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1.
Karen M. Lawford Audrey R. Giles Ivy L. Bourgeault 《Women and birth : journal of the Australian College of Midwives》2018,31(6):479-488
Background
Aboriginal peoples in Canada are comprised of First Nations, Métis, and Inuit. Health care services for First Nations who live on rural and remote reserves are mostly provided by the Government of Canada through the federal department, Health Canada. One Health Canada policy, the evacuation policy, requires all First Nations women living on rural and remote reserves to leave their communities between 36 and 38 weeks gestational age and travel to urban centres to await labour and birth. Although there are a few First Nations communities in Canada that have re-established community birthing and Aboriginal midwifery is growing, most First Nations communities are still reliant on the evacuation policy for labour and birthing services. In one Canadian province, Manitoba, First Nations women are evacuated to The Pas, Thompson, or Winnipeg but most – including all women with high-risk pregnancies – go to Winnipeg.Aim
To contribute scholarship that describes First Nations women’s and community members’ experiences and perspectives of Health Canada’s evacuation policy in Manitoba.Methods
Applying intersectional theory to data collected through 12 semi-structured interviews with seven women and five community members (four females, one male) in Manitoba who had experienced the evacuation policy. The data were analyzed thematically, which revealed three themes: resignation, resilience, and resistance.Findings
The theme of resignation was epitomized by the quote, “Nobody has a choice.” The ability to withstand and endure the evacuation policy despite poor or absent communication and loneliness informed of resilience. Resistance was demonstrated by women who questioned the necessity and requirement of evacuation for labour and birth. In one instance, resistance took the form of a planned homebirth with Aboriginal registered midwives.Conclusion
There is a pressing need to improve the maternity care services that First Nations women receive when they are evacuated out of their communities, particularly when understood from the specific legal and constitutional position of First Nations women in Manitoba. 相似文献2.
Donna Weetra Karen Glover Roxanne Miller Rikki Wilson Cathy Leane Deanna Stuart-Butler Amanda Mitchell Deirdre Gartland Stephanie Brown 《Women and birth : journal of the Australian College of Midwives》2019,32(1):72-79
Background
Aboriginal women and families are under-represented in Australian research on pregnancy and childbirth. The Aboriginal Families Study aimed to investigate the views and experiences of a representative sample of women giving birth to an Aboriginal baby in South Australia between July 2011 and June 2013, using methods designed to respect Aboriginal culture and communities.Methods
A team of 12 Aboriginal researchers facilitated community engagement and recruitment of Aboriginal and non-Aboriginal mothers of Aboriginal infants in urban, regional and remote areas of South Australia over a two-year period.Results
A total of 344 women took part, around a quarter of all Aboriginal women giving birth in South Australia in the study period (39% urban, 35% regional and 25% from remote areas). Participants were representative in relation to maternal age (mean age of 25 years, range = 15–43 years). Over half of women (56%) first heard about the study via a member of the fieldwork team making contact with them through community connections. Other major sources of recruitment were: Aboriginal health services/programs (20%) and public maternity hospitals (16%). Almost all of the women (95%) recruited via community networks of the fieldwork team completed the questionnaire. In contrast, 51% of women recruited via public hospitals completed the questionnaire (odds ratio = 0.1, 95% confidence interval 0.0–0.1, p < 0.001).Conclusions
Aboriginal researchers’ community knowledge and leadership is critical to the conduct of successful Aboriginal health research. High levels of participation in research by ‘harder to reach’ populations are achievable when researchers take time to build relationships and work in partnership with communities. 相似文献3.
Christina M. Bertilone Suzanne P. McEvoy Dena Gower Nola Naylor June Doyle Val Swift-Otero 《Women and birth : journal of the Australian College of Midwives》2017,30(2):121-128
Background
Pregnancy, labour and neonatal health outcomes for Australian Aboriginal women and their infants are frequently worse than those of the general population. Provision of culturally competent services may reduce these differences by improving access to timely and regular antenatal care. In an effort to address these issues, the Aboriginal Maternity Group Practice Program commenced in south metropolitan Perth, Western Australia, in 2011. The program employed Aboriginal Grandmothers, Aboriginal Health Officers and midwives working in a partnership model with pre-existing maternity services in the area.Aim
To identify elements of the Aboriginal Maternity Group Practice Program that contributed to the provision of a culturally competent service.Methods
The Organisational Cultural Competence Assessment Tool was used to analyse qualitative data obtained from surveys of 16 program clients and 22 individuals from partner organisations, and interviews with 15 staff.Findings
The study found that the partnership model positively impacted on the level of culturally appropriate care provided by other health service staff, particularly in hospitals. Two-way learning was a feature. Providing transport, team home visits and employing Aboriginal staff improved access to care. Grandmothers successfully brought young pregnant women into the program through their community networks, and were able to positively influence healthy lifestyle behaviours for clients.Conclusion
Many elements of the Aboriginal Maternity Group Practice Program contributed to the provision of a culturally competent service. These features could be considered for inclusion in antenatal care models under development in other regions with culturally diverse populations. 相似文献4.
Karen Adams Shannon Faulkhead Rachel Standfield Petah Atkinson 《Women and birth : journal of the Australian College of Midwives》2018,31(2):81-88
Background
The 2007 United Nations Declaration on the Rights of Indigenous Peoples states that Indigenous peoples have the right to self-determination for social and cultural development. This fundamental right has been impeded worldwide through colonisation where many Indigenous peoples have had to adapt to ensure continuation of cultural knowledge and practice. In South East Australia colonisation was particularly brutal interrupting a 65,000 year-old oral culture and archives have increasing importance for cultural revival.Aim
The aim of this research was to collate archival material on South East Australian Aboriginal women’s birthing knowledge and practice.Methods
Archivist research methods were employed involving a search for artefacts and compiling materials from these into a new collection. This process involved understanding the context of the artefact creation. Collaborative yarning methods were used to reflect on materials and their meaning.Findings
Artefacts found included materials written by non-Aboriginal men and women, materials written by Aboriginal women, oral histories, media reports and culturally significant sites. Material described practices that connected birth to country and the community of the women and their babies. Practices included active labour techniques, pain management, labour supports, songs for labour, ceremony and the role of Aboriginal midwives. Case studies of continuing cultural practice and revival were identified.Conclusion
Inclusion of Aboriginal women’s birthing practices and knowledge is crucial for reconciliation and self-determination. Challenging the colonisation of birthing, through the inclusion of Aboriginal knowledge and practice is imperative, as health practices inclusive of cultural knowledge are known to be more effective. 相似文献5.
6.
Bec Jenkinson Sue Kruske Sue Kildea 《Women and birth : journal of the Australian College of Midwives》2018,31(6):433-441
Background
The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care.Objectives
We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal. We term this the Personalised Alternative Care and Treatment framework.Discussion
The Personalised Alternative Care and Treatment framework addresses Australian policy, practice, education and professional issues to underpin woman-centred care in the context of maternal refusal. It embeds Respectful Maternity Care in system-level maternity care policy; highlights the woman’s role as decision maker about her maternity care; documents information exchanged with women; creates a ‘living’ plan that respects the woman’s birth intentions and can be reviewed as circumstances change; enables communication between clinicians; permits flexible initiation pathways; provides for professional education for clinicians, and incorporates a mediation role to act as a failsafe.Conclusion
The Personalised Alternative Care and Treatment framework has the potential to meet the needs of women, clinicians and health services when pregnant women decline recommended maternity care. 相似文献7.
8.
9.
Lindsay Cole Amanda LeCouteur Rebecca Feo Hannah Dahlen 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e95-e101
Problem
Studies of women’s childbirth preferences repeatedly show that natural birth remains highly valued, yet the majority of births involve some form of medical intervention. Reasons for this lack of correspondence have typically been investigated through interviews and focus-groups with women. Relatively little research explores the ways in which women describe their experiences of childbirth outside of such research settings.Background
Most maternity services promote woman-centred care, whereby women are encouraged to take active roles in deciding how to give birth. However, recent research indicates that women often report feeling disempowered during labour and birth in hospital settings.Aim
We sought to examine how women account for use of medical intervention in hospitals by examining narratives posted on online discussion forums.Method
A thematic analysis of 106 publically available birth stories, sourced using the Internet search terms ‘birth story’, and ‘birth narrative’, was undertaken.Findings
Medical interventions in childbirth were routinely described as unwanted, yet as unavoidable, and two types of account were typically drawn on to explain their use: Protection of the baby/mother; and inflexible hospital policy/practice. We examine these two types of account, focusing on how their design oriented to the discordance between mothers’ reported desires for a natural birth, and their experiences in hospital.Conclusion
The experience of medical intervention in childbirth is routinely oriented to as a matter that requires explanation or account in online birth narratives. Women repeatedly referred to their preference to avoid intervention, but described being unable to do so in hospital. 相似文献10.
Sophie D. Hickey Sarah-Jade Maidment Kayla M. Heinemann Yvette L. Roe Sue V. Kildea 《Women and birth : journal of the Australian College of Midwives》2018,31(4):263-268
Problem
There is increasing demand for capacity building among the Aboriginal and Torres Strait Islander (Indigenous) maternal and infant health workforce to improve health outcomes for mothers and babies; yet few studies describe the steps taken to mentor novice Indigenous researchers to contribute to creating a quality evidence-base in this space.Background
The Indigenous Birthing in an Urban Setting study is a partnership project aimed at improving maternity services for Indigenous families in South East Queensland.Aim
To describe our experience setting up a Participatory Action Research team to mentor two young Indigenous women as research assistants on the Indigenous Birthing in an Urban Setting study.Methods
Case study reflecting on the first six months.Findings
Participatory Action Research was a very effective method to actively mentor and engage all team members in reflective, collaborative research practice, resulting in positive changes for the maternity care service. The research assistants describe learning to conduct interviews and infant assessments, as well as gaining confidence to build rapport with families in the study. Reflecting on the stories shared by the women participating in the study has opened up a whole new world and interest in studying midwifery and child health after learning the difficulties and strengths of families during pregnancy and beyond.Discussion
We encourage others to use Participatory Action Research to enable capacity building in the Aboriginal and Torres Strait Islander midwifery workforce and in health research more broadly. 相似文献11.
Elizabeth C. Rigg Virginia Schmied Kath Peters Hannah G. Dahlen 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e77-e87
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.Aim
To explore the role, practice and training of unregulated birthworkers in Australian and establish what they would do if legislation prohibited their practice.Methods
This study used a mixed methods sequential exploratory design to explore the practice, training and role of unregulated birthworkers in Australia. In phase one, four unregulated birthworkers were interviewed in-depth and the findings informed the development of a survey in phase two. This was distributed nationally through two consumer websites, social media, Facebook and email. Data from both phases were integrated.Findings
Unregulated birthworkers in Australia provide homebirth services to women with high and low-risk pregnancies when this choice is unavailable or unacceptable within mainstream services. They operate covertly to protect their practice and avoid the scrutiny of authorities. Unregulated birthworkers can be experienced and trained in childbirth care and practice, much like a midwife working within a holistic paradigm of care.Conclusion
Unregulated birthworkers believe they provide women with the homebirth service they want but cannot access. Mainstream service providers need to listen to consumer criticisms, as women seek answers outside the system. Change is needed to improve and align services with women’s expectations of homebirth. 相似文献12.
Megan Cooper Helen McCutcheon Jane Warland 《Women and birth : journal of the Australian College of Midwives》2017,30(5):431-441
Background
Accessibility of water immersion for labour and/or birth is often dependent on the care provider and also the policies/guidelines that underpin practice. With little high quality research about the safety and practicality of water immersion, particularly for birth, policies/guidelines informing the practice may lack the evidence necessary to ensure practitioner confidence surrounding the option thereby limiting accessibility and women’s autonomy.Aim
The aims of the study were to determine how water immersion policies and/or guidelines are informed, who interprets the evidence to inform policies/guidelines and to what extent the policy/guideline facilitates the option for labour and birth.Method
Phase one of a three-phase mixed-methods study critically analysed 25 Australian water immersion policies/guidelines using critical discourse analysis.Findings
Policies/guidelines pertaining to the practice of water immersion reflect subjective opinions and views of the current literature base in favour of the risk-focused obstetric and biomedical discursive practices. Written with hegemonic influence, policies and guidelines impact on the autonomy of both women and practitioners.Conclusion
Policies and guidelines pertaining to water immersion, particularly for birth reflect opinion and varied interpretations of the current literature base. A degree of hegemonic influence was noted prompting recommendations for future maternity care policy and guidelines’.Ethical considerations
The Human Research Ethics Committee of the University of South Australia approved the research. 相似文献13.
14.
Christine A. Marsh Jenny Browne Jan Taylor Deborah Davis 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e1-e11
Background
Being involved in any child protection system is complex and multifaceted and none more so than in non-voluntary Assumption of Care which occurs in New South Wales when, for child protection concerns, the Department of Family and Community Services removes a newborn baby from her/his mother.Objective
This research studied childbearing women’s and professionals’ experiences of Assumption of Care at birth to increase understanding of individual participants’ stories, how they made sense of meanings and how these experiences framed their lives.Method
A narrative inquiry framework guided interviews with four groups: childbearing women, midwives, social workers and Family and Community Services case managers. Holistic form was used for reading, interpreting and analysing the narratives.Findings
This research found unwanted emotional (isolation, shame, guilt, loss, disenfranchised grief) and physical consequences (depression, substance abuse complications) for women experiencing an Assumption of Care at the time of birth. There were also conflicting ethical and moral positions for the professionals involved. The use/abuse of power, concealment of facts and disenfranchised grief were identified as intertwined plots that caused or increased tensions.Discussion
Both the women and the professionals felt pressure from trying to achieve competing and overlapping roles. The unwanted effects of Assumption of Care are exacerbated by the current child protection and maternity care systems.Conclusion
To address the tensions raised in this study, we suggest a two-fold change to maternity care for women at risk of an Assumption of Care: a therapeutic justice model of maternity care and continuity of midwifery care with a dedicated midwife. Introducing these changes could increase women’s and children’s safety and wellbeing. 相似文献15.
Laura Y. Whitburn Lester E. Jones Mary-Ann Davey Susan McDonald 《Women and birth : journal of the Australian College of Midwives》2019,32(1):28-38
Background
The pain experience associated with labour is complex. Literature indicates psychosocial and environmental determinants of labour pain, and yet methods to support women usually target physiological attributes via pharmacological interventions.Aim
To provide an update of our understanding of labour pain based on modern pain science. The review aims to help explain why women can experience labour pain so differently — why some cope well, whilst others experience great suffering. This understanding is pertinent to providing optimal support to women in labour.Method
A literature search was conducted in databases Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO, using search terms labor/labour, childbirth, pain, experience and perception. Thirty-one papers were selected for inclusion.Findings
Labour pain is a highly individual experience. It is a challenging, emotional and meaningful pain and is very different from other types of pain. Key determinants and influences of labour pain were identified and grouped into cognitive, social and environmental factors.Conclusion
If a woman can sustain the belief that her pain is purposeful (i.e. her body working to birth her baby), if she interprets her pain as productive (i.e. taking her through a process to a desired goal) and the birthing environment is safe and supportive, it would be expected she would experience the pain as a non-threatening, transformative life event. Changing the conceptualisation of labour pain to a purposeful and productive pain may be one step to improving women’s experiences of it, and reducing their need for pain interventions. 相似文献16.
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17.
Emma L. Kingwell Janice Butt Gavin Leslie 《Women and birth : journal of the Australian College of Midwives》2017,30(2):e73-e77
Background
Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable.Introduction
Rising levels of maternal morbidity from non-obstetric causes have led midwives to work with women who require highly complex care, beyond the standard customary midwifery role. Whilst the nursing profession has developed and refined its expertise as a specialty in the field of high-dependency care, the midwifery profession has been less likely to pursue this as a specific area of practice.Discussion
This paper explores the literature surrounding maternity high-dependency care. From the articles reviewed, four key themes emerge which include; the need for maternity high-dependency care, maternal morbidity and maternity high-dependency care, the role of the midwife and maternity high-dependency care and midwifery education and preparation for practice. It highlights the challenges that health services are faced with in order to provide maternity high-dependency care to women. Some of these challenges include resourcing and budgeting limitations, availability of educators with the expertise to train staff, and the availability of suitably trained staff to care for the women when required.Conclusion
In order to provide maternity high-dependency care, midwives need to be suitably equipped with the knowledge and skills required to do so. 相似文献18.
Ling-ling Gao Hong Lu Nicky Leap Caroline Homer 《Women and birth : journal of the Australian College of Midwives》2019,32(2):e279-e283
Background
With the recent surging economic and social development in China, midwifery has undergone transformation.Aim
A narrative review of literature relating to midwifery in mainland China was undertaken to examine the characteristics of midwifery’s potential development within relevant historical, economic and sociopolitical contexts. The aim was to assist future planning and the setting of strategic directions in policy in China.Methods
Online bibliographic databases from 2000 to 2015 were searched including MEDLINE, WanFang Data and Chinese National Knowledge Infrastructure. A process of narrative synthesis was used to analyse the selected papers and major issues were identified.Results
Twenty-one papers were included in the review. Two overarching issues were identified in relation to midwifery in mainland China: the history and status of midwifery education; and the practice and regulation of the midwifery profession. In recent decades, midwifery education, regulation and practice have occurred within systems that view midwifery as a specialisation of nursing. This means that there continues to be little opportunity for midwives to practise according to the international definition and scope of practice of the midwife.Conclusion
Midwifery in China must continue to develop in parallel with international trends. Investment in midwifery education alone will not suffice; it will have to operate within strong government policy regarding regulation, effective human resources management, visibility of the role of the midwife and development of the service delivery environment in which future midwives will work in China. 相似文献19.
Kiri A. Latuskie Naomi C.Z. Andrews Mary Motz Tom Leibson Zubin Austin Shinya Ito Debra J. Pepler 《Women and birth : journal of the Australian College of Midwives》2019,32(1):e57-e64
Background
Substance use during pregnancy is a major public health concern, stemming from potential physical and psychosocial harms to both the mother and child.Purpose
To understand women’s experiences using substances during pregnancy and the reasons that women continue and/or discontinue using substances.Methods
Focus groups were conducted with women who attended an early intervention program for pregnant or parenting women with substance use issues.Results
Women identified that external and internal stressors, feelings of guilt and low-self efficacy, and a lack of understanding of the scientific and medical consequences of substance use contributed to their continued substance use. Conversely, women highlighted the importance of high self-efficacy and the quality of relationships when trying to make positive changes to their substance use during pregnancy.Conclusions
Recommendations are proposed for easier access to and more comprehensive services. Healthcare professionals and service providers should offer non-judgmental care by building high-quality relationships with pregnant women with substance use issues, to increase these women’s self-efficacy and empower them to discontinue substance use. 相似文献20.
Cath Rogers Laurence Lepherd Rahul Ganguly Sebastian Jacob-Rogers 《Women and birth : journal of the Australian College of Midwives》2017,30(2):e89-e95