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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3.
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4.
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5.
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6.
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7.
Kathleen M. Baird Amornrat S. Saito Jennifer Eustace Debra K. Creedy 《Women and birth : journal of the Australian College of Midwives》2018,31(4):285-291
Background
Asking women about experiences of domestic violence in the perinatal period is accepted best practice. However, midwives and nurses may be reluctant to engage with, or effectively respond to disclosures of domestic violence due a lack of knowledge and skills.Aim
To evaluate the impact of training on knowledge and preparedness of midwives and nurses to conduct routine enquiry about domestic violence with women during the perinatal period.Method
A pre-post intervention design was used. Midwives and nurses (n = 154) attended a full day workshop. Of these, 149 completed pre-post workshop measures of knowledge and preparedness. Additional questions at post-training explored participants’ perceptions of organisational barriers to routine enquiry, as well as anticipated impact of training on their practice. Training occurred between July 2015 and October 2016.Findings
Using the Wilcoxon signed-rank test, all post intervention scores were significantly higher than pre intervention scores. Knowledge scores increased from a pre-training mean of 21.5–25.6 (Z = ?9.56, p < 0.001) and level of preparedness increased from 40.8 to 53.2 (Z = ?10.12, p < 0.001). Most participants (93%) reported improved preparedness to undertake routine enquiry after training. Only a quarter (24.9%) felt their workplace allowed adequate time to respond to disclosures of DV.Conclusions
Brief training can improve knowledge, preparedness, and confidence of midwives and nurses to conduct routine enquiry and support women during the perinatal period. Training can assist midwives and nurses to recognise signs of DV, ask women about what would be helpful to them, and address perceived organisational barriers to routine enquiry. Practice guidelines and clear referral pathways following DV disclosure need to be implemented to support gains made through training. 相似文献8.
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9.
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10.
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11.
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S.A.S. Moimaz N.B. Rocha C.A.S. Garbin T.A. Rovida N.A. Saliba 《Women and birth : journal of the Australian College of Midwives》2017,30(2):e119-e124
Background
Knowing the intention of mothers is important to plan actions to improve exclusive breastfeeding rates.Aim
The objective of this retrospective study was to verify the intention to breastfeed and the intended breastfeeding duration of a group of women participating in a public prenatal dental care program in the city of Araçatuba, Brazil.Methods
The records of 933 childbearing women were analyzed and their intention to breastfeed and intended breastfeeding duration were associated to women’s age, ethnicity, marital status, education, employment, number of gestations, previous breastfeeding experience, previous breastfeeding guidance, presence of complications during pregnancy, and systemic diseases. Data were inserted into Epi Info 2000 and analyzed with Biostat, at a 5% level of significance, and confidence interval of 95%.Findings
Participants mean age was 26.1 ± 5.9 years. The majority of women (96.5%) declared their intention to breastfeed their babies. The main variables to affect the intention to breastfeed were the number of gestations (p = 0.001), previous breastfeeding experience (p = 0.03), and previous breastfeeding guidance (p = 0.01). Intended breastfeeding duration was significantly affected by women’s age (p = 0.04), employment (0.02), the number of gestations (p = 0.001), and previous breastfeeding experience (p = 0.04).Conclusions
Previous positive breastfeeding experience and guidance during prenatal examinations positively affected women’s intention to breastfeed; while older, unemployed women in their second or more gestation and previous breastfeeding experience intended to breastfeed their children for longer periods of time. 相似文献13.
Arndt Büssing Undine Waßermann Niels Christian Hvidt Alfred Längler Michael Thiel 《Women and birth : journal of the Australian College of Midwives》2018,31(2):e89-e98
Background
Spirituality is part of the basic needs of all humans, yet often undervalued by health professionals. Less is known about the spiritual needs of mothers of preterm or sick new born children.Aim
Identify unmet psychosocial and spiritual needs of these mothers, and to relate these needs to their perceived stress and impairments of life concerns.Methods
Anonymous cross-sectional survey with standardized instruments (e.g., Spiritual Needs Questionnaire) among 125 mothers of two paediatric departments in Germany.Findings
Mothers felt supported by their partner and hospital staff, and hospital staff assured 82% of them that they must not worry about their child’s prognosis. They nevertheless did have specific unmet spiritual needs. Religious Needs and Existentialistic Needs scored lowest, while Giving/Generativity Needs were of moderate and Inner Peace Needs of strongest relevance. With respect to the expected diagnosis and prognosis of their child, there were no significant differences for their secular spiritual needs scores, but significant differences for Religious Needs which scored highest in mothers with children having an unclear prognosis (F = 8.6; p = .004). Particularly Inner Peace Needs correlated with their stress perception (r = .34), impairments of life concerns (r = .25) and grief (r = .23).Discussion
Mothers of sick born/premature children felt supported by the hospital team and their partner, but nevertheless experienced stress and daily life impairments, and particularly have unmet Inner Peace Needs.Conclusions
Addressing mothers’ specific needs may help support them in their struggle with their difficult situation avoiding fears and insecurity and thus facilitating positive bonding to their child. 相似文献14.
Roianne West Somer Wrigley Kyly Mills Kate Taylor Dale Rowland Debra K. Creedy 《Women and birth : journal of the Australian College of Midwives》2017,30(3):236-244
Background
Midwives have a central role in closing the gap in health inequalities between Australias’ First Peoples and other childbearing women. The Aboriginal and Torres Strait Islander Health Curriculum Framework (The Framework) identifies five core cultural capabilities (respect, communication, safety and quality, reflection and advocacy) to foster culturally safe health care.Aim
To use a decolonising, First Peoples-led approach to develop and validate a tool to measure the development students’ cultural capabilities.Method
A pre- post intervention design was used. Development of the Cultural Capability Measurement Tool followed a staged process which centred on First Peoples’ knowledges. This process included: item generation, expert review; a pilot, test-retest; and psychometric testing (reliability, factor analysis and construct validity). All third year midwifery students (n = 49) enrolled in a discrete First Peoples health course were invited to complete the survey pre and post course.Findings
A response rate of 77.5% (n = 38/49) pre-course and 30.6% (15/49) at post-course was achieved. The tool demonstrated good internal reliability (Cronbach alpha = .89–.91). Principal component analysis with varimax rotation produced a five-factor solution. A paired samples t-test revealed a significant increase from pre-course (mean 93.13, SD 11.84) to post-course scores (mean = 100.53, SD 7.54) (t (14) = ?2.79, p = .014).Conclusion
A First Peoples approach was critical to tool development and conceptual validity. The 22 item Cultural Capability measurement Tool reflected the core cultural capabilities of The Framework. The draft tool appears suitable for use with midwifery students. 相似文献15.
Karen Matvienko-Sikar Samantha Dockray 《Women and birth : journal of the Australian College of Midwives》2017,30(2):e111-e118
Problem
Low prenatal well-being has adverse outcomes for mother and infant but few interventions currently exist to promote and maintain prenatal well-being.Background
Mindfulness and gratitude based interventions consistently demonstrate benefits in diverse populations. Interventions integrating these constructs have potential to improve psychological and physiological health during pregnancy.Aim
The aim of this pilot study is to examine the effect of a novel gratitude and mindfulness based intervention on prenatal stress, cortisol levels, and well-being.Methods
A pilot randomised controlled trial was conducted with 46 pregnant women. Participants used an online mindfulness and gratitude intervention 4 times a week for 3 weeks. Measures of prenatal stress, salivary cortisol, gratitude, mindfulness, and satisfaction with life were completed at baseline, 1.5 weeks later, and 3 weeks later.Findings
Intervention participants demonstrated significant reductions in prenatal stress in comparison to the control condition (p = .04). Within subjects reductions in waking (p = .004) and evening cortisol (p > .001) measures were observed for intervention participants. Significant effects were not observed for other well-being outcomes.Discussion
Reducing self-report and physiological stress in pregnancy can improve maternal and infant outcomes. The findings of this pilot study indicate potential direct effects of the intervention on self-reported stress in comparison to a treatment-as-usual control. Effects on a biomarker of stress, cortisol, were also observed within the intervention group.Conclusion
A brief mindfulness and gratitude based intervention has the potential to reduce stress in pregnancy. Future research is needed to further explore mechanisms and potential benefits of such interventions. 相似文献16.
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Stephen J. Robson Hassan Vally Abdel-Latif Mohamed Maggie Yu Elizabeth M. Westrupp 《Women and birth : journal of the Australian College of Midwives》2017,30(6):506-510
Background
The proportion of babies born by caesarean section in Australia has almost doubled over the last 25 years. Factors known to contribute to caesarean such as higher maternal age, mothers being overweight or obese, or having had a previous caesarean do not completely account for the increased rate and it is clear that other influences exist.Aim
To identify previously unsuspected risk factors associated with caesarean using nationally-representative data from the Longitudinal Study of Australian Children.Methods
Data were from the birth cohort, a long-term prospective study of approximately 5000 children that includes richly-detailed data regarding maternal health and exposures during pregnancy. Logistic regression was used to examine the contribution of a wide range of pregnancy, birth and social factors to caesarean.Findings
28% of 4862 mothers were delivered by caesarean. The final adjusted analyses revealed that use of diabetes medication (OR = 3.1, 95% CI = 1.7–5.5, p < 0.001) and maternal mental health problems during pregnancy (OR = 1.3, CI = 1.1–1.6, p = 0.003) were associated with increased odds of caesarean. Young maternal age (OR = 0.6, CI = 0.5–0.7, p < 0.001), having two or more children (OR = 0.7, CI = 0.6–0.9, p < 0.001), and fathers having an unskilled occupation (OR = 0.7, CI = 0.6–1.0, p = 0.036) were associated with reduced odds of caesarean.Conclusion
Our findings raise the prospect that the effect of additional screening and support for maternal mental health on caesarean rate should be subject of prospective study. 相似文献19.
Paula Olsen Moira Williamson Victoria Traynor Chris Georgiou 《Women and birth : journal of the Australian College of Midwives》2018,31(1):31-37