Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of midwives in Greater Western Sydney,Australia

Background

Despite links between poor maternal oral health, adverse pregnancy outcomes and early childhood decay there is limited emphasis on maternal oral health in Australia. To address this, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in collaboration with the Australian College of Midwives.

Neonatal resuscitation training for midwives in Australia: A discussion of current practice

BackgroundMore than 300,000 babies are born in Australia each year, with almost 20% of newborns requiring some form of neonatal resuscitation at birth. The most common first responders to a neonatal resuscitation emergency are midwives. While the Australian and New Zealand Council on Resuscitation guides midwives’ practice during a neonatal resuscitation, each state and territory uses varying strategies to train and assess midwives proficiency in neonatal resuscitation.AimTo examine the neonatal resuscitation training requirements for midwives and raise awareness for the lack of consistency in training in Australia.DiscussionA significant variation was found in the teaching methods and frequency of training for neonatal resuscitation across Australia. Neonatal resuscitation is mandated through a state-wide guideline or policy in only four of the states with seven formal neonatal resuscitation training programs used across seven states and territories. Although a multi-modal approach to learning is present in all of the programs, the combination of teaching methods differ.Conclusion and RecommendationsA standardised, evidence-based training program is required to ensure consistency in training for midwives in Australia. Multi-modal learning is common across all current training programs; however, the best combination of multi-modal teaching methods needs to be determined. Neonatal resuscitation training needs to occur at least annually, as recommended by the Australian and New Zealand Council on Resuscitation.     

The importance of involving midwives before and during the implementation of an antenatal pertussis vaccination program in New South Wales,Australia

Problem

Typically there is limited opportunity for stakeholder engagement to determine service delivery gaps when implementing an outbreak or supplementary vaccination program.

The profile of women who consult midwives in Australia

BackgroundThere is no Australian data on the characteristics of women who consult with midwives.AimTo determine the profile of women who consult midwives in Australia.MethodsThis cross-sectional research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH). Participants were the younger (31–36 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n = 801). The main outcome measure was consultation with a midwife.FindingsOf the 801 women who indicated that they were currently pregnant at the time of the survey, 19%, 42%, and 70% of women in the first, second and third trimesters respectively had consulted with a midwife. Women were more likely to consult a midwife if they: also consulted with a hospital doctor (OR = 2.70, 95% CI: 1.66, 4.40); also consulted with a complementary and alternative medicine practitioner (OR = 1.94, 95% CI: 1.25, 3.03); were depressed (OR = 1.84, 95% CI: 1.03, 3.28); constipated (OR = 1.80, 95% CI: 1.04, 3.13); or had been diagnosed or treated for hypertension during pregnancy (OR = 2.78, 95% CI: 1.27, 6.09). Women were less likely (OR = 0.34, 95% CI: 0.21, 0.56) to consult with a midwife if they had private health insurance.ConclusionWomen were more likely to consult with midwives in conjunction with consultations with hospital doctors or complementary and alternative medicine practitioners. Women with private health insurance were less likely to consult midwives. More research is necessary to determine the implications of the lack of midwifery care for these women.     

The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study

BackgroundIn Australia the majority of homebirths are attended by privately practising midwives (PPMs). In recent years PPMs have been increasingly reported to the Australian Health Practitioner Regulation Agency (AHPRA) mostly by other health professionals.Purposeto explore the experiences of PPMs in Australia who have been reported to the AHPRA.MethodsA qualitative interpretive approach, employing in-depth interviews with eight PPMs was undertaken and analysed using thematic analysis. A feminist theoretical framework was used to underpin the research.ResultsThe majority of reports made to AHPRA occurred when midwives supported women who chose care considered outside the recommended Australian College of Midwives (ACM) Consultation and Referral Guidelines. During data analysis an overarching theme emerged, “Caught between women and the system”, which described the participants’ feelings of working as a PPM in Australia. There were six themes and several sub-themes: The suppression of midwifery, A flawed system, Lack of support, Devastation on so many levels, Making changes in the aftermath and Walking a tight rope forever. The findings from this study reveal that midwives who are under investigation suffer from emotional and psychological distress. Understanding the effects of the process of investigation is important to improve the quality of professional and personal support available to PPMs who are reported to AHPRA and to streamline processes.ConclusionIt is becoming increasingly difficult for PPMs to support the wishes and needs of individual women and also meet the requirements of the regulators, as well as the increasingly risk averse health service.     

The impact of planning for COVID-19 on private practising midwives in Australia

ProblemThe COVID-19 pandemic response has required planning for the safe provision of care. In Australia, privately practising midwives are an important group to consider as they often struggle for acceptance by the health system.BackgroundThere are around 200 Endorsed Midwives eligible to practice privately in Australia (privately practising midwives) who provide provide the full continuum of midwifery care.AimTo explore the experience of PPMs in relation to the response to planning for the COVID-19 pandemic.MethodsAn online survey was distributed through social media and personal networks to privately practising midwives in Australia in April 2020.ResultsOne hundred and three privately practising midwives responded to the survey. The majority (82%) felt very, or well informed, though nearly half indicated they would value specifically tailored information especially from professional bodies. One third (35%) felt prepared regarding PPE but many lacked masks, gowns and gloves, hand sanitiser and disinfectant. Sixty four percent acquired PPE through social media community sharing sites, online orders, hardware stores or made masks. Sixty-eight percent of those with collaborative arrangements with local hospitals reported a lack of support and were unable to support women who needed transfer to hospital. The majority (93%) reported an increase in the number of enquiries relating to homebirth.ConclusionPrivately practising midwives were resourceful, sought out information and were prepared. Support from the hospital sector was not always present. Lessons need to be learned especially in terms of integration, support, education and being included as part of the broader health system.     

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

IntroductionEpisiotomy is still performed routinely by clinicians in many countries. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy practice among clinicians working in public hospitals in Jordan.MethodsA cross-sectional study, using a self-administered survey questionnaire, was conducted among midwives and obstetricians in three public hospitals in Jordan.Results112 (87.5%) clinicians responded to the questionnaire. Low knowledge level of evidence about overuse and risk of episiotomy was identified among participants with a significant difference among obstetricians and midwives (P < 0.05). Results revealed that both obstetricians and midwives have limited access to evidence which is not emphasised in their learning, practice, or hospital policy. The majority of obstetricians (80%) and midwives (79%) thought an episiotomy rate of 81% is about right. The most common reason for performing episiotomy identified by both obstetricians (83.1%) and midwives (75.5%) was to reduce the risk of 3rd and 4th degree perineal laceration. The most common obstacle to reducing episiotomy rate reported by obstetricians (78.0%) was lack of training on preventing perineal tears, while the most common obstacles reported by midwives were insufficient time to wait for the perineum to stretch (56.6%) and difficulty changing the conventional practices in the labour ward (52.8%).ConclusionThis study identifies that obstetricians and midwives in Jordan rely on non evidence-based beliefs to guide their practice on performing an episiotomy. Training, continuing education, and developing evidence based clinical policies and guidelines for surgical procedures, such as in an episiotomy, are needed.     

Cross-sectional survey of antenatal education attendance among nulliparous pregnant women in Sydney,Australia

BackgroundAntenatal education aims to provide expectant parents with strategies for dealing with pregnancy, childbirth and parenthood and may have the potential to reduce obstetric intervention and fear of childbirth. We aimed to investigate antenatal education attendance, reasons for and barriers to attending, and techniques taught and used to manage labour.MethodsAntenatal and postnatal surveys were conducted among nulliparous women with a singleton pregnancy at two maternity hospitals in Sydney, Australia in 2018. Classes were classified into psychoprophylaxis, birth and parenting, other, or no classes. Reasons for and barriers to attendance, demographic characteristics, and techniques taught and used in labour were compared by class type, using Pearson’s Chi Squared tests of independence.Findings724 women were surveyed antenatally. The main reasons for attending classes were to better manage the birth (86 %), feel more secure in baby care (71 %) and as a parent (60 %); although this differed by class type. Reasons for not attending classes included being too busy (33 %) and cost (27 %). Epidural, breathing techniques, massage and nitrous oxide were the most common techniques taught. Women who attended psychoprophylaxis classes used a wider range of pain relief techniques in labour. Women found antenatal classes useful preparation for birth (94 %) and parenting (74 %). Women surveyed postnatally wanted more information on baby care/sleeping and breastfeeding.ConclusionThe majority of women found antenatal education useful and utilised techniques taught. Education providers should ensure breastfeeding and infant care information is provided, and barriers to attendance such as times and cost should be addressed.     

The role,practice and training of unregulated birth workers in Australia: A mixed methods study

Background

In Australia, the provision of homebirth services by unregulated birthworkers (doulas, ex-registered midwives, traditional midwives and lay workers) has increased. Accessing a homebirth with a registered midwife via mainstream services is limited. Concern is growing that new legislation aimed at prohibiting unregulated birthworkers practice may result in homebirth going underground.

A comparative analysis of immigrant skills and their utilization in Australia,Canada, and the USA

We compare literacy test scores and their impact on wage and employment outcomes of Australian, Canadian, and the US immigrants. Overall, we find little to distinguish the skills of immigrants to these three countries, although there is some indication of gains at the lower end of the distribution among Australian immigrants arriving after the mid-1990s. Relative immigrant wage returns to literacy are, however, substantially higher in the USA, which we argue reflects language-skill complementarities, as opposed to more efficient skill utilization or unobserved productivity characteristics.     

Pain relief for childbirth: The preferences of pregnant women,midwives and obstetricians

ObjectiveTo compare the personal preferences of pregnant women, midwives and obstetricians regarding a range of physical, psychosocial and pharmacological methods of pain relief for childbirth.MethodSelf-completed questionnaires were posted to a consecutive sample of 400 pregnant women booked-in to a large tertiary referral centre for maternity care in South Australia. A similar questionnaire was distributed to a national sample of 500 obstetricians as well as 425 midwives at: (1) the same hospital as the pregnant women, (2) an outer-metropolitan teaching hospital and (3) a district hospital. Eligible response rates were: pregnant women 31% (n = 123), obstetricians 50% (n = 242) and midwives 49% (n = 210).FindingsOverall, midwives had a greater personal preference for most of the physical pain relief methods and obstetricians a greater personal preference for pharmacological methods than the other groups. Pregnant women's preferences were generally located between the two care provider groups, though somewhat closer to the midwives. All groups had the greatest preference for having a support person for labour with more than 90% of all participants wanting such support. The least preferred method for pregnant women was pethidine/morphine (14%).ConclusionThere are differences in the personal preferences of pregnant women, midwives and obstetricians regarding pain relief for childbirth. It is important that the pain relief methods available in maternity care settings reflect the informed preferences of pregnant women.     

Contraception provision in the postpartum period: Knowledge,views and practices of midwives

BackgroundWomen are susceptible to unintended pregnancies in the first year after giving birth, particularly as consideration of contraception may be a low priority during this time. Discussing and providing contraception before women leave hospital after giving birth may prevent rapid repeat pregnancy and its associated risks. Midwives are well placed to assist with contraceptive decision-making and provision; however, this is not routinely undertaken by midwives in the Australian hospital setting and little is known regarding their views and experiences in relation to contraception.MethodsAn anonymous survey was conducted with midwives at two urban hospitals in New South Wales to better understand their contraceptive knowledge, views and practices regarding midwifery-led contraception provision in the postpartum period.FindingsThe survey was completed by 128 midwives. Most agreed that information about contraception provided in the postpartum period is valuable to women, although their knowledge about different methods was variable. The majority (88%) believed that midwives have a role in providing contraceptive information, and 79% reported currently providing contraceptive counselling. However, only 14% had received formal training in this area.ConclusionFindings demonstrate that most midwives provide some contraception information and believe this is an important part of a midwife’s role. Yet most have not undertaken formal training in contraception. Additional research is needed to explore the content and quality of midwives’ contraception discussions with women. Training midwives in contraceptive counselling would ensure women receive accurate information about available options. Upskilling midwives in contraception provision may increase postpartum uptake and reduce rapid repeat pregnancies.     

Access,boundaries and confidence: The ABC of facilitating continuity of care experience in midwifery education

BackgroundTo register as a midwife in Australia, students must complete minimum requirements of clinical experiences throughout their programme. This includes following women through their childbirth journey in order to gain continuity of care experience. Research suggests that women and students find the continuity of care experience (COCE) valuable. Nevertheless, students cite difficulty in achieving these experiences.Aim This project sought to explore the challenges and identify supportive strategies for midwifery students undertaking the COCE.MethodsThis project adopted an action research approach incorporating the four stages of planning, action, observation and reflection. This paper specifically reports the findings from the planning stage in which a focus group with education providers, facilitator and students was conducted and a survey with students (n = 69) was undertaken. Key themes were identified through thematic analysis and a number of actions were proposed.FindingsThree main themes, ‘access’, ‘boundaries’ and ‘confidence’ were identified as challenges for students undertaking the COCE. Students raised concern regarding lack of access to women for COCE. They identified a need to establish clear professional and personal boundaries in managing the COCE. Students also highlighted the significance of confidence on the success of their experience. Throughout the study students identified strategies that could assist in the COCE.ConclusionThere is a need for clarity and support around the COCE for all stakeholders. Placing the COCE within a Service Learning model is one response that ensures that this experience is understood as being symbiotic for women and students and enables supportive actions to be developed and implemented.     

Marital decision-making and the timing of first birth in rural China before the 1990s

Using a sample of couples drawn from the three provinces of Guangdong, Shandong, and Shaanxi, we investigated whether couples' increasing freedom to choose whom to marry influenced the timing of first birth in rural China during the four decades before the 1990s. The shortening of first-birth intervals in the period is found to be associated with the shift from arranged to free-choice marriages. The association is attributed largely to increased intimacy and coital frequency after marriage together with postponement of age at first marriage.     

Marital decision-making and the timing of first birth in rural China before the 1990s

Using a sample of couples drawn from the three provinces of Guangdong, Shandong, and Shaanxi, we investigated whether couples’ increasing freedom to choose whom to marry influenced the timing of first birth in rural China during the four decades before the 1990s. The shortening of first-birth intervals in the period is found to be associated with the shift from arranged to free-choice marriages. The association is attributed largely to increased intimacy and coital frequency after marriage together with postponement of age at first marriage.     

Feasibility,acceptability and sustainability of postpartum contraceptive implant provision by midwives in NSW public hospitals

BackgroundRepeat pregnancy in the first year after a birth is common. Many of these conceptions are unintended and may be prevented by providing access to contraception in the immediate postpartum period. Midwives in the hospital setting could potentially play a greater role in improving postnatal contraception information and provision.AimWe sought to implement and examine the success of a program training hospital-based midwives in immediate postpartum implant insertion.MethodsThis mixed methods study in two hospitals in New South Wales sought to explore the feasibility, acceptability and sustainability of a program that provided competency-based implant insertion training for midwives. The study documented training completion, implant insertion numbers and experience, and conducted end of study interviews with midwives and stakeholders.FindingsTwenty-seven midwives undertook training and inserted 265 implants during the study period. Interviews with 13 midwives and 11 stakeholders concluded the program to be feasible and acceptable with midwives reporting high satisfaction from their involvement. All interviewees felt that midwives were well placed to insert implants, and reported that challenges around workload and opportunities for practice were generally manageable. It was recognised that sustainability of the program would require supportive policy and regular insertion opportunities.ConclusionsMidwives successfully upskilled in implant insertions and there was widespread support for the program with expectations it would be sustained. Provision of contraceptive information and implant insertion by midwives in the immediate postpartum period is likely to increase contraceptive choice and access for women and contribute to reducing rapid repeat pregnancies.