher: Elsevier BV
Date: 04-2023
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.VACCINE.2019.10.006
Abstract: Despite the enormous benefits of childhood and maternal immunisation to in idual and population health, the uptake of maternal vaccines during pregnancy remains suboptimal. Midwives are a trusted information source for parents and play an important role in the provision of immunisation information. Understanding midwives' attitudes and vaccine knowledge, along with their confidence to discuss maternal and childhood immunisation with parents, is key to reducing parental decisional conflict and achieving immunisation goals. An online study was conducted to investigate midwives' knowledge and attitudes towards maternal and childhood vaccination along with their confidence to answer parents' vaccine-related questions. Midwives were recruited by email via the midwifery peek body, the Australian College of Midwives. A total of 359 midwives completed the online survey. The majority of midwives supported maternal (influenza 83%, pertussis 90.5%) and childhood immunisation (85.8%) however, 69.4% of respondents wanted further training about immunisation. Midwives who felt their midwifery education adequately covered immunisation were more confident advising parents about maternal (p = 0.007) and childhood immunisation (p < 0.001). Similarly, Midwives were significantly more likely to confidently advise parents about maternal (p < 0.001) and childhood immunisations (p < 0.001) if they had completed a specific immunisation training course outside of their midwifery course. Most midwives working in Australia support vaccination. However, access to contemporary, culturally appropriate education that enables midwives to engage confidently with parents about immunisation is lacking. Education based on a women-centred approach within the pre-registration curriculum along with continuing professional development programs could enable midwives to reduce the evidence to practice gap by increasing vaccine uptake.
Publisher: Informa UK Limited
Date: 03-07-2020
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.NEPR.2022.103329
Abstract: The aim of this discussion paper is to discuss learning theories in midwifery education, as related to the Midwifery Continuity of Care Experience and to propose an original conceptual framework based on Heutagogy. Midwifery education curricula include a number of midwifery practice experiences. One of the requirements is for students to provide Midwifery Continuity of Care. To achieve these experiences, students in Australia are required to provide care to at least ten (10) women through pregnancy, be on call for the woman's birth and provide at least two visits post-birth. Continuity of care experiences appear to have been incorporated without sufficient consideration of the educational purpose of the experience, or how the experiences contribute to the development of the profession. Although we do know midwifery practice embraces woman-centred care as its philosophical underpinning, a learning approach that is congruent with this philosophy needs to be clearly articulated. A discussion paper that compared and contrasted learning theories to align with Midwifery Continuity of Care experiences. A review of the literature on learning theories was conducted before comparing and contrasting the theories to arrive at a conceptual framework focused on learning theory and its application to the Midwifery Continuity of Care Experience. Heutagogy provides a potentially congruent educational learning approach to underpin the continuity of care experiences, in comparison to traditional learning theories of pedagogy and andragogy. With a paucity of research in the application of heutagogy to midwifery education, it's conceptual underpinnings and the possible application to the Continuity of Care Experience, this paper explores the possible theoretical applications of heutagogy to midwifery education. As a learning theory, heutagogy is well - aligned with woman-centred care. Heutagogy provides a theoretical framework suitable to underpin strategies, including the conceptual framework proposed, that may assist in empowering students to participate in their own education by giving them the ability to be self-determined in both their approach to learning and to evaluate their own learning needs.
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.WOMBI.2019.02.006
Abstract: Inactivated influenza vaccine and diphtheria-tetanus acellular pertussis vaccine are routinely recommended during pregnancy to protect women and their babies from infection. Additionally, the hepatitis B vaccine is recommended for infants within the first week of life however, little is known about midwives' experiences of recommending and delivering these immunisations. Midwives are a trusted source of vaccine information for parents and the confident provision of information about immunisation during antenatal clinic visits has been found to increase the uptake of antenatal and childhood vaccines. This study aims to explore midwives' experiences of discussing maternal and childhood immunisation with women and their partners and their confidence in answering parent's questions. We conducted 23 semi-structured interviews with registered Australian midwives working in public and private hospital settings, and in private practice. Midwives find negotiating the requirement to recommend immunisation within a women-centred framework challenging at times. The vast majority of midwives described their education on immunisation as inadequate and workplace issues, such as time pressure, were identified as further barriers to effective communication about immunisation. The provision of immunisation training within midwifery education and continued professional development is critical. Appropriately resourcing midwives with the necessary infrastructure, education and resources to fully inform parents about immunisation may have a positive impact on vaccine uptake.
Publisher: Elsevier BV
Date: 02-2023
DOI: 10.1016/J.WOMBI.2022.03.006
Abstract: Strong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings. To develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings. A Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants. Three concepts of theory emerged: 'engaging the gatekeepers', 'midwives lacking confidence' and 'women rallying together'. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models. The findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives' reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers. Implementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.NEPR.2016.01.003
Abstract: The aim of this paper was to explore the mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia. Most new graduates find employment in hospitals and undertake a new graduate program rotating through different wards. A limited number of new graduate midwives were found to be working in midwifery continuity of care. The new graduate midwives in this study were mentored by more experienced midwives. Mentoring in midwifery has been described as being concerned with confidence building based through a personal relationship. A qualitative descriptive study was undertaken and the data were analysed using continuity of care as a framework. We found having a mentor was important, knowing the mentor made it easier for the new graduate to call their mentor at any time. The new graduate midwives had respect for their mentors and the support helped build their confidence in transitioning from student to midwife. With the expansion of midwifery continuity of care models in Australia mentoring should be provided for transition midwives working in this way.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.WOMBI.2021.07.001
Abstract: Aspects of the midwifery workplace culture have previously been measured as negative with limited leadership or support. Support for midwives is essential for them to face the complexity and workloads in Australian maternity units. Understanding the culture of the midwifery workplace is important to develop strategies to stem workforce attrition and to optimise care of women and their families. This study aimed to assess midwives' perceptions of workplace culture in two maternity units in Sydney, Australia, and compare the results with a national study using the same validated instrument. This study reports results using the Australian Midwifery Workplace Culture instrument (n = 49 midwives) and stakeholder groups (n = 10). Simple descriptive statistics were used, and the qualitative responses were analysed thematically. Compared to the national s le, participants rated their workplace more favourably, especially their relationships with managers and colleagues. Over one-third (36.7%) considered that their workplace had a positive culture, compared with 27.9%. However, they rated their workplaces more negatively on time constraints and staff resources, and reported limited autonomy. Workplaces were highly medicalised which impacted their philosophy of woman-centred care and their ability to work autonomously. Factors related to collegiality in the workplace, relationship with managers, midwives' intention to leave the profession and time constraints are discussed in comparison to the national study, as well as other relevant research. Conclusion Workplace collaboration, support, respect and understanding were extremely important to midwives, as were adequate staffing levels, teamwork and opportunities for further education.
Publisher: Elsevier BV
Date: 03-2021
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-055660
Abstract: Gestational weight gain (GWG) is an important indicator of fetal well-being during pregnancy. Inadequate or excessive GWG could have undesirable effects on birth weight. However, information regarding the influence of GWG on birth weight is lacking from the Ethiopian setting. This study aimed to determine the influence of GWG and other maternal-related factors on birth weight in Addis Ababa, Ethiopia. A cohort of pregnant women who received the first antenatal care before or at 16 weeks of gestation in health centres in Addis Ababa were followed from 10 January 2019 to 25 September 2019. Data were collected using a structured questionnaire and medical record reviews. We conducted a multivariable linear regression analysis to determine the independent effect of gestational weight on birth weight. Of the 395 women enrolled in the study, the participants’ pregnancy outcome was available for 329 (83.3%). The mean birth weight was 3130 (SD, 509) g. The proportion of low birth weight ( g) was 7.5% (95% CI 4.8% to 11.0%). Babies born to underweight women were 150.9 g (95% CI 5.8 to 308.6 g, p=0.049) lighter than babies born to normal-weight women. Similarly, babies whose mothers gained inadequate weight were 248 g (95% CI 112.8 to 383.6 g, p .001) lighter than those who gained adequate weight. Moreover, babies whose mothers had a previous history of abortion or miscarriages or developed gestational hypertension in the current pregnancy were 147.2 g (95% CI 3.2 to 291.3 g, p=0.045) and 310.7 g (95% CI 62.7 to 552.8 g, p=0.012) lighter, respectively, compared with those whose mothers had not. Prepregnancy weight, GWG, having had a previous history of abortion or miscarriages, and developing gestational hypertension during a current pregnancy were independently associated with birth weight. Pregnancy-related weight management should be actively promoted through intensive counseling during routine antenatal care contacts.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.MIDW.2019.03.001
Abstract: The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care and emphasises relational and continuity elements. Continuity of care is increasingly a focus of maternity care policy in the United Kingdom. While some outcomes have been shown to be improved, there is uncertainty about why certain models of care are more effective. Our overall objective is to develop a maternity care evaluation toolkit which incorporates this Framework along with other outcome evaluations. An initial step in developing this toolkit was to use the adapted Framework to evaluate perceptions and experiences of maternity care. Our specific objective in this study was to test this adapted Framework in a series of focus groups with key stakeholders, and to compare findings between different groups. Findings related to service users (pregnant women and new mothers) are reported in our accompanying paper this paper presents findings from focus groups with service providers (midwives and obstetricians), and then compares user and provider perspectives. A qualitative comparative enquiry involving three focus groups with 26 midwives (eight newly qualified eight working in a community midwifery unit and ten senior tertiary-based) and two focus groups with twelve obstetricians of all grades. We used a six-phase thematic analysis to derive then compare the focus groups' principal sub-themes we then mapped these to the original Quality Maternal and Newborn Care Framework and compared these service providers' responses with those from the pregnant women and new mothers. Two health boards in Scotland. Midwives and obstetricians who had experience of various models of maternity care. There were significant areas of overlap in their perceptions of providing maternity care. All groups reported 'limited resources and time' the community midwifery unit and senior midwives and one group of obstetricians provided a critique of the system. Achieving tailored care was acknowledged as a problem by the senior midwives and one group of obstetricians. Only obstetricians discussed strategies for improvement. The newly qualified midwives were most positive in their responses. There was both overlap and contrast when comparing the views of service users and providers. We found most agreement when participants discussed some of the Framework's characteristics of care in negative terms, such as (in) accessible care, (lack of) adequate resources, and (absence of) tailored care. Being able firstly to map the participants' responses to the Quality Maternal and Newborn Care Framework, and then to identify strengths and gaps in the provision of quality maternity care, suggests to us that the Framework, derived as it is from a comprehensive analysis of the global evidence on quality care, can indeed be used to inform an evaluation toolkit. While aware that we cannot generalise from this limited qualitative study, we are currently undertaking similar work in other countries by which we hope to confirm our findings and further develop the toolkit.
Publisher: Elsevier BV
Date: 10-2017
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 09-2022
Publisher: Elsevier BV
Date: 02-2023
Publisher: Public Library of Science (PLoS)
Date: 23-04-2020
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.MIDW.2019.03.002
Abstract: There is evidence that continuity of care - increasingly a focus of maternity care policy in the UK - contributes to improved outcomes. However, uncertainty remains about which models of care are most effective in which circumstances, and why this is. A plausible explanation is grounded in the idea that the continuity elements of care contribute to and reinforce best quality care. The Quality Maternal and Newborn Care Framework describes the components and characteristics of quality care. As a first step in developing a maternity care evaluation toolkit, we adapted this Framework to see if it could be used to evaluate perceptions and experiences of different models of care. A qualitative comparative enquiry using focus groups. From a six-phase thematic analysis, we first derived then compared the principal sub-themes from the focus groups and mapped these to the original Framework. Two health boards in Scotland. Pregnant women, new mothers, midwives and obstetricians who had experience of various models of maternity care. This paper reports findings from the pregnant women and new mothers. These are presented in two parts: the seven focus groups with pregnant women and new mothers are reported in this paper the five focus groups with midwives and obstetricians in our accompanying paper. Those using the maternity services had experience of caseloading midwifery, 'modified universal provision' and 'high risk' models of maternity care. While women from all groups shared certain perspectives, those with experience of caseloading midwifery were consistently positive, reporting positive relationships, tailored care and effective communication. Women experiencing other models of care, especially the modified universal provision model, tended to report more negative relational experiences: lack of information, lack of tailored care, and anxiety and confusion. Timing of the focus group (i.e. during pregnancy or after the birth) appeared to make little difference to responses. Mapping responses to the Framework's characteristics of care was straightforward mapping also showed how the Framework's components of care are interlinked. Our adaptation of the Quality Maternal and Newborn Care Framework as a data collection tool allowed us to compare women with experience of different models of care, and relational factors were identifiable in many responses. Positive responses were found in all models but were most emphasised in the caseloading midwifery model, suggesting that the experience of caseloading continuity and its relational elements is highly valued. While further work is required to identify if this can be linked to improved clinical outcomes, we have established that the Quality Maternal and Newborn Care Framework can be adapted as an exploratory tool for assessing perceptions and experiences of maternity care.
Publisher: Hindawi Limited
Date: 29-02-2016
DOI: 10.1111/JONM.12364
Abstract: This study explores the views of midwifery managers and key stakeholders, regarding the facilitators and barriers to employing new graduate midwives in midwifery continuity of care models. Maternity services in Australia are shifting towards midwifery continuity of care models, where midwives work in small group practices, requiring a change to the management of staff. Public policy in Australia supports maternity services to be reconfigured in this way. Historically, experienced midwives work in these models, as demand grows new graduates are employed to staff the models. A qualitative descriptive approach exploring the manager's experience of employing new graduate's in the models. Managers, clinical educators and hospital midwifery consultants (n = 15) were recruited by purposeful s ling. Drivers, enablers, facilitators and barriers to employing new graduates in the models were identified. Visionary leadership enabled the managers to employ new graduates in the models through initial and ongoing support. Managing the myths stemming from fear of employing new graduates to work in midwifery continuity of care models was challenging. Managers and other key stakeholders provide initial and ongoing support through orientation and providing a reduced workload. Visionary leadership can be seen as critical to supporting new graduates into midwifery continuity of care models. The challenges for management to overcome include managing the myths stemming from fear of employing new graduates to work in a flexible way around the needs of the women within an organisation culture.
Publisher: Elsevier BV
Date: 05-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2022
Publisher: Wiley
Date: 05-12-2022
DOI: 10.1111/BIRT.12694
Abstract: The Quality Maternal and Newborn Care (QMNC) Framework describes the care that childbearing women and newborn infants need in all settings. It comprises five components and was designed for use in planning, workforce development, and resource allocation, aimed at improving the quality and cost effectiveness of maternal and newborn care globally. The purpose of this paper is to describe the first phase of a project designed to transform the Framework into a quantitative tool for service user assessment of the quality of maternity care. Each component of the original Framework content was developed into a draft service user questionnaire and distributed to an expert panel, drawn from a range of low‐, middle‐, and high‐resource countries. The panel consisted of five Framework authors, nine midwife researchers, six midwives, and five service user (consumer) advocates. Two rounds of discussion and revision were undertaken with the expert panel who commented on the importance, relevance and clarity of questions, and then on their necessity, wording, and order. A third round involved two experts in survey design. Following 24 responses in the first round, the questions were refined and returned to the panel. After incorporating the second‐round comments from 16 experts, the survey was then sent to two experts in questionnaire design and construction. Face validity was affirmed through this consultative process. Despite Covid‐19 pandemic‐related restrictions, this robust iterative consultative process with an international expert panel has resulted in the prototype QMNC Framework index (QMNCFi)—a questionnaire designed for use in erse settings to assess the quality of maternity care. The QMNCFi's psychometric properties are now being tested in an international online survey.
Publisher: Elsevier BV
Date: 2018
Publisher: Elsevier BV
Date: 07-2023
Publisher: Public Library of Science (PLoS)
Date: 17-12-2020
DOI: 10.1371/JOURNAL.PONE.0244221
Abstract: Midwives and obstetricians are key maternity care providers they are the most trusted source of information regarding nutrition and gestational weight gain. However, their views, practices and perceived barriers to managing pregnancy related weight gain have not been studied in Ethiopia. The aim of this study was to explore midwives’ and obstetricians’ observations and perspectives about gestational weight gain and postpartum weight management in Ethiopia. We conducted face-to-face interviews with 11 midwives and 10 obstetricians, from January 2019 to March 2019. All interview data were transcribed verbatim. We analysed the data using thematic analysis with an inductive approach. We identified three themes and associated subthemes. Midwives and obstetricians had limited knowledge of the optimal gestational weight gain. Almost all participants were unaware of the presence of the Institute of Medicine recommendations for optimal weight gain in pregnancy. According to the study participants, women in Ethiopia do not want to gain weight during pregnancy, but do want to gain weight after the birth. Counselling about gestational weight gain and postpartum weight management was not routinely provided for pregnant women. This is mostly because gestational weight gain counselling was not considered to be a priority by maternity care providers in Ethiopia. The limited knowledge of and low attention to pregnancy related weight management by midwives and obstetricians in this setting needs appropriate intervention. Adapting a guideline for pregnancy weight management and integrating it into antenatal care is essential.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.MIDW.2018.02.007
Abstract: first year midwifery students learn early in semester about situations in midwifery where a high level of emotion is expressed, such as taking a sexual history, being faced with the body image changes of pregnancy and working with women in the extreme pain of labour. Commencing students usually have not had exposure to the realities of studying and working in midwifery, and often have an idealised view of midwifery that may lead to attrition from the course. We aimed to equip students with personal and professional tools to discuss sensitive issues in midwifery and promote self-care through the development of two workshops. The first workshop focussed on sensitive issues in midwifery and the second on self-care strategies. quantitative and qualitative data were collected pre and post workshops using a survey. the workshops were developed at one university in New South Wales, Australia. Beginning first year midwifery students MEASUREMENTS: feeling more comfortable, confident and knowledgeable was measured using a paired t-test from the responses on a pre and post workshop survey. Content analysis was performed on the qualitative survey responses. there were significant increases in the students feeling more comfortable to discuss sensitive issues in midwifery following the first workshop. They found meeting new people, respecting opinions, normalizing confronting topics to be valuable and useful. The second workshop found significant differences in being more confident and knowledgeable to access and try new self-care strategies in both their personal and professional life. Students discussed learning to be more mindful in order to prepare for stressful situations. They became aware of their feeling and thoughts when under stress and said they would practice techniques including meditation. the workshops assisted the students to develop peer support, self-care strategies and coping mechanisms when faced with the intimate and sometimes confronting nature of midwifery practice. Through embedding these first year workshops early in the degree we hope to address attrition rates and facilitate the students' to become the compassionate, caring, woman-centred midwives that they envisioned. the workshops have the potential for replication in other universities to support and nurture beginning midwifery students.
Publisher: Elsevier BV
Date: 04-2018
Publisher: Public Library of Science (PLoS)
Date: 14-08-2018
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.WOMBI.2021.03.006
Abstract: Having a known midwife throughout pregnancy, birth and the early parenting period improves outcomes for mothers and babies. In Australia, midwifery continuity of care has been recommended in all states, territories and nationally although uptake has been slow. Several barriers exist to implementing midwifery continuity of care models and some maternity services have responded by introducing modified models of continuity of care. An antenatal and postnatal continuity of care model without intrapartum care is one ex le of a modified model of care that has been introduced by health services. The aim of this study was to explore the value and acceptability of an antenatal and postnatal midwifery program to women, midwives and obstetricians prior to implementation of the model at one hospital in Metropolitan Sydney, Australia. A qualitative descriptive methodology was undertaken to discover the value and acceptability to the implementation of the model. Data was collected via focus groups and one to one interviews from the service users (pregnant women and two partners) and service providers (midwives and obstetricians). We also collected demographic data to demonstrate the ersity of the setting. The Quality Maternal Newborn Care (QMNC) Framework was used to guide the focus groups and analyse the data. Four themes emerged from the data that were named feeling safe and connected, having more quality time and being confident, having a sense of community and respecting cultural ersity. The findings were analysed through the lens of the quality components of the QMNC framework. The final findings demonstrate the value and acceptability of implementing this model of care from women's, midwives and obstetrician's perspective. Providing midwifery continuity of care through the antenatal and postnatal period without intrapartum care, is being implemented in Australia without any research. Using the QMNC framework is a useful way to explore the qualities of a new emerging service and the values and acceptability of this model of care for service providers and service users.
Publisher: Elsevier BV
Date: 10-2013
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.WOMBI.2017.11.007
Abstract: High-level evidence demonstrates midwifery continuity of care is beneficial for women and babies. Women have limited access to midwifery continuity of care models in Australia. One of the factors limiting women's access is recruiting enough midwives to work in continuity. Our research found that newly graduated midwives felt well prepared to work in midwifery led continuity of care models, were well supported to work in the models and the main driver to employing them was a need to staff the models. However limited opportunities exist for new graduate midwives to work in midwifery continuity of care. The aim of this paper therefore is to describe a conceptual model developed to enable new graduate midwives to work in midwifery continuity of care models. The findings from a qualitative study were synthesised with the existing literature to develop a conceptual model that enables new graduate midwives to work in midwifery continuity of care. The model contains the essential elements to enable new graduate midwives to work in midwifery continuity of care models. Each of the essential elements discussed are to assist midwifery managers, educators and new graduates to facilitate the organisational changes required to accommodate new graduates. The conceptual model is useful to show maternity services how to enable new graduate midwives to work in midwifery continuity of care models.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.MIDW.2014.12.013
Abstract: midwifery continuity of care has been shown to be beneficial to women through reducing interventions and other maternal and neonatal morbidity. In Australia, numerous government reports recognise the importance of midwifery models of care that provide continuity. Given the benefits, midwives, including new graduate midwives, should have the opportunity to work in these models of care. Historically, new graduates have been required to have a number of years׳ experience before they are able to work in these models of care although a small number have been able to move into these models as new graduates. to explore the experiences of the new graduate midwives who have worked in midwifery continuity of care, in particular, the support they received and, to establish the facilitators and barriers to the expansion of new graduate positions in midwifery continuity of care models. a qualitative descriptive study was undertaken framed by the concept of continuity of care. the new graduate midwives valued the relationship with the women and with the group of midwives they worked alongside. The ability to develop trusting relationships, consolidate skills and knowledge, be supported by the group and finally feeling prepared to work in midwifery continuity of care from their degree were all sub-themes. All of these factors led to the participants feeling as though they were 'becoming a real midwife'. this is the first study to demonstrate that new graduate midwives value working in midwifery continuity of care - they felt well prepared to work in this way from their degree and were supported by midwives they worked alongside. The participants reported having more confidence to practice when they have a relationship with the woman, as occurs in these models.
Publisher: Springer International Publishing
Date: 2019
Publisher: Elsevier BV
Date: 03-2023
DOI: 10.1016/J.WOMBI.2022.07.001
Abstract: All women require access to quality maternity care. Continuity of midwifery care can enhance women's experiences of childbearing and is associated with positive outcomes for women and infants. Much research on these models has been conducted with women with uncomplicated pregnancies less is known about outcomes for women with complexities. To explore the outcomes and experiences for women with complex pregnancies receiving midwifery continuity of care in Australia. This integrative review used Whittemore and Knafl's approach. Authors searched five electronic databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and MAG Online) and assessed the quality of relevant studies using the Critical Appraisal Skills Programme (CASP) appraisal tools. Fourteen studies including women with different levels of obstetric risk were identified. However, only three reported outcomes separately for women categorised as either moderate or high risk. Perinatal outcomes reported included mode of birth, intervention rates, blood loss, perineal trauma, preterm birth, admission to special care and breastfeeding rates. Findings were synthesised into three themes: 'Contributing to safe processes and outcomes', 'Building relational trust', and 'Collaborating and communicating'. This review demonstrated that women with complexities in midwifery continuity of care models had positive experiences and outcomes, consistent with findings about low risk women. The nascency of the research on midwifery continuity of care for women with complex pregnancies in Australia is limited, reflecting the relative dearth of these models in practice. Despite favourable findings, further research on outcomes for women of all risk is needed to support the expansion of midwifery continuity of care.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2021
DOI: 10.1186/S12978-021-01202-Y
Abstract: Gaining excessive or inadequate gestational weight is associated with many adverse maternal and fetal outcomes. Inadequate gestational weight gain (GWG) increases the risk of fetal growth restriction, pre-term birth, and low birth weight. It is a public health concern in sub-Saharan Africa. The aim of this study was to assess the patterns and predictors of GWG in Addis Ababa, Ethiopia. We conducted a prospective cohort study among pregnant women who attended antenatal care in health centres in Addis Ababa, from January to September 2019. Data were collected by a structured questionnaire and checklists and analysed using Stata version-14. Weight at or before 16 weeks gestation was used as a proxy for pre-pregnancy weight. Women’s height and baseline weight were measured by data collectors, and we obtained weight at the end of the 24th and 36th weeks of gestation from women’s medical records. GWG was categorized as inadequate, adequate and excessive based on the United States Institute of Medicine criteria. Predictors of GWG were identified using multinomial logistic regression. A total of 395 pregnant women were enrolled in the study. GWG was assessed for 369 (93%) women. The median GWG was 8.7 kg with inter quartile ranges (25th, 75th percentiles) of 7.0 kg and 11.6 kg. More than two-third of the participants, 248 (67.2% [95% CI: 62.2, 72.0%]), gained inadequate weight 103 (27.9% [95% CI: 23.4, 32.8%]) gained adequate weight and 18 (4.9% [95% CI: 2.9%, 7.6%]) gained excessive weight. Three quarters (75%) of underweight women gained inadequate gestational weight, whereas 43% of overweight or obese women gained inadequate gestational weight. Being underweight (AOR = 3.30 [95% CI: 1.32, 8.24]) or normal weight (AOR = 2.68 [95% CI: 1.37, 5.24]) before pregnancy increased the odds of gaining inadequate gestational weight compared to overweight or obese women. Not having paid employment was associated with higher odds of gaining inadequate gestational weight compared to women employed outside the home (AOR = 2.17 [95% CI: 1.16, 4.07]). Most pregnant women in Addis Ababa gain inadequate gestational weight. In particular, three quarters of underweight women gained inadequate gestational weight. Being underweight, normal weight or having no paid employment were associated with higher odds of inadequate GWG. Promoting adequate GWG in Addis Ababa among underweight and normal weight women may be an important public health initiative.
Publisher: Springer International Publishing
Date: 2019
No related grants have been discovered for Allison Cummins.