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1.
Kathleen Baird Debra K. Creedy Amornrat S. Saito Jennifer Eustace 《Women and birth : journal of the Australian College of Midwives》2018,31(5):398-406
Background
Routine enquiry about domestic violence during pregnancy is accepted best practice. Training is essential to improve knowledge and practice. Few studies have undertaken a comprehensive evaluation of training impact over time.Aim
To evaluate the longitudinal impact of a domestic violence training and support program to promote midwives’ routine antenatal enquiry for domestic violence using a mixed methods design.Method
Data sources included (1) surveys of midwives at 6 months post-training, (2) interviews with key stakeholders at 12 months, (3) chart audit data of screening, risk, and disclosure rates (for 16 months). Measures included midwives’ knowledge, preparation for routine enquiry, knowledge of domestic violence and perceptions of impact of the training and support for practice change.Findings
Forty (out of 83) participant surveys could be matched and responses compared to baseline and post-training scores. Wilcoxon signed-rank test identified that all 6-month follow-up scores were significantly higher than those at baseline. Level of preparedness increased from 42.3 to 51.05 (Z = 4.88, p < .001); and knowledge scores increased from a mean of 21.15 to 24.65 (Z = 4.9, p < .001). Most participants (>90%) reported improved confidence to undertake routine inquiry. A chart audit of screening rates revealed that of the 6671 women presenting for antenatal care, nearly 90% were screened. Disclosure of domestic violence was low (<2%) with most women at risk or experiencing violence declining referral.Conclusions
Training, support processes, and referral pathways, contributed to midwives’ sustained preparedness and knowledge to conduct routine enquiry and support women disclosing domestic violence. 相似文献2.
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Jennifer Fenwick Mary Sidebotham Jenny Gamble Debra K. Creedy 《Women and birth : journal of the Australian College of Midwives》2018,31(1):38-43
Background
Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives.Aim
To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity.Method
Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n = 862) was divided into two groups; midwives working in continuity (n = 214) and those not working in continuity (n = 648). Mann Whitney U tests were used to compare the groups.Results
The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p = .002; CBI Work p < .001; CBI Client p < .001) and Anxiety (p = .007) and Depression (p = .004) sub-scales. Midwives providing continuity reported significantly higher scores on the PEMs Autonomy/Empowerment subscale (p < .001) and the Skills and Resources subscale (p = .002). There was no difference between the groups in terms of satisfaction with time off and work-life balance.Conclusion
Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward. 相似文献5.
Maria Noonan Julie Jomeen Rose Galvin Owen Doody 《Women and birth : journal of the Australian College of Midwives》2018,31(6):e358-e366
Background
Midwives have a primary role in facilitating the first stage of perinatal mental health risk reduction through inquiring about perinatal mental health, identifying risk factors and current perinatal mental health problems, providing support or crisis intervention, referring for treatment and decreasing stigmatisation.Aims
The aims of this study were to determine midwives’ (a) knowledge of and confidence to identify and manage perinatal mental health problems, (b) attitudes towards women who experience severe mental illness and (c) perceived learning needs.Design
A cross-sectional survey design.Methods
The study was conducted between September 2016 and April 2017 in seven Maternity services in the Republic of Ireland with a purposeful non-random convenience sample of midwives (n = 157). Data was anonymously collected utilising the Perinatal Mental Health Questionnaire, the Mental Illness: Clinician’s Attitudes scale and the Perinatal Mental Health Learning Needs questionnaire.Findings
Midwives indicated high levels of knowledge (71.1%) and confidence (72%) in identifying women who experience depression and anxiety however, they reported less confidence in caring (43.9%) for women. Only 17.8% (n = 28) of midwives felt equipped to support women whilst 15.3% (n = 24) reported having access to sufficient information. Midwives desire education on the spectrum of perinatal mental health problems. The mean score for the Mental Illness: Clinician’s Attitudes scale was 36.31 (SD = 7.60), indicating positive attitudes towards women with severe mental illness.Conclusion
Midwives require further education on perinatal mental health across cultures with a skill focus and which explores attitudes delivered in a study day format. 相似文献6.
Robin S. Cronin Minglan Li Kate Culliney Robyn Maude Katherine Nelson 《Women and birth : journal of the Australian College of Midwives》2018,31(5):422-429
Background
Second-degree tears are the most common form of perineal trauma occurring after vaginal birth managed by New Zealand midwives, although little is known about midwives’ perineal practice.Aim
The aim of this study was to identify how midwives managed the last second-degree perineal tear they treated and the level to which their practice reflects National Institute for Health and Care Excellence guidelines.Methods
An (anonymous) online survey was conducted over a six-week period in 2013. New Zealand midwives who self-identified as currently practising perineal management and could recall management of the last second-degree tear they treated were included in the analysis.Findings
Of those invited, 645 (57.1% self-employed, 42.9% employed) were eligible and completed surveys. Self-employed midwives reported greater confidence (88.0% vs 74.4%, p < 0.001) and more recent experience (85.1% vs 57.4%, p < 0.001) with perineal repair than employed midwives. Midwives who left the last second-degree tear unsutured (7.3%) were more likely to report low confidence (48.9% vs 15.4%, p < 0.001) and less recent experience with repair (53.2% vs 24.7%, p < 0.001), and were less likely to report a digital-rectal examination (10.6% vs 49.0%, p < 0.001), compared to midwives who sutured. Care consistent with evidence-based guidelines (performing a digital-rectal examination, 59.4% vs 49.3% p = 0.005; optimal suturing techniques, 62.2% vs 48.7%, p = 0.001) was associated with recent perineal education.Conclusions
Midwives’ management of the last second-degree perineal tear is variable and influenced by factors including: employment status, experience, confidence, and perineal education. There is potential for improvement in midwives’ management through increased uptake of evidence-based guidelines and through ongoing education. 相似文献7.
Julia Leinweber Debra K. Creedy Heather Rowe Jenny Gamble 《Women and birth : journal of the Australian College of Midwives》2017,30(1):40-45
Background
Midwives frequently witness traumatic birth events. Little is known about responses to birth trauma and prevalence of posttraumatic stress among Australian midwives.Aim
To assess exposure to different types of birth trauma, peritraumatic reactions and prevalence of posttraumatic stress.Methods
Members of the Australian College of Midwives completed an online survey. A standardised measure assessed posttraumatic stress symptoms.Findings
More than two-thirds of midwives (67.2%) reported having witnessed a traumatic birth event that included interpersonal care-related trauma features. Midwives recalled strong emotions during or shortly after witnessing the traumatic birth event, such as feelings of horror (74.8%) and guilt (65.3%) about what happened to the woman. Midwives who witnessed birth trauma that included care-related features were significantly more likely to recall peritraumatic distress including feelings of horror (OR = 3.89, 95% CI [2.71, 5.59]) and guilt (OR = 1.90, 95% CI [1.36, 2.65]) than midwives who witnessed non-interpersonal birth trauma. 17% of midwives met criteria for probable posttraumatic stress disorder (95% CI [14.2, 20.0]). Witnessing abusive care was associated with more severe posttraumatic stress than other types of trauma.Discussion
Witnessing care-related birth trauma was common. Midwives experience strong emotional reactions in response to witnessing birth trauma, in particular, care-related birth trauma. Almost one-fifth of midwives met criteria for probable posttraumatic stress disorder.Conclusion
Midwives carry a high psychological burden related to witnessing birth trauma. Posttraumatic stress should be acknowledged as an occupational stress for midwives. The incidence of traumatic birth events experienced by women and witnessed by midwives needs to be reduced. 相似文献8.
Lyndall Mollart Virginia Skinner Jon Adams Maralyn Foureur 《Women and birth : journal of the Australian College of Midwives》2018,31(1):44-51
Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Literature describing CAM and self-help options midwives recommend to women experiencing a post-date pregnancy is sparse. This study aimed to investigate if Australian midwives’ personal CAM use impacts on discussions and recommendations of CAM/Self-help strategies.
Methodology/design
A survey of a national midwifery association midwifery members (n = 3,552) was undertaken at a midwifery conference (October 2015) and via e-bulletins (November 2015–March 2016). The self-administered survey included questions on what self-help and CAM strategies midwives discuss and recommend to women with a post-date pregnancy, midwives’ confidence levels on discussing or recommending CAM, midwives’ own personal use of CAM.Findings
A total of 571 registered midwives completed the survey (16%). Demographics (age, years as a midwife, state of residence) reflected Australian midwives and the midwifery association membership. Most respondents discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. The top five CAM recommended were Acupuncture (65.7%), Acupressure (58.1%), Raspberry Leaf (52.5%), Massage (38.9%) and Hypnosis/Calmbirthing/Hypnobirthing (35.7%). Midwives were more likely to discuss strategies if they personally used CAM (p < .001), were younger (p < .001) or had worked less years as midwives (p = .004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p = .001).Conclusion
Midwives’ personal use of CAM influenced their discussions and recommendations of CAM/self-help strategies to women experiencing a post-date pregnancy. This study has implications for inclusion of CAM in midwifery education curricula. 相似文献9.
Martine Hollander Lianne Holten Annemieke Leusink Jeroen van Dillen Esteriek de Miranda 《Women and birth : journal of the Australian College of Midwives》2018,31(6):505-512
Problem and background
This study explores the experiences of Dutch midwives and gynaecologists with pregnant women who request more, less or no care during pregnancy and/or childbirth.Methods
All Dutch midwives and (trainee) gynaecologists were invited to fill out a questionnaire specifically designed for the purposes of this study. Holistic midwives were analysed separately from regular community midwives.Findings
Most maternity care providers in the Netherlands receive requests for less care than recommended at least once a year. The most frequently maternal requests were declining testing for gestational diabetes (66.3%), opting for a home birth in case of a high risk pregnancy (65.3%), and declining foetal monitoring during labour (39.6%). Holistic midwives are more convinced of an increasing demand for less care than community midwives (73.1% vs. 35.2%, p = <0.001). More community midwives than hospital staff reported to have declined one or more request for less care than recommended (48.6% vs. 27.9%, p = <0.001). The majority of hospital staff also receive at least one request for an elective caesarean section every year.Discussion and conclusion
Requests for more and less care than indicated during pregnancy and childbirth are equally prevalent in this study. However, a request for less care is more likely to be declined than a request for more care. Counselling women who disagree with their care provider demands time. In case of requests for less care, second best care should be considered. 相似文献10.
J. Fenwick H. Brittain J. Gamble 《Women and birth : journal of the Australian College of Midwives》2017,30(6):497-505
Background
Reporting the outcomes for women and newborns accessing private midwives with visiting rights in Australia is important, especially since this data cannot currently be disaggregated from routinely collected perinatal data.Aim
1) Evaluate the outcomes of women and newborns cared for by midwives with visiting access at one Queensland facility and 2) explore private midwives views about the structures and processes contributing to clinical outcomes.Methods
Mixed methods. An audit of the ‘all risk’ 529 women receiving private midwifery care. Data were compared with national core maternity variables using Chi square statistics. Telephone interviews were conducted with six private midwives and data analysed using thematic analysis.Findings
Compared to national data, women with a private midwife were significantly more likely to be having a first baby (49.5% vs 43.6% p = 0.007), to commence labour spontaneously (84.7% vs 52.7%, p < 0.001), experience a spontaneous vaginal birth (79% vs 54%, p < 0.001) and not require pharmacological pain relief (52.9% vs 23.1%, p < 0.001). The caesarean section rate was significantly lower than the national rate (13% vs 32.8%, p < 0.001). In addition fewer babies required admission to the Newborn Care Unit (5.1% vs 16%, p < 0.001). Midwives were proud of their achievements. Continuity of care was considered fundamental to achieving quality outcomes. Midwives valued the governance processes embedded around the model.Conclusions
Private midwives with access to the public system is safe. Ensuring national data collection accurately captures outcomes relative to model of care in both the public and private sector should be prioritised. 相似文献11.
Catherine Kilgour Fiona Elizabeth Bogossian Leonie Callaway Cindy Gallois 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e24-e33
Problem
The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up.Aim
Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care.Methods
Purposive sampling and convergent interviews explored participants’ communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory.Setting and participants
Clinicians who provided maternity care at a tertiary referral hospital (n = 13) in Queensland, Australia, and general practitioners (n = 16) who provided maternity shared care with that hospital between December 2012 and July 2013.Findings
Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared.Conclusion
Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up. 相似文献12.
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Joyce C.S. Camargo Vitor Varela Fernanda M. Ferreira Lucila Pougy Angela M. Ochiai Maria Elisabete Santos Maria Catarina L.R. Grande 《Women and birth : journal of the Australian College of Midwives》2018,31(5):e325-e333
Introduction
The following quantitative observational study aimed to analyse the maternal and neonatal outcomes of 90 low-risk pregnant women who gave birth in water at São Bernardo Hospital.Methods
A form containing information on the obstetric history of the parturient, the type of immersion, and the labour and birth follow-up was used by midwives to collect the data.Background
The Apgar score (at 1 min after birth) used in this study, called Aqua Apgar, was adapted by Cornelia Enning.Results
The mean water immersion time was 1 h and 46 min and had an influence on the duration of labour (mean 5 h and 37 min), with a statistically significant difference (P = 0.004). There was a decreased cervical dilatation time and a shorter duration of the expulsion phase. In the immersion scenario, 30% of the women did not undergo any examination to assess the length of the cervix, and 57.8% presented intact perennial areas or first-degree tears. As for neonatal outcomes, during maternal immersion, 97% maintained normal fetal heart rates (between 110 and 160 beats per minute) and Aqua Apgar was higher than 7, both in the first minute (mean of 9.4) and in the fifth minute of life (mean of 9.9).Conclusion
These safety outcomes, based on sound scientific evidence, should increasingly support and inform clinical decisions and increase the number of waterbirths in health facilities. The results of this study align with growing evidence that suggests waterbirth is a safe delivery option and therefore should be offered to women. 相似文献15.
Annabel Sheehy Rachel M. Smith Joanne E. Gray Caroline S.E. Homer 《Women and birth : journal of the Australian College of Midwives》2019,32(2):e182-e188
Background
Midwives in Australia are educated through a range of routes providing flexible ways to become a midwife. Little is known about whether the route to registration impacts on mid-career experiences, in particular, whether the pathway (post-nursing pathway compared with ‘direct-entry’) makes any difference.Aim
The aim of this study was to explore the midwifery workforce experiences and participation in graduates six to seven years after completing either a post-nursing Graduate Diploma in Midwifery (GradDip) or an undergraduate degree, the Bachelor of Midwifery (BMid), from one university in New South Wales, Australia.Methods
Data were collected from mid-career midwives having graduated from one NSW university from 2007–2008 using a survey. The survey included validated workforce participation instruments — the Maslach Burnout Inventory (MBI), the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Perceptions of Empowerment in Midwifery Scale (PEMS).Results
There were 75 respondents: 40% (n = 30) Bachelor of Midwifery and 60% (n = 45) GradDip graduates. The age range was 27–56 years old (mean age = 36 years) Bachelor of Midwifery graduates being on average 7.6 years older than Graduate Diploma in Midwifery graduates (40 vs 33 years; p < 0.01). Almost 80% (59), were currently working in midwifery. Nine of the 12 not working in midwifery (75%) planned to return. There were no differences in workforce participation measures between the two educational pathways. Working in a continuity of care model was protective in regards to remaining in the profession.Conclusion
Most mid-career graduates were still working in midwifery. There were no differences between graduates from the two pathways in relation to burnout, practice experiences or perceptions of empowerment. 相似文献16.
Shahnaz Torkzahrani Fatemeh Mahmoudikohani Kiarash Saatchi Reyhaneh Sefidkar Mojdeh Banaei 《Women and birth : journal of the Australian College of Midwives》2017,30(1):46-50
Background
Induction of labor is a common obstetric procedure. Acupressure is a natural method that is used for inducing uterine contractions. Nevertheless, few studies have examined the impact of acupressure on the induction of labor.Aim
The aim of this study was to evaluate the effect of acupressure on the initiation of labor.Material and methods
In this randomized clinical trial, 162 nulliparous pregnant women were admitted to the hospital. They were categorized into 3 groups; acupressure, sham acupressure and control. Acupressure points SP6, BL 60 and BL 32 were pressured bilaterally. The intervention was done by the researcher every other day between 9 am and 11 am. The intervention was carried out on women in the afternoon and the following day. Subjects were examined to determine the initiation of labor symptoms48 and 96 h after the start of intervention and at the time of hospitalization. Data were analyzed using the ANOVA, Kruskal–Wallis and Chi-square tests (p < 0.05).Results
There was no significant difference among the groups for spontaneous initiation of labor within 48 h (P = 0.464), and 49–96 h after beginning the intervention (P = 0.111) and 97 h after beginning the intervention to the time of hospitalization for the spontaneous initiation of labor (P = 0.897). There were no significant differences in the secondary outcomes between the groups.Conclusion
According to the finding of this study, it seems that acupressure treatment was not effective in initiating labor as compared with the sham acupressure and the routine care groups. 相似文献17.
Adriana Amorim Francisco Sonia Maria Junqueira Vasconcellos De Oliveira Mary Steen Moacyr Roberto Cuce Nobre Eder Viana De Souza 《Women and birth : journal of the Australian College of Midwives》2018,31(5):e334-e340
Background
Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy.Aims
To evaluate if a 10 min ice-pack application relieved postpartum perineal pain and if the analgesic effect was maintained for up to 2 h.Methods
A randomised controlled trial conducted from December 2012 to February 2013 with 69 primiparous women ≥18 years old, 6–24 h postpartum, with perineal pain ≥3, who had not received anti-inflammatory medication or analgesics after childbirth, who were randomised to a single ice-pack application on the perineum for 10 min or standard care. The primary and secondary outcomes were a reduction ≥30% in perineal pain intensity, immediately after the application and the maintenance of the analgesic effect for up to 2 h, respectively.Findings
Immediately post-intervention, the proportion of women whose perineal pain decreased ≥30% was significantly higher in the experimental group. Within 2 h, there was no significant difference in the pain levels in both groups. Within 2 h, for 61.9% and 89.3% of women in the experimental and control group, respectively, the perineal pain levels remained unchanged. For the remaining participants, perineal pain was increasing after an average time of 1 h 45 min and 1 h 56 min for the experimental and control groups, respectively.Conclusion
By applying an ice-pack for 10 min to the perineum, effective pain relief is achieved, that is maintained for between 1 h 45 min and 2 h. 相似文献18.
Marjon De Roose Dimitri Beeckman Katrijn Eggermont Elke Vanhouche Ann Van Hecke Sofie Verhaeghe 《Women and birth : journal of the Australian College of Midwives》2018,31(3):e197-e203
Problem
To date, it is unclear which factors are associated with parenting stress.Background
There are no studies investigating the association between parenting stress and coping strategies such as coparenting and social support, while simultaneously considering demographic and obstetric factors, in mothers of singletons and twins.Aim
To investigate if parenting stress is associated with personal, and obstetric characteristics, the level of coparenting, and the availability of and satisfaction with social support in mothers of singletons and twins until one year postpartum.Methods
A cross-sectional study was conducted. A total of 151 singleton mothers and 101 twin mothers were included.Results
Both singleton and twin mothers experiencing lower parenting stress levels indicated a better coparenting relationship quality (β = ?0.253, p < 0.01; β = ?0.341, p = 0.001). Elevated parenting stress levels positively influenced the level of satisfaction with social support in only mothers of twins (β = 0.273, p < 0.01). The availability of social support, personal, and obstetric characteristics were not associated with the level of parenting stress in neither singleton nor twin mothers.Conclusion
Coparenting seems to be a significant coping strategy reducing the level of parenting stress in singleton and twin mothers, irrespective of their personal and obstetric characteristics. Large-scale longitudinal research is needed to identify predictors of parenting stress, which may help to develop parenting stress reducing interventions. The acknowledgement and support of an adequate coparenting relationship quality by health care professionals might be an important factor to include in such interventions. 相似文献19.
Amelia Lee Michelle Newton Jessica Radcliffe Regina Belski 《Women and birth : journal of the Australian College of Midwives》2018,31(4):269-277
Background
Dietary intake of pregnant women do not appear to meet the dietary recommendations. Nutrition knowledge and practices of pregnant women and their antenatal care clinicians are factors that may be influential on dietary intakes of pregnant women.Aim
To assess and compare pregnancy nutrition recommendation knowledge and to explore how nutrition knowledge impacts on food choices in pregnant women and nutrition education practices of antenatal care providers.Methods
An explanatory sequential research mixed methods study design was applied. All participants were recruited from a metropolitan maternity hospital in Melbourne, Australia. The first phase assessed pregnancy nutrition knowledge and sources of nutrition information using a questionnaire (n = 202) then followed semi-structured interviews with women and clinicians (n = 31).Findings
The clinicians obtained significantly higher nutrition scores than compared to women, however, nutrition knowledge gaps were highlighted for both women and clinicians. Women reported receiving limited nutrition advice, a reflection of the clinicians reporting they provided limited nutrition advice.Conclusion
A key challenge for women adhering to dietary recommendations was having inadequate knowledge of the dietary recommendations and receiving limited information from their care providers. Similarly, as well as time constraints, limited nutrition knowledge and a lack of nutrition training impacted on the capacity of clinicians to provide adequate nutrition education. 相似文献20.
Jane Warland Pauline Glover 《Women and birth : journal of the Australian College of Midwives》2017,30(1):23-28