An account of significant events influencing Australian breastfeeding practice over the last 40 years

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.     

It’s Not What You Pay it’s the Way that You Pay it and that’s What Gets Results: Jockeys’ Pay and Performance

Management scholars and economists have recently set out the requirements of a system to elicit good performance when it is necessary to align the interests of the principal and agent. We analyse pay and performance in an occupation — jockeys — replete with moral hazard possibilities. We are able to do this because, most unusually, a measure of pure individual performance exists for an unbalanced panel of some 50 individuals for 8 years. Three hypotheses are tested. First, in line with classic agency theory, we expect monitoring mechanisms and incentive contracts to be used to align the interests of principals and agents. Second, pay and performance should be positively associated, subject to the first hypothesis being confirmed. Third, a limited number of jockeys were paid via an alternative mechanism involving very large non-contingent retainer fees. This serves as our counterfactual payment system. In line with agency theory we expect worse performance under such a system than under an incentive contract. The three hypotheses are confirmed: incentive contracts generate superior performance to non-contingent payment systems. Our evidence suggests that ‘it’s not what you pay it’s the way that you pay it … and that’s what gets results’. It is maddening that society confers its blessings on traditional academic pursuits but views the study of horseracing as utter frivolity (Beyer, 1983).     

Making available information from studies sponsored by the pharmaceutical industry: some current practices

Since the web-based registry ClinicalTrials.gov was launched on 29 February 2000, the pharmaceutical industry has made available an increasing amount of information about the clinical trials that it sponsors. The process has been spurred on by a number of factors including a wish by the industry to provide greater transparency regarding clinical trial data; and has been both aided and complicated by the number of institutions that have a legitimate interest in guiding and defining what should be made available. This article reviews the history of this process of making information about clinical trials publicly available. It provides a reader's guide to the study registries and the databases of results; and looks at some indicators of consistency in the posting of study information.     

Participatory action research opens doors: Mentoring Indigenous researchers to improve midwifery in urban Australia

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.

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 Kids Say Project: Supporting Children to Talk about their Experiences and to Engage in Decision-making

Research and policy calls for hearing the voices of children and youth in out-of-home care and involving them in decisions about their own lives. The “Kids Say” cards were designed to facilitate this engagement, particularly with Indigenous children and youth. A feasibility study explored the extent to which the Kids Say cards were acceptable to young people, and prompted discussion about their lives and what is important to them. The study involved 47 participants, aged 7 to 18 years, from three cultural groups: Aboriginal n?=?20; culturally and linguistically diverse (CALD) n?=?10; non-Indigenous English-speaking n?=?17. The cards were found to be appealing to all three groups, and to facilitate child and youth voice. Findings also did not differ significantly according to gender or age. These preliminary findings indicate the potential value of appropriate practice tools to support children and youth to share their experiences and participate in decision-making.

IMPLICATIONS

• Engaging resources, such as the Kids Say resource, are potentially valuable in supporting practitioners to encourage children and young people to share their experiences and participate in decision-making about their own care and service needs.

• Training in creating safe sharing contexts for children and young people is essential. While emphasis is often given to gathering child voices, there is a need for at least equal emphasis on respectful adult listening.