Australian women's experiences of living with gestational diabetes

PurposeThe purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM.MethodsParticipants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes.ResultsOf 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p = 0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p = 0.061). Those diagnosed with GDM in a previous pregnancy (p = 0.034) and younger women (p = 0.054) were less likely to view the diagnosis as an opportunity to improve their health.ConclusionsThis study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.     

Women's access needs in maternity care in rural Tasmania,Australia: A mixed methods study

ObjectivesThis study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services.MethodsA mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care.FindingsThe survey was completed by n = 210 women, with a response rate of 35%, with n = 22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs.ConclusionThe study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families.     

The impact of routine assessment of past or current mental health on help-seeking in the perinatal period

BackgroundClinical practice guidelines now recommend that women be asked about their past or current mental health as a routine component of maternity care. However, the value of this line of enquiry in increasing engagement with support services, as required, remains controversial.AimThe current study aimed to examine whether assessment of past or current mental health, received with or without referral for additional support, is associated with help-seeking during pregnancy and the postpartum.MethodsA subsample of women drawn from the Australian Longitudinal Study on Women's Health (young cohort) who reported experiencing significant emotional distress during pregnancy (N = 398) or in the 12 months following birth (N = 380) participated in the study.ResultsMultivariate analysis showed that women who were not asked about their emotional health were less likely to seek any formal help during both pregnancy (adjOR = 0.09, 95%CI: 0.04–0.24) and the postpartum (adjOR = 0.07, 95%CI: 0.02–0.13), as were women who were asked about these issues but who were not referred for additional support (antenatal: adjOR = 0.26, 95%CI: 0.15–0.45; postnatal: adjOR = 0.14, 95%CI: 0.07–0.27). However, considerable levels of consultation with general practitioners, midwives and child health nurses, even in the absence of referral, were evident.ConclusionThis study demonstrates that enquiry by a health professional about women's past or current mental health is associated with help-seeking throughout the perinatal period. The clinical and resource implications of these findings for the primary health care sector should be considered prior to the implementation of future routine perinatal depression screening or psychosocial assessment programmes.     

When it hurts I think: Now the baby dies. Risk perceptions of physical activity during pregnancy

BackgroundA decrease in the level of physical activity from pre-pregnancy to pregnancy seems to be a general problem, despite the obvious health benefits of physical activity. Quantitative studies indicate that pregnant women's fears might explain why they reduce their level of physical activity, but still no qualitative research has investigated the experiences influencing these women.QuestionTo explore healthy women's perceptions of risk associated with physical activity during pregnancy.MethodAn interpretive narrative approach was used to gain insight into pregnant women's personal stories and lived experiences. Five Danish pregnant women aged 26–36 years participated in semi-structured, in-depth interviews between September and December 2010. The analysis method was based on two types of narrative inquiry: (1) a narrative analysis to cover the story, and (2) a paradigmatic analysis to cover the themes.FindingsMost of the pregnancy stories highlighted a specific experience, which made the women anxious. These experiences were: previous miscarriages, fertility treatment and shortened cervix. Also bodily challenges and pain scared the women, such as hypertonic pelvic muscles, Braxton Hicks contractions, abdominal pain, exhaustion, and shortness of breath. The stories also described the impacts of women's relatives and friends on their perceptions of risk.ConclusionSpecial consideration should be given to pregnant women who have had negative experiences in previous pregnancies and bodily challenges, which make them anxious and discourage them from being physically active. Healthcare professionals could also pay attention to the fact that women's relatives and friends play a major role in women's perceptions of risk.     

Unintended pregnancy and intimate partner violence around pregnancy in a population-based study

BackgroundIntimate partner violence (IPV) and unintended pregnancy are public health issues that can affect the health and well-being of women and their children. However, the relationship between IPV and women's ability to control their fertility has not been adequately explored.AimTo investigate the association between unintended pregnancy and emotional or physical violence perpetrated by partners around pregnancy.MethodsA population-based study was undertaken, recruiting women (n = 779) at the hospital obstetric departments and gathering social and family data. IPV was diagnosed by using the Index of Spouse Abuse (ISA). Data were gathered by trained midwives in 15 public hospitals in southern Spain and multivariate logistic regression analysis was performed.FindingsThe pregnancy was reported to be unintended by 118 (15.1%) of the study population. Unintended pregnancy was significantly associated with: physical and/or emotional IPV around pregnancy, age, marital status, cohabitation, educational level, and employment status. After adjusting for socio-demographic characteristics, emotional IPV around pregnancy was significantly associated with an unintended pregnancy (AOR = 2.5; 95% CI = 1.5–4.3). Being in a non-committed relationship was a risk factor (AOR = 3.5; 95% CI = 1.8–6.1) and being in employment a protective factor (AOR = 0.4; 95% CI = 0.2–0.8) for an unintended pregnancy.ConclusionWomen who report an unintended pregnancy may be experiencing emotional IPV. The risk of emotional IPV is higher if women reporting an unintended pregnancy are in a committed relationship, married, or in employment. A better understanding of the relationship between unintended pregnancy and violence can aid midwives about potential reproductive health risk factors associated with abuse.     

Women's frequency of alcohol consumption prior to pregnancy and at their pregnancy-booking visit 2001–2006: A cohort study

BackgroundWith evidence of offspring harms and concern for younger women's drinking behaviours, this study uses a hospital cohort to trend the use and changes in women's reported alcohol consumption.AimsTo examine (i) the trend of women's reported alcohol consumption over time, (ii) whether any increases in the frequency of alcohol consumption prior to a pregnancy are accompanied by increases in the frequency of alcohol consumption in pregnancy and (iii) the characteristics of women consuming alcohol at these times.MethodsMidwives collected routine data on 19,699 women between 2001 and 2006. Data on women's alcohol use prior to pregnancy and at their pregnancy-booking visit were analysed using a non-parametric test for trend and with bivariate and multivariate tests adjusting for possible confounders.FindingsThe proportion of women reporting at-least weekly alcohol use prior to pregnancy was 25.4% and 5.9% at their pregnancy-booking visit. A significant linear increase over time (p < 0.001) was found in the rate of women aged 20 years and older reporting at-least weekly alcohol use prior to pregnancy. Tertiary-educated women were more likely to consume alcohol at-least weekly prior to pregnancy. Women aged less than 20 years were less likely to report at-least weekly alcohol use at both time points. Having more children and Asian ethnicity were associated with a lower risk of at-least weekly alcohol use at these times.ConclusionThe majority of women reduce their alcohol consumption once they learn they are pregnant, with some evidence this trend may have increased in recent years.     

Changing the risky beliefs of post-partum women about therapeutic sun-exposure

BackgroundMany post-partum women hold risky beliefs about perceived therapeutic benefits of sun-exposure in the post-partum period and infancy.QuestionCan a maternity hospital based educational intervention reduce the prevalence of such beliefs among post-partum women?MethodsIn this outcome evaluation of an interventional study, two groups of healthy post-partum women (hospital inpatients) were interviewed, 1–4 days following delivery. The first cross-section (106 women) was recruited prior to in-services for maternity staff; the second (203 women) was recruited after completion of the in-services. Data were compared between the groups.FindingsMore pre-intervention than post-intervention women reported they would expose their baby to sunlight to treat suspected jaundice (28.8% vs 13.3%; p < 0.001) or help his/her skin adapt to the sun (10.5% vs 2.5%; p = 0.003); or use sunlight to manage breastfeeding-associated sore/cracked nipples (7.6% vs 2%; p = 0.026).ConclusionThis simple, effective educational intervention could be implemented in programmes for parents, health professionals and students.     

Putting evidence into practice: A quality activity of proactive pain relief for postpartum perineal pain

BackgroundPerineal pain associated with perineal trauma is often underestimated. Offering regular pain relief may be advantageous compared to waiting for women to request it. Changing clinical practice in a sustained way needs a whole of team approach.AimTo reduce women's pain following perineal trauma in the first 48 h following childbirth and to undertake this as multidisciplinary, quality activity.MethodsIn November 2008 a questionnaire was distributed to 18 new mothers who had sustained perineal trauma during the birth in order to assess pain levels in the first 48 h and to investigate pain management therapies used. Following this survey a multidisciplinary project team undertook a series of brainstorming sessions, reviewed the literature and undertook staff surveys to identify key factors impacting on women's perineal pain. A process of decision making led to education and support of women and staff. An evidence based guideline, which involved prescribing regular pain relief for women and offering an ice pack within 1 h of giving birth was implemented, and a brochure was designed for women. A follow up questionnaire was distributed in June 2010 to 18 women and pain scores before and after the change in policy were compared.ResultsPrior to the practice change in 2008 67% of the women surveyed rated their pain as ‘moderate’ to ‘a lot’ 48 h following the birth. Following the change in practice and implementation of a new guideline a second survey in 2010 at 48 h postpartum found 60% of women in the post intervention group rated their perineal pain as ‘a lot’ to ‘moderate’. There had been a 33% increase in women's use of pain relief options compared to the pre-intervention survey. The practice change was sustained and adopted by all the staff.ConclusionBy taking a multidisciplinary quality activity an effective practice change was facilitated that appeared to decrease women's perineal pain in the 48 h following birth.     

Midwives’ self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey

BackgroundLittle is known about midwives’ knowledge and skills to assess and promote maternal health literacy.AimsTo test the reliability and validity of a new tool to assess midwives’ health literacy knowledge, skills and attitudes.MethodsUsing a cross-sectional design, midwives were recruited through professional and social media networks. The online survey included demographic and professional questions and a new measure on midwives’ health literacy knowledge, skills and attitudes. Convergent validity was assessed using ten items from the Caring Assessment Scale. Perceived barriers to promoting maternal health literacy were sought.FindingsThree hundred and seven participants completed the survey. A two-factor solution accounted for 41% of variance and resulted in 14 items, including all attitude items, being removed. Cronbach’s alpha reliability was acceptable (Skills = .76; Knowledge = .66). Convergent validity was established. Most midwives (77.1%, n = 221) reported giving limited attention to formally assessing women’s health literacy. Between 30 to 60% of midwives never or only sometimes used specific techniques to promote maternal health literacy. Most (75%, n = 201) had not received education about health literacy.Discussion and ConclusionsThe new Transforming Maternity Care Collaborative Health Literacy tool was valid and reliable. Few midwives formally assessed or promoted women’s health literacy. Midwives require education about maternal health literacy assessment and promotion to ensure women understand information being conveyed. A large national survey of midwives using the new tool is recommended.     

‘I really needed help’: What mothers say about their post-birth care in Queensland,Australia

BackgroundAustralian mothers consistently rate postnatal care as the poorest aspect of their maternity care, and researchers and policymakers have widely acknowledged the need for improvement in how postnatal care is provided.AimTo identify and analyse mothers’ comments about postnatal care in their free text responses to an open ended question in the Having a Baby in Queensland Survey, 2010, and reflect on their implications for midwifery practice and maternity service policies.MethodsThe survey assessed mothers’ experiences of maternity care four months after birth. We analysed free-text data from an open-ended question inviting respondents to write ‘anything else you would like to tell us’. Of the final survey sample (N = 7193), 60% (N = 4310) provided comments, 26% (N = 1100) of which pertained to postnatal care. Analysis included the coding and enumeration of issues to identify the most common problems commented on by mothers. Comments were categorised according to whether they related to in-hospital or post-discharge care, and whether they were reported by women birthing in public or private birthing facilities.ResultsThe analysis revealed important differences in maternal experiences according to birthing sector: mothers birthing in public facilities were more likely to raise concerns about the quality and/or duration of their in-hospital stay than those in private facilities. Conversely, mothers who gave birth in private facilities were more likely to raise concerns about inadequate post-discharge care. Regardless of birthing sector, however, a substantial proportion of all mothers spontaneously raised concerns about their experiences of inadequate and/or inconsistent breastfeeding support.ConclusionWomen who birth in private facilities were more likely to spontaneously report concerns about their level of post-discharge care than women from public facilities in Queensland, and publically provided community based care is not sufficient to meet women's needs. Inadequate or inconsistent professional breastfeeding support remains a major issue for early parenting women regardless of birthing sector.     

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.     

Comparison of breastfeeding in rural areas of Sweden and Australia – a cohort study

BackgroundBreastfeeding rates in Sweden and Australia appears to be decreasing in both countries. National statistics shows that 87% of infants in Sweden and 73% in Australia receive any breastfeeding two months of age.AimTo compare women's experiences of breastfeeding in Sweden and Australia and to identify factors associated with breastfeeding two months after birth.MethodsA cohort study in two rural hospitals in mid Sweden (n = 300) and north-eastern Victoria in Australia (n = 91) during 2007–2009. Participants responded to questionnaires in mid pregnancy and two months after birth. Crude and adjusted odds ratios with a 95% confidence interval were used to detect differences between women in both cohorts.FindingsWomen in Sweden (88.3%) were more likely to report any breastfeeding of the baby two months after birth (OR 2.41; 95% CI: 1.33–4.38) compared to women in Australia (75.8%) but were less satisfied with breastfeeding support and information. The most important factor associated with breastfeeding at two months postpartum for the Swedish women was to have received sufficient information about breastfeeding on the postnatal ward (OR 2.3; 95% CI 1.41–4.76) while for the Australian women receiving the best possible help when breastfeeding for the first time was most important (OR 4.3; 95% CI 1.50–12.46).ConclusionThe results indicate that Swedish women were more likely than their Australian counterparts to breastfeed the baby two months after birth. The findings demonstrated the importance of sufficient information and help when breastfeeding is initiated.     

Prenatal stress,health, and health behaviours during the COVID-19 pandemic: An international survey

BackgroundPregnant women’s stress, mental and physical health, and health behaviours can have important implications for maternal and child health outcomes.AimTo examine pregnant women’s levels of stress, mental and physical health, and health behaviours during the COVID-19 pandemic.MethodsA cross-sectional survey was conducted online, with recruitment and data collection occurring between 16/6/20 and 17/7/20. Participants were pregnant women recruited via online pregnancy/parenting communities. Participants self-reported their levels of general stress, pregnancy-specific stress and COVID-19 related stress, mental and physical health, general health behaviours, and COVID-19 related health behaviours.Findings573 pregnant women participated in the survey. Participants were most commonly resident in the United States (42.6%, n = 243), Ireland (41.2%, n = 235) or the United Kingdom (10%, n = 57). The majority (80.0%, n = 457) were married and educated to degree level or above (79.3, n = 453). Pregnant women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Encouragingly, pregnant women in this study generally reported high levels of adherence to public health advice and pregnancy health behaviours. Stress and general mental health outcomes were best predicted by well-being factors (including stress and social support). Health impairing behaviours (e.g. poor diet) were predicted by both well-being and demographic factors.DiscussionInterventions targeting pregnancy- and pandemic-specific stress at the population level will be essential to support mental health and minimise adverse outcomes for women and children during the pandemic.     

The comparison of the interpersonal action component of woman-centred care reported by healthy pregnant women in different sized practices in the Netherlands: A cross-sectional study

BackgroundThe number of interventions is lower, and the level of satisfaction is higher among women who receive midwife-led primary care from one or two midwives, compared to more midwives. This suggests that midwives in small-sized practices practice more women-centred. This has yet to be explored.ObjectiveTo examine pregnant women’s perceptions, of the interpersonal action component of woman-centred care by primary care midwives, working in different sized practices.MethodsA cross-sectional study using the Client Centred Care Questionnaire (CCCQ), administered during the third trimester of pregnancy among Dutch women receiving midwife-led primary care from midwives organised in small-sized practices (1−2 midwives), medium-sized (3−4 midwives) and large-sized practices (≥5 midwives). A Welch ANOVA with post hoc Bonferroni correction was performed to examine the differences.Results553 completed questionnaires were received from 91 small-sized practices/104 women, 98 medium-sized practices/258 women and 65 large-sized practices/191 women. The overall sum scores varied between 57–72 on a minimum/maximum scoring range of 15–75. Women reported significantly higher woman-centred care scores of midwives in small-sized practices (score 70.7) compared with midwives in medium-sized practices (score 63.6) (p < .001) and large-sized practices (score 57.9) (p < .001), showing a large effect (d .88; d 1.56). Women reported statistically significant higher woman-centred care scores of midwives in medium-sized practices compared with large-sized practices (p < .001), showing a medium effect (d .69).ConclusionThere is a significant variance in woman-centred care based on women’s perceptions of woman-midwife interactions in primary care midwifery, with highest scores reported by women receiving care from a maximum of two midwives. Although the CCCQ scores of all practices are relatively high, the significant differences in favour of small-sized practices may contribute to moving woman-centred care practice from ‘good’ to ‘excellent’ practice.     

What are the experiences of women with obesity receiving antenatal maternity care? A scoping review of qualitative evidence

ProblemObesity is a major public health problem and is rising in prevalence in child-bearing women. The complications of pregnancy in women with obesity are well documented. Pregnant women with obesity require different maternity care considerations to normal weight women. How women respond to the care of health professionals, determines how likely they will be to engage with it, and thus research into the current care experiences of women with obesity is valuable.ObjectiveThe purpose of this scoping review was to examine the evidence of the antenatal maternity care experiences of women with obesity (BMI ≥ 30 kg/m²).MethodA systematic literature search was conducted for English language publications 2008–2018 using Medline, Scopus, PsycINFO and CINAHL. Following critical appraisal, and a search of the reference lists of primary articles, 17 articles resulted for this review. A thematic synthesis process was used to collate the findings.FindingsFour major themes were identified: 1) inconsistent or absent information regarding weight management, 2) the stigma and stereotyping associated with their obesity, 3) medicalisation and depersonalisation of pregnant women with obesity, and 4) a desire for information and need for change.ConclusionThe findings suggested that based on women’s experiences there is a need for improved education and communication for health care professionals when caring for pregnant women with obesity. Some conflicting information from women in the studies highlight the need for further research in the area, and the implementation of individualised care and continuity of care for pregnant women with obesity.     

Midwives’ insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with ‘high risk’ pregnancies: A qualitative study

ProblemChildbearing women from ethnic minority groups in the United Kingdom (UK) have significantly poorer perinatal outcomes overall.BackgroundChildbearing women from ethnic minority groups report having poorer experiences and outcomes in perinatal care, and health professionals report having difficulty in providing effective care to them. Yet barriers in relation to providing such care remain underreported.AimThe aim of this study was to elicit midwives' insights in relation to the common barriers in providing effective perinatal care to women from ethnic minority groups with 'high risk' pregnancies and how to overcome these barriers.MethodsA qualitative study was undertaken in a single obstetric led unit in London, UK. A thematic analysis was undertaken to identify themes from the data.FindingsA total of 20 midwives participated. They self-identified as White British (n = 7), Black African (n = 7), Black Caribbean (n = 3) and Asian (n = 3). Most (n = 12) had more than 10 years’ experience practising as a registered midwife (range 2 – 35 years). Four themes were identified: 1) Communication, 2) Continuity of carer, 3) Policy and 4) Social determinants. Racism and unconscious bias underpin many of the findings presented.DiscussionCo-created community hubs may improve access to more effective care for childbearing women from ethnic minority groups. A focus on robust anti-racism interventions, continuity of carer, staff wellbeing and education along with the provision of orientation and bespoke translation services are also suggested for the reduction of poorer outcomes and experiences.ConclusionAlong with policies designed to promote equality and irradicate racism, there is a need for co-created community hubs and continuity of carer in perinatal services. Further research is also required to develop and evaluate culturally safe, and evidence-based interventions designed to address the current disparities apparent.