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1.
Birth centres and the national maternity services review: response to consumer demand or compromise?
Dahlen H Jackson M Schmied V Tracy S Priddis H 《Women and birth : journal of the Australian College of Midwives》2011,24(4):165-172
Background
In February 2009 the Improving Maternity Services in Australia – The Report of the Maternity Services Review (MSR) was released and recommended improving women's access to and availability of birth centres. It was unclear if this was in response to an overwhelming request for birth centres in the submissions received by the commonwealth or a compromise for excluding homebirth from the maternity service reforms.Aim
The aim of this paper was to examine what was said in the submissions to the MSR about birth centres.Methods
Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Ageing website. All 832 submissions were downloaded, and read for any mention of the words ‘birth centre’, ‘birth center’. Content analysis was used to categorise and report the data.Results
Of the 832 submissions to the MSR 197 (24%) mentioned birth centres while 470 (60%) of the submissions mentioned homebirth. Only 31 (4%) of the submissions to the Maternity Review mentioned birth centres without mentioning home birth also. Most of the submissions emphasised that ‘everything should be on the menu’ when it came to place of birth and care provider. Reasons for choosing a birth centre were identified as: ‘the best compromise available, ‘the right and natural way’ and ‘the birth centre as safe’. Women had certain requirements of a birth centre that included: ‘continuity of carer’, ‘midwife led’, ‘a sanctum from medicalised care’, ‘resources to cope with demand’, ‘close to home’, and ‘flexible guidelines and admission criteria’. Women weighed up a series of requirements when deciding whether to give birth in a birth centre.Discussion
The recommendation by the MSR to expand birth centres and ignore home birth is at odds with the strong view expressed that ‘everything should be on the menu’. The requirements women described of birth centre care are also at odds with current trends.Conclusion
If there is to be an expansion of birth centres, service providers need to make sure that women's views are central to the design. Women will not cease having homebirths due to expanded birth centre options. 相似文献2.
3.
Robyn E. Thompson Sue V. Kildea Lesley M. Barclay Sue Kruske 《Women and birth : journal of the Australian College of Midwives》2011,24(3):97-104
Background
Low breastfeeding duration rates reflect the pain and distress experienced by many women who discontinue breastfeeding in the early weeks and months of life. This paper explores modern key historical events that have significantly influenced Australian breastfeeding education and practice.Method
Relevant literature reviewed from 1970 to 2010 identified key events that appear to have contributed to the decrease in Australian breastfeeding rates and the increase in women experiencing breastfeeding complications, particularly nipple pain and trauma.Findings and discussion
The rise in institutionalisation and medical intervention in labour and birth has also medicalised midwifery practice. Technocratic intrusion and institutionalised care is contributing to the separation of the mother and newborn at birth. Delayed mother–baby initiation of breastfeeding and interruption of the duration of the first, and subsequent breastfeeds, negatively affects the innate ability of the mother and newborn to establish and sustain breastfeeding. The ‘pathologising’ of breastfeeding that involve midwives teaching women complicated and unnatural breastfeeding techniques interfere with instinctive sensory and mammalian behaviours and further contributes to the high complication rates.Conclusion
Midwives are encouraged to reflect on their role as ‘experts’ in the breastfeeding process and give confidence to women so that they utilise their instinctive ability to breastfeed by self-determined techniques that encourage mammalian skills for newborn sustenance and survival. 相似文献4.
Giulia Corno Ernestina Etchemendy Macarena Espinoza Rocío Herrero Guadalupe Molinari Alba Carrillo Constance Drossaert Rosa Maria Baños 《Women and birth : journal of the Australian College of Midwives》2018,31(1):e1-e8
Background
Detrimental effects of women’s negative feelings during pregnancy have been extensively examined and documented, but research on the influence of positive feelings and protective factors on their prenatal mental health is scarce. Evidence from the positive psychology field has shown that practicing some brief positive exercises, called positive psychology interventions, can maximize well-being by increasing positive emotions, engagement, and meaning.Aim
The aim of this study is to examine the effect of a positive psychology web-based intervention on indices of women’s prenatal well-being.Methods
Specifically, a case series design was adopted, and data from six women are presented. Participants were involved in a 5-week online positive psychology intervention that includes a set of positive psychology interventions specifically adapted for pregnant women. Measures of women’s mental well-being, depression, pregnancy-related anxiety, life satisfaction, and social support were measured at pre- and post-intervention. Compliance with the intervention and exercise preferences were assessed at post-test. Single-item related well-being measures were assessed weekly.Findings and discussion
The findings of this case series study indicate potential effects of the intervention on supporting mental well-being and decreasing depressive symptomatology in these pregnant women. Furthermore, this study provides some suggestions for developing future online-based positive interventions addressed to pregnant women. However, these findings are preliminary, and future studies are needed in order to assess the effects of the intervention in a wider population of pregnant women. 相似文献5.
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6.
Ingegerd Hildingsson Helen Haines Annika Karlström Astrid Nystedt 《Women and birth : journal of the Australian College of Midwives》2017,30(5):e242-e247
Background
The prevalence of fear of birth has been estimated between 8–30%, but there is considerable heterogeneity in research design, definitions, measurement tools used and populations. There are some inconclusive findings about the stability of childbirth fear.Aim
to assess the prevalence and characteristics of women presenting with scores ≥60 on FOBS-The Fear of Birth Scale, in mid and late pregnancy, and to study change in fear of birth and associated factors.Methods
A prospective longitudinal cohort study of a one-year cohort of 1212 pregnant women from a northern part of Sweden, recruited in mid pregnancy and followed up in late pregnancy. Fear of birth was assessed using FOBS-The fear of birth scale, with the cut off at ≥60.Findings
The prevalence of fear of birth was 22% in mid pregnancy and 19% in late pregnancy, a statistically significant decrease. Different patterns were found where some women presented with increased fear and some with decreased fear. The women who experienced more fear or less fear later in pregnancy could not be differentiated by background factors.Conclusions
More research is needed to explore factors important to reduce fear of childbirth and the optimal time to measure it. 相似文献7.
Wendy L.M. Franks Kenda E. Crozier Bridget L.M. Penhale 《Women and birth : journal of the Australian College of Midwives》2017,30(4):e179-e187
Background/objectives
British public health and academic policy and guidance promotes service user involvement in health care and research, however collaborative research remains underrepresented in literature relating to pregnant women’s mental health. The aim of this participatory research was to explore mothers’ and professionals’ perspectives on the factors that influence pregnant women’s mental health.Method
This qualitative research was undertaken in England with the involvement of three community members who had firsthand experience of mental health problems during pregnancy. All members of the team were involved in study design, recruitment, data generation and different stages of thematic analysis. Data were transcribed for individual and group discussions with 17 women who self-identified as experiencing mental health problems during pregnancy and 15 professionals who work with this group. Means of establishing trustworthiness included triangulation, researcher reflexivity, peer debriefing and comprehensive data analysis.Findings
Significant areas of commonality were identified between mothers’ and professionals’ perspectives on factors that undermine women’s mental health during pregnancy and what is needed to support women’s mental health. Analysis of data is provided with particular reference to contexts of relational, systemic and ecological conditions in women’s lives.Conclusions
Women’s mental health is predominantly undermined or supported by relational, experiential and material factors. The local context of socio-economic deprivation is a significant influence on women’s mental health and service requirements. 相似文献8.
9.
Sarah E. Bledsoe Cynthia F. Rizo Traci L. Wike Candace Killian-Farrell Julia Wessel Anne-Marie O. Bellows Alison Doernberg 《Women and birth : journal of the Australian College of Midwives》2017,30(5):e248-e257
Problem
Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes.Background
However, few pregnant adolescent women with depression receive psychiatric services, especially low-income or racial/ethnic minority adolescent women.Aim
This qualitative study explores perceptions of depression, psychiatric services, and barriers to accessing services in a sample of low-income, pregnant racial/ethnic minority adolescent women. Our goal was to better understand the experiences of depression during pregnancy for these vulnerable adolescent women, and thereby improve their engagement and retention in services for perinatal depression.Methods
We recruited 20 pregnant adolescent women who screened positive for depression from 2 public health prenatal clinics in the southeastern United States. Participants were low-income and primarily racial/ethnic minority women between 14 and 20 years old. Data were collected through individual in-depth, ethnographically informed interviews.Findings
Generally, participants lacked experience with psychiatric services and did not recognize their symptoms as depression. However, participants perceived a need for mood improvement and were interested in engaging in services that incorporated their perspective and openly addressed stigma.Discussion
Participants reported practical and psychological barriers to service engagement, but identified few cultural barriers. Family perceptions of psychiatric services served as both a barrier and support.Conclusion
Adolescent women are more likely to engage in psychiatric services if those services reduce practical and psychological barriers, promise relief from the symptoms perceived as most meaningful, and address underlying causes of depression. Culture may affect Latina adolescent women’s perceptions of depression and services. 相似文献10.
Angela L. Todd Lillian Y. Zhang Amina Z. Khambalia Christine L. Roberts 《Women and birth : journal of the Australian College of Midwives》2017,30(2):e78-e82
Background
Estimated date of birth (EDB) is used to guide the care provided to women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined.Aims
To explore women’s expectations of giving birth on or near their EDB, and their attitudes to alternative estimates for timing of birth.Methods
A survey of pregnant women attending four public hospitals in Sydney, Australia, between July and December 2012.Results
Among 769 surveyed women, 42% expected to birth before their due date, 16% after the due date, 15% within a day or so of the due date, and 27% had no expectations. Nulliparous women were more likely to expect to give birth before their due date. Women in the earlier stages of pregnancy were more likely to have no expectations or to expect to birth before the EDB while women in later pregnancy were more likely to expect birth after their due date. For timing of birth information, only 30% of women preferred an EDB; the remainder favoured other options.Conclusions
Most women understood the EDB is imprecise. The majority of women expressed a preference for timing of birth information in a format other than an EDB. In support of woman-centred care, clinicians should consider discussing other options for estimated timing of birth information with the women in their care. 相似文献11.
Dahlen H Schmied V Tracy SK Jackson M Cummings J Priddis H 《Women and birth : journal of the Australian College of Midwives》2011,24(4):148-155
Background
In February 2009 the Improving Maternity Services in Australia – The Report of the Maternity Services Review (MSR) was released, with the personal stories of women making up 407 of the more than 900 submissions received. A significant proportion (53%) of the women were said to have had personal experience with homebirth. Little information is provided on what was said about homebirth in these submissions and the decision by the MSR not to include homebirth in the funding and insurance reforms being proposed is at odds with the apparent demand for this option of care.Method
Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Aging website. All 832 submissions were downloaded, coded and then entered into NVivo. Content analysis was used to analyse the data that related to homebirth.Findings
450 of the submissions were from consumers of maternity services (54%). Four hundred and seventy (60%) of the submissions mentioned homebirth. Overall there were 715 references to home birth in the submissions. The submissions mentioning homebirth most commonly discussed the ‘Benefits’ and ‘Barriers’ in accessing this option of care. Benefits to the baby, mother and family were described, along with the benefits obtained from having a midwife at the birth, receiving continuity of care and having a good birth experience. Barriers were described as not having access to a midwife, no funding, no insurance and lack of clinical privileging for midwives.Conclusion
Many positive recommendations have come from the MSR, however the decision to exclude homebirth from these reforms is perplexing considering the large number of submissions describing the benefits of and barriers to homebirth in Australia. A concerning number of submissions discuss having had or having considered an unattended birth at home due to these barriers. Overall there is the belief that not enabling access to funded, insured homebirth in Australia is a violation of human rights. It appears that homebirth was considered by the MSR as ‘too hot to handle’ and by dismissing it as a minority issue the government sought to avoided dealing with homebirth as a ‘sensitive and controversial issue.’ 相似文献12.
Sigridur Sia Jonsdottir Marga Thome Thora Steingrimsdottir Linda Bara Lydsdottir Jon Fridrik Sigurdsson Halldora Olafsdottir Katarina Swahnberg 《Women and birth : journal of the Australian College of Midwives》2017,30(1):e46-e55
Background
It is inferred that perinatal distress has adverse effects on the prospective mother and the health of the foetus/infant. More knowledge is needed to identify which symptoms of perinatal distress should be assessed during pregnancy and to shed light on the impact of women’s satisfaction with their partner relationship on perinatal distress.Aim
The current study aimed to generate knowledge about the association of the partner relationship and social support when women are dealing with perinatal distress expressed by symptoms of depression, anxiety and stress.Methods
A structured interview was conducted with 562 Icelandic women who were screened three times during pregnancy with the Edinburgh Depression Scale and the Depression, Anxiety, Stress Scale. Of these, 360 had symptoms of distress and 202 belonged to a non-distress group. The women answered the Multidimensional Scale of Perceived Social Support and the Dyadic Adjustment Scale. The study had a multicentre prospective design allowing for exploration of association with perinatal distress.Findings
Women who were dissatisfied in their partner relationship were four times more likely to experience perinatal distress. Women with perinatal distress scored highest on the DASS Stress Subscale and the second highest scores were found on the Anxiety Subscale.Conclusion
Satisfaction in partner relationship is related to perinatal distress and needs to be assessed when health care professionals take care of distressed pregnant women, her partner and her family. Assessment of stress and anxiety should be included in the evaluation of perinatal distress, along with symptoms of depression. 相似文献13.
Lynne Staff Meredith Nash 《Women and birth : journal of the Australian College of Midwives》2017,30(5):354-360
Aim
To discuss corporeal support of the brain-dead pregnant woman and to critically examine important aspects of this complex situation that remain as yet unexplored.Background
When brain death of the woman occurs during pregnancy, the fetus may be kept inside the corporeally supported body for prolonged periods to enable continued fetal growth and development. This has been increasingly reported in medical literature since 1982 and has received considerable media attention in the past few years.Implications for midwives and nurses
Sophisticated advances in medical technologies have altered the boundaries of conception and birth, life and death, Western biomedical and cultural conceptions of women and their bodies, fetal personhood, fetal rights and fetal patienthood, profoundly influencing maternal behaviors, medical decisions and the treatment of pregnant women. This is especially so in the rare, but fraught instance of brain death of the pregnant woman, where nurses and midwives working in High Dependency Care units undertake the daily care of the corporeally supported body that holds a living fetus within it. This discussion enables critical and ethical conversation around the complexities of developing appropriate discourse concerning the woman who suffers brain death during pregnancy and considers the complexities for nurses and midwives caring for the Woman/body/fetus in this context. The potential impact on the fetus of growing and developing inside a ‘dead’ body is examined, and the absence in the literature of long-term follow up of infants gestated thus is questioned. 相似文献14.
Valerie Fleming Yvonne Meyer Franziska Frank Susanne van Gogh Laura Schirinzi Bénédicte Michoud Claire de Labrusse 《Women and birth : journal of the Australian College of Midwives》2017,30(6):443-449
Problem and background
Despite a generally affluent society, the caesarean section rate in Switzerland has steadily climbed in recent years from 22.9% in 1998 to 33.7% in 2014. Speculation by the media has prompted political questions as to the reasons. However, there is no clear evidence as to why the Swiss rate should be so high especially in comparison with neighbouring countries.Aim
To describe the emerging expectations of giving birth of healthy primigravid women in the early second semester of pregnancy in four Swiss cantons.Methods
Qualitative individual interviews with 58 healthy primigravid women, were audio recorded, transcribed and subjected to thematic analysis. Recruitment took place through public and private hospitals, birth centres, obstetricians and independent midwives. The main ethical issues were informed consent, autonomy, confidentiality and anonymity.Findings
The three main themes identified were taking or avoiding decisions, experiencing a continuum of emotions and planning the care.Discussion
Being pregnant was part of a project women had mapped out for their lives. Only three women in our sample expressed a wish for a caesarean section. One of the strongest emotions was that of fear but in contrast some participants expressed faith that their bodies would cope with the experience.Conclusion
Bringing together the three languages and cultures produced a truly “Swiss” study showing contrasts between a matter of fact approach to pregnancy and the concept of fear. Such a contrast is worthy of further and deeper exploration by a multi-disciplinary research team. 相似文献15.
Sandy M. Zgheib Mohammad Kacim Karel Kostev 《Women and birth : journal of the Australian College of Midwives》2017,30(6):e265-e271
Background
During the last decades, there has been an alarming and dramatic increase in the number of cesarean births in both developed and undeveloped countries. This increase has not been clinically justified but, nevertheless, has raised an important number of issues.Aim
The aim of this study was to determine the risk factors associated with the high cesarean section rates in Lebanon.Methods
This study is based on a sample of 29,270 Lebanese women who were pregnant between 2000 and 2015. Among these, 14,327 gave birth by cesarean section and 14,943 gave birth vaginally. To identify the risk factors of cesarean section, logistic regression was applied as a statistical method using the SPSS statistical package.Findings
Of the 29,270 pregnant women included in the study, 49% had cesarean sections while 51% gave birth vaginally. Repeat cesarean section accounted for 23% while vaginal birth after cesarean accounted for only 0.2% of deliveries. In addition, weekdays were associated with a preference of providers to carry out more cesarean sections. According to an analysis of our data using logistic regression, the risk factors associated with the increase in cesarean section rates were advanced maternal age, elective cesarean section, malpresentation of fetus, multiple birth, prolonged pregnancy, prolonged labor, and fetal distress.Conclusion
Based on these results, it is recommended that a new health policy be implemented to reduce the number of unnecessary cesarean deliveries in Lebanon. 相似文献16.
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17.
Jenny S. Hall Mary Mitchell 《Women and birth : journal of the Australian College of Midwives》2017,30(3):214-219
Focus
There is currently limited information available on how midwifery students learn to provide care that promotes dignity and respect.Background
In recent years the importance of dignity in healthcare and treating people with respect has received considerable emphasis in both a national and international context.Aim
The aim of this discussion paper is to describe an educational workshop that enables learning to promote dignity and respect in maternity care.Discussion
An interactive workshop, using different creative methods as triggers for learning will be described. Provision of learning opportunities for students around dignity and respect is important to ensure appropriate care is provided in practice. The use of creative methods to inspire has contributed to deep learning within participants. An evaluation of the workshop illustrated how learning impacted on participants practice. Data to support this is presented in this paper.Conclusion
The use of creative teaching approaches in a workshop setting appears to provide an effective learning opportunity around dignified and respectful care. These workshops have evoked a deep emotional response for some participants, and facilitators must be prepared for this outcome to ensure a safe space for learning. 相似文献18.
Cherelle M.V. van Stenus Magda M. Boere-Boonekamp Erna F.G.M. Kerkhof Ariana Need 《Women and birth : journal of the Australian College of Midwives》2018,31(6):e380-e388
Problem
It is unknown if client experiences with perinatal healthcare differ between low-risk and high-risk women.Background
In the Netherlands, risk selection divides pregnant women into low- and high-risk groups. Receiving news that a pregnancy or childbirth has an increased likelihood of complications can cause elevated levels of emotional distress.Aim
The purpose of this study is to describe client experiences with perinatal healthcare and to determine which, if any, background characteristics, pregnancy circumstances, childbirth or follow-up care characteristics are explaining variables of differences in client experiences between high-risk and low-risk women.Methods
Client experiences were measured with a validated questionnaire completed by 1388 women within 12 weeks after childbirth.Findings
Women rated their experiences with perinatal healthcare with a mean score of 3.78 on a scale of 1–4; 5.5% of the women rated their experiences as “notably bad”. Client experiences with perinatal healthcare show small variations, with a lower mean score for women who were at high risk (3.75) compared to low-risk women (3.84). This difference is partially due to more unplanned medical interventions and pain relief during childbirth in the high-risk group. Also, single mothers and non-Dutch women were more susceptible to less positive experiences.Conclusion
Given the potential negative impact of adverse client experiences, this study highlights the need for healthcare professionals to be aware of what women are susceptible for having had negative experiences. It is advised that healthcare provision be altered to tailor to the needs of these women. 相似文献19.
20.
Rosalind Haddrill Georgina L. Jones Dilly Anumba Caroline Mitchell 《Women and birth : journal of the Australian College of Midwives》2018,31(3):220-231