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To explore Australian healthcare providers' perspectives on factors that influence disclosure and domestic violence screening through the lens of Heise's (1998) integrated ecological framework.This paper reports the findings that were part of a sequential mixed methods study with survey data informing interview questions. Participants for interviews were recruited after expressing an interest after completing surveys, as well as via snowball sampling.Semi-structured interviews were undertaken in 2017 with 12 practicing healthcare providers delivering care to women in the perinatal period in Greater Western Sydney, NSW, Australia. Data were analysed using Braun and Clarke's (2006) six-step thematic approach.The findings were framed within Heise's integrated ecological framework under four main themes. The main themes were 'Ontogenic: Factors preventing women from disclosing'; 'Microsystem: Factors preventing healthcare providers from asking'; 'Exosystem: Organizational structures not conducive to screening'; and 'Macrosystem: Cultural attitudes and socioeconomic influences affecting screening'.Organizational policies are needed for better systems of reminding healthcare providers to enquire for domestic and family violence and mandating this within their practices. Mandatory domestic and family violence education and training that is suitable for the time constraints and learning needs of the healthcare provider is recommended for all healthcare providers caring for perinatal women. Further research is needed in addressing culturally specific barriers for healthcare providers to enquire about domestic and family violence in a culturally appropriate way.No Patient or Public Contribution was embedded into the research reported in this paper as this research was specifically exploring healthcare providers' perspectives on domestic violence screening within their own practice experience.

Understanding Research is a series of articles aimed at dispelling the myths around research theories and practices, and exploring just what is meant by the different terminologies encountered when reading and using research articles. On alternate months we explore different aspects of research to make this knowledge accessible and relevant. It forms part of the Evidence series and aims to help midwives understand, use and engage with research, and consider how research matters to their practice.

Background There is a need for evidence-based guidance on complementary medicines and therapies (CMT) use during pregnancy due to high prevalence of use and lack of guidance on the balance of benefit and harms. Aim Evaluate the extent to which current clinical practice guidelines relevant to Australian healthcare professionals make clear and unambiguous recommendations about CMT use in pregnancy, and synthesise these recommendations. Methods The search included EMBASE, PubMed, the National Health and Medical Research Council’s Clinical Practice Guidelines Portal, and websites of Australian maternity hospitals and professional/not-for-profit organisations for published guidelines on pregnancy care. Data were synthesised narratively. Guidelines were appraised by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Findings A total of 48 guidelines were found, of which 41% provided recommendations that were not limited to routine vitamin and mineral supplementation. There were wide variations in recommendations, particularly for vitamin D and calcium. There was some consensus on recommending ginger and vitamin B6 for nausea and vomiting, and additional supplementation for women with obesity. Guidelines generally scored poorly in the domains of editorial independence and rigour of development. Discussion There is a lack of guidance with regard to appropriate CMT use during pregnancy, which may result in less-than-optimal care. Inconsistency between guidelines may lead to variations in care. Conclusion Guidelines should include clear and unambiguous guidance on appropriate CMT use during pregnancy, be based on a structured search of the evidence and informed by stakeholder engagement.

In collaboration between a researcher and poet, we have used poetry inquiry to create a collection of found poems from open-ended survey data. Found poems were created using the written responses from the Australian Birth Experience Study survey and the poems highlighted women’s experiences of traumatic birth. Analysis was undertaken through reflexive poetry from the poet and through reflection by the researcher. The poems display themes of lack of control and consent. These poems illuminate the voices of the women who shared their traumatic birthing stories to gain understanding and raise awareness in the community on aspects of birth trauma.

Background In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women’s perspective. Methods A national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents’ answers to the open-ended questions. Results Two main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, ‘Someone in my corner’, included the sub-categories ‘belief in women birthing’, ‘supported my decisions’ and ‘respectful maternity care’. The negative main category ‘Fighting for my birthing rights’ included the sub-categories ‘the odds were against me’, ‘lack of belief in women giving birth’ and ‘coercion’. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care. Conclusions In this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care.

The COVID-19 pandemic has impacted perinatal mental health globally. We determined the maternal factors and pandemic-related experiences associated with clinically significant perinatal (pregnant and post-partum) depressive symptoms in Australian women. Participants (n = 2638; pregnant n = 1219, postnatal n = 1419) completed an online survey (August 2020 through February 2021) and self-reported on depression, social support, and COVID-19 related experiences. We found elevated depressive symptoms amongst 26.5% (pregnant) and 19% (postnatal) women. Multiple logistic regression analyses showed higher likelihood of elevated depression associated with residence in Victoria, lower education, past/current mental health problems, greater non-pandemic prenatal stress, age ≥ 35 years (pregnant women) and existing physical health issues or disability in self or others (postnatal women). Greater family stress/discord and lower social support (friends) was associated with higher odds of elevated perinatal depression, while lower social support (family) was significantly associated with elevated depressive symptoms in pregnant women. Greater depression was associated with social distancing, pandemic-related news exposure and changes to prenatal care (pregnant women). Single postnatal women showed lower odds of elevated depression than partnered women. Our findings underscore the importance of universal screening for depression and targeted support during a pandemic for perinatal women displaying vulnerability factors.

Globally, significant numbers of women report obstetric violence (OV) during childbirth. The United Nations has identified OV as gendered violence. OV can be perpetrated by any healthcare professional (HCP) and is impacted by systemic issues such as HCP education, staffing ratios, and lack of access to continuity of care. The current study explored the experiences of OV reported in a national survey in 2021 by Australian women who had a baby in the previous 5 years. A content analysis of 626 open text comments found three main categories: “I felt dehumanised,” “I felt violated,” and “I felt powerless.” Women reported bullying, coercion, non-empathic care, and physical and sexual assault. Disrespect and abuse and non-consented vaginal examinations were the subcategories with the most comments.

Background Good mentoring is important for students to support their adjustment to and learning in the clinical environment. The quality of the mentoring relationship is key for students but there is a lack of evidence explaining how a good mentor/mentee relationship establishes and develops over time. Aim To explore the developing relationship between mentors and mentees participating in a structured midwifery mentoring program in one Local Health District in Sydney, Australia. Methods A qualitative interpretive descriptive research design was utilised. Data were collected using 10 focus groups with midwife mentors (n = 31) and seven focus groups and four interviews with Bachelor of Midwifery student mentees (n = 24), over a 12-month period. Thematic analysis using an inductive approach was applied incorporating constant comparison to identify themes and sub-themes. Findings Three overarching themes and three sub-themes were identified. The first theme was ‘The great unknown’. Within the second theme ‘Building the relationship’ were three subthemes: trying to connect; becoming known; and an insider on your side. The final theme ‘the virtuous circle’ described the reciprocal relationship and benefits that developed between mentor and mentee. Discussion The mentor/mentee relationship took time to develop and went through a number of phases. A positive mentor/ mentee relationship flattened hierarchical differences, increased student confidence and capacity for learning, and reflected the midwifery continuity of care relationship between midwife and woman built on respect and partnership. Conclusion Developing a successful midwifery mentoring relationship takes persistence, reassurance, and mutual disclosure ultimately resulting in a recurring cycle of encouragement and support.

Background This case study explores the four pregnancy and birthing journeys of Wiradjuri & Ngemba-Wayilwan woman, Fleur Magick Dennis. Fleur provides a personal account of her journeys and relates them to socio-cultural issues surrounding her life during these times. Fleur experienced her first birth in hospital and her three next births at different locations out of hospital on Wiradjuri Country. Fleur is able to show that her personal wellbeing & healing and that of her family & community is linked to her having been able to birth according to her spiritual & cultural beliefs. The midwife for Fleur’s third and fourth pregnancy, Hazel Keedle, then provides a brief account of her experiences supporting Fleur in her choices and explores the impact of these births on her midwifery and personal life.

Little is known about the experiences of undergraduate midwifery students employed as Assistants in Midwifery (AIM) in Australia.Assistants in Nursing have been embedded in the Australian health system for many years, but the AIM role is relatively new. Undergraduate Bachelor of Midwifery students, in second or third year, can gain employment as an AIM at hospital maternity units. Little is known about the scope of practice for these roles and the experiences of AIM.This study aimed to explore the experiences and scope of practice of AIM in New South Wales (NSW), Australia, over the last five years.A Qualtrics online survey enabled collection of quantitative and qualitative data from 128 respondents in late 2019. This was accompanied with the analysis of position descriptions for all AIM jobs advertised between September 2019 and February 2020.Analysis of AIM position descriptions reflected nursing language rather than midwifery. Survey responses demonstrated ambiguity about the AIM scope of practice and the appropriate level of supervision required to perform the role. Qualitative data revealed the many benefits of the role for midwifery students.Opportunities to participate in midwifery assistant work enhances student confidence and improves job readiness. However, a clearly defined scope of practice is one of the most important components of any employment model for undergraduate students. Clarification of the role and scope of practice of the AIM role is long overdue. There is ongoing need for advocacy to ensure that students working as AIM are employed to carry out midwifery activities and are supervised by midwives.This project provides insight into the advantages and disadvantages of working as an AIM whilst studying for a Bachelor of Midwifery degree. While the AIM position reaps many rewards for students, appropriate supervision in the workplace requires availability of adequate numbers of employed registered midwives.

Background Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women but internationally VBAC rates remain low. In Australia women planning a VBAC may experience different models of care including continuity of care (CoC). There are a limited number of studies exploring the impact and influence of CoC on women’s experiences of planning a VBAC. Continuity of care (CoC) with a midwife has been found to increase spontaneous vaginal birth and decrease some interventions. Women planning a VBAC prefer and benefit from CoC with a known care provider. This study aimed to explore the influence, and impact, of continuity of care on women’s experiences when planning a VBAC in Australia. Methods The Australian VBAC survey was designed and distributed via social media. Outcomes and experiences of women who had planned a VBAC in the past 5 years were compared by model of care. Standard fragmented maternity care was compared to continuity of care with a midwife or doctor. Results In total, 490 women completed the survey and respondents came from every State and Territory in Australia. Women who had CoC with a midwife were more likely to feel in control of their decision making and feel their health care provider positively supported their decision to have a VBAC. Women who had CoC with a midwife were more likely to have been active in labour, experience water immersion and have an upright birthing position. Women who received fragmented care experienced lower autonomy and lower respect compared to CoC. Conclusion This study recruited a non-probability based, self-selected, sample of women using social media. Women found having a VBAC less traumatic than their previous caesarean and women planning a VBAC benefited from CoC models, particularly midwifery continuity of care. Women seeking VBAC are often excluded from these models as they are considered to have risk factors. There needs to be a focus on increasing shared belief and confidence in VBAC across professions and an expansion of midwifery led continuity of care models for women seeking a VBAC.

Background There appears to be a chasm between idealised motherhood and reality, and for women who experience birth trauma this can be more extreme and impact on mental health. Australia is unique in providing residential parenting services to support women with parenting needs such as sleep or feeding difficulties. Women who attend residential parenting services have experienced higher rates of intervention in birth and poor perinatal mental health but it is unknown how birth trauma may impact on early parenting. Aims and objectives This study aims to explore the early parenting experiences of women who have accessed residential parenting services in Australia and consider their birth was traumatic. Methods In-depth interviews were conducted with eight women across Australia who had experienced birth trauma and accessed residential parenting services in the early parenting period. These interviews were conducted both face to face and over the telephone. The data was analysed using thematic analysis. Findings One overarching theme was identified: “The Perfect Storm of Trauma” which identified that the participants in this study who accessed residential parenting services were more likely to have entered pregnancy with pre-existing vulnerabilities, and experienced a culmination of traumatic events during labour, birth, and in the early parenting period. Four subthemes were identified: “Bringing Baggage to Birth”, “Trauma through a Thousand Cuts”, “Thrown into the Pressure Cooker”, and “Trying to work it all out”. Conclusion How women are cared for during their labour, birth and postnatal period impacts on how they manage early parenthood. Support is crucial for women, including practical parenting support, and emotional support by health professionals and peers.

Purpose This article explores the development and evaluation of a smartphone mobile software application (app) to collect qualitative data. The app was specifically designed to capture real-time qualitative data from women planning a vaginal birth after caesarean delivery. This article outlines the design and development of the app to include funding, ethics, and the recruitment of an app developer, as well as the evaluation of using the app by seven participants. Organizing Construct Data collection methods used in qualitative research include interviews and focus groups (either online, face-to-face, or by phone), participant diaries, or observations of interactions. This article identifies an alternative data collection methodology using a smartphone app to collect real-time data. Conclusions The app provides real-time data and instant access to data alongside the ability to access participants from a variety of locations. This allows the researcher to gain insight into the experiences of participants through audio or video recordings in longitudinal studies without the need for constant interactions or interviews with participants. Clinical Relevance Using smartphone applications can allow researchers to access participants who are traditionally hard to reach and access their data in real time. Evaluating these apps before use in research is invaluable.

Background Most women who have a caesarean can safely have a vaginal birth after caesarean (VBAC) for their next birth, but more women have an elective repeat caesarean than a VBAC. Methods The aim of this qualitative study was to explore the experiences of women planning a vaginal birth after caesarean (VBAC) in Australia, the interactions with their health care providers and their thoughts, feelings and experiences after an antenatal appointment and following the birth. The study explored the effect of different models of care on women’s relationships with their health care provider using a feminist theoretical lens. Eleven women who had previously experienced a caesarean section and were planning a VBAC in their current pregnancy used the ‘myVBACapp’ to record their thoughts after their antenatal appointments and were followed up with in-depth interviews in the postnatal period. Results Fifty-three antenatal logs and eleven postnatal interviews were obtained over a period of eight months in 2017. Women accessed a variety of models of care. The four contextual factors found to influence whether a woman felt resolved after having a VBAC or repeat caesarean were: ‘having confidence in themselves and in their health care providers’, ‘having control’, ‘having a supportive relationship with a health care provider’ and ‘staying active in labour’. Conclusions The findings highlight that when women have high feelings of control and confidence; have a supportive continual relationship with a health care provider; and are able to have an active labour; it can result in feelings of resolution, regardless of mode of birth. Women’s sense of control and confidence can be undermined through the impact of paternalistic and patriarchal maternity systems by maintaining women’s subordination and lack of control within the system. Women planning a VBAC want confident, skilled, care providers who can support them to feel in control and confident throughout the birthing process. Continuity of care (CoC) provides a supportive relationship which some women in this study found beneficial when planning a VBAC. Electronic supplementary material The online version of this article (10.1186/s12884-019-2297-4) contains supplementary material, which is available to authorized users.

Background This study was developed to assist academics and curriculum designers to understand the perspectives and expectations of students when designing a program of study and inclusive of students as partners. The purpose of this qualitative study was to explore the perceptions and experiences of students enrolled in the Bachelor of Nursing (BN). Settings, participants, methods The setting is a multi-campus university in Australia. Participants were currently enrolled and recruited from the Bachelor of Nursing, Bachelor of Nursing Advanced and Bachelor of Nursing Graduate Entry. Semi-structured focus group interviews and thematic analysis was used to collect and analyse the data. Results Three major themes were identified from the focus group interviews: 1. Expectations; 2. Interesting and stimulating; and 3. Preparedness for study and clinical practice. Conclusion Students held strong personal reasons for pursuing a nursing degree. The geographic location and international rankings were factors for choosing the university in this study. Student's perceptions and experiences of the curriculum and support identified that their BN program was interesting and adequately prepared them for clinical practice. Some areas for improvement were more detail during program orientation related to clinical practice requirements and more assistance with engaging with learning and teaching technologies.

This article explores the development and evaluation of a smartphone mobile software application (app) to collect qualitative data. The app was specifically designed to capture real-time qualitative data from women planning a vaginal birth after caesarean delivery. This article outlines the design and development of the app to include funding, ethics, and the recruitment of an app developer, as well as the evaluation of using the app by seven participants.Data collection methods used in qualitative research include interviews and focus groups (either online, face-to-face, or by phone), participant diaries, or observations of interactions. This article identifies an alternative data collection methodology using a smartphone app to collect real-time data.The app provides real-time data and instant access to data alongside the ability to access participants from a variety of locations. This allows the researcher to gain insight into the experiences of participants through audio or video recordings in longitudinal studies without the need for constant interactions or interviews with participants.Using smartphone applications can allow researchers to access participants who are traditionally hard to reach and access their data in real time. Evaluating these apps before use in research is invaluable.

Background Treatment strategies for the management of antenatal depression are limited by varied and often modest response rates, unpleasant medication side effects and uncertainty regarding foetal safety. Consequently, many pregnant women experiencing depression seek alternative non-pharmaceutical options. Acupuncture may provide a safe and potentially effective additional treatment, however further investigation is required. In this qualitative study, we explored the views of health professionals regarding the possible incorporation of acupuncture into mainstream care. Methods Two separate focus groups were run with 16 midwives. In-depth interviews were conducted with two maternity service managers and nine doctors (3 obstetricians, 2 psychiatrists and 4 general practitioners). Data was analysed using thematic analysis. Results Participants were generally positive about acupuncture and open to its possible inclusion in conventional care, on the proviso that it was safe and could be shown to be effective. The overarching theme to emerge was ‘acupuncture for antenatal depression: it’s worth giving it a go’, which participants concluded after considering ‘the dilemma of mental health’ treatment during the antenatal period and the additional limitations this presented, along with the belief that ‘if it doesn’t do any harm, I’m not against it’. Practical considerations regarding potential ‘barriers’ and facilitators’ to implementation were additionally explored in ‘making it mainstream’, whereby the different ‘philosophical beliefs’ held by participants were seen to influence perspectives. Conclusion Participants expressed an overall positive attitude towards the possible inclusion of acupuncture into mainstream care for antenatal depression, suggesting various hospital barriers could be overcome with further safety and effectiveness evidence.

Background Vaginal birth after caesarean can be a safe and satisfying option for many women who have had a previous caesarean, yet rates of vaginal birth after caesarean remain low in the majority of countries. Exploring women’s experiences of vaginal birth after caesarean can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a vaginal birth after caesarean. Methods This paper reports on a meta-ethnographic review of 20 research papers exploring women’s experience of vaginal birth after caesarean in a variety of birth locations. Meta-ethnography utilises a seven-stage process to synthesise qualitative research. Results The overarching theme was ‘the journey from pain to power’. The theme ‘the hurt me’ describes the previous caesarean experience and resulting feelings. Women experience a journey of ‘peaks and troughs’ moving from their previous caesarean to their vaginal birth after caesarean. Achieving a vaginal birth after caesarean was seen in the theme ‘the powerful me,’ and the resultant benefits are described in the theme ‘the ongoing journey’. Conclusion Women undergo a journey from their previous caesarean with different positive and negative experiences as they move towards their goal of achieving a vaginal birth after caesarean. This ‘journey from pain to power’ is strongly influenced by both negative and positive support provided by health care practitioners. Positive support from a health care professional is more common in confident practitioners and continuity of care with a midwife.

Background Caesarean section is rising in the developed world and vaginal birth after caesarean (VBAC) is declining. There are increased reports of women seeking a homebirth following a caesarean section (HBAC) in Australia but little is known about the reasons for this study aimed to explore women's reasons for and experiences of choosing a HBAC. Methods Twelve women participated in a semi-structured one-to-one interview. The interviews were digitally recorded, then transcribed verbatim. These data were analysed using thematic analysis. Results The overarching theme that emerged was ‘It’s never happening again’. Women clearly articulated why it [caesarean section] was never happening again under the following sub themes: ‘treated like a piece of meat’, ‘I was traumatised by it for years’, ‘you can smell the fear in the room’, ‘re-traumatised by the system’. They also described how it [caesarean section] was never happening again under the sub themes: ‘getting informed and gaining confidence’, ‘avoiding judgment through selective telling’, ‘preparing for birth’, ‘gathering support’ and ‘all about safety but I came first’. The women then identified the impact of their HBAC under the subthemes ‘I felt like superwoman’ and ‘there is just no comparison’. Conclusions Birth intervention may cause physical and emotional trauma that can have a significant impact on some women. Inflexible hospital systems and inflexible attitudes around policy and care led some women to seek other options. Women report that achieving a HBAC has benefits for the relationship with their baby. VBAC policies and practices in hospitals need to be flexible to enable women to negotiate the care that they wish to have.