Search

Background: Global and national frameworks for midwifery education recognise and prioritise the provision of midwifery continuity of care. Previous studies report that learning is enhanced when students have professional experience placements within these models, however there remains wide variation in midwifery students' access to placements within these models in Australia., Aim: To evaluate Bachelor of Midwifery students' experiences in midwifery continuity of care models within two local health districts in New South Wales, Australia., Method: A mixed methods design was used: qualitative data collected through interviews, and quantitative data collected via an online survey using the Midwifery Student Evaluation of Practice (MidSTEP) tool. Thematic analysis of qualitative data and descriptive analysis of quantitative data was undertaken., Results: Sixteen students responded, four students were interviewed, and 12 students completed the survey. The MidSTEP mean scores for all sub-scales rated above 3.0/4.0. Participants rated 'work across the full scope of midwifery practice' and five out of eight subscales of Philosophy of Midwifery Practice at 100 %. 'Experiences prepare me to be a change agent for maternity service reform' rated the lowest (67 %). Three qualitative themes emerged: care versus carer model; learning experience; and future career as a caseload midwife., Conclusion: A mixed method approach using a validated tool to measure student experiences, contributes to the evidence that students value professional experience placements within midwifery continuity of care models. Currently this is not an option for all midwifery students and as midwifery continuity of care models expand, these findings will inform further implementation of student professional experience placement within these models., Competing Interests: Declaration of Competing Interest All authors declare that there is no actual or potential conflict of interest, including financial and personal relationships with people or organisations, within 12months of beginning the submitted work that could inappropriately influence (bias) our work., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Problem and Background: Caesarean section (CS) rates in Australia and many countries worldwide are high and increasing, with elective repeat caesarean section a significant contributor., Aim: To determine whether midwifery continuity of care for women with a previous CS increases the proportion of women who plan to attempt a vaginal birth in their current pregnancy., Methods: A randomised controlled design was undertaken. Women who met the inclusion criteria were randomised to one of two groups; the Community Midwifery Program (CMP) (continuity across the full spectrum - antenatal, intrapartum and postpartum) (n=110) and the Midwifery Antenatal Care (MAC) Program (antenatal continuity of care) (n=111) using a remote randomisation service. Analysis was undertaken on an intention to treat basis. The primary outcome measure was the rate of attempted vaginal birth after caesarean section and secondary outcomes included composite measures of maternal and neonatal wellbeing., Findings: The model of care did not significantly impact planned vaginal birth at 36 weeks (CMP 66.7% vs MAC 57.3%) or success rate (CMP 27.8% vs MAC 32.7%). The rate of maternal and neonatal complications was similar between the groups., Conclusion: Model of care did not significantly impact the proportion of women attempting VBAC in this study. The similarity in the number of midwives seen antenatally and during labour and birth suggests that these models of care had more similarities than differences and that the model of continuity could be described as informational continuity. Future research should focus on the impact of relationship based continuity of care., (Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Literature describing CAM and self-help options midwives recommend to women experiencing a post-date pregnancy is sparse. This study aimed to investigate if Australian midwives' personal CAM use impacts on discussions and recommendations of CAM/Self-help strategies., Methodology/design: A survey of a national midwifery association midwifery members (n=3,552) was undertaken at a midwifery conference (October 2015) and via e-bulletins (November 2015-March 2016). The self-administered survey included questions on what self-help and CAM strategies midwives discuss and recommend to women with a post-date pregnancy, midwives' confidence levels on discussing or recommending CAM, midwives' own personal use of CAM., Findings: A total of 571 registered midwives completed the survey (16%). Demographics (age, years as a midwife, state of residence) reflected Australian midwives and the midwifery association membership. Most respondents discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. The top five CAM recommended were Acupuncture (65.7%), Acupressure (58.1%), Raspberry Leaf (52.5%), Massage (38.9%) and Hypnosis/Calmbirthing/Hypnobirthing (35.7%). Midwives were more likely to discuss strategies if they personally used CAM (p<.001), were younger (p<.001) or had worked less years as midwives (p=.004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p=.001)., Conclusion: Midwives' personal use of CAM influenced their discussions and recommendations of CAM/self-help strategies to women experiencing a post-date pregnancy. This study has implications for inclusion of CAM in midwifery education curricula., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Problem: One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section., Background: Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC)., Aim: To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women., Methods: A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted., Findings: The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted., Conclusion: Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication., (Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Research Question: To determine the incidence and level of work-related stress and burnout in midwives and contributing and protective demographic factors that may influence those levels., Participants and Method: All registered midwives (152) working in two public hospital maternity units within the same health service district in NSW completed the Maslach Burnout Inventory Human Services Survey and a demographic survey including care model, shift work, lifestyle data and exercise level., Findings: There was a response rate of 36.8% with 56 (56/152) midwives completing the surveys. Almost two thirds (60.7%) of midwives in this sample experienced moderate to high levels of emotional exhaustion, a third (30.3%) scoring low personal accomplishment and a third (30.3%) experiencing depersonalization related to burnout. Significant differences were found among groups of midwives according to years in the profession, shifts worked, how many women with multiple psychosocial issues were included in the midwife's workload and the midwife's uptake of physical exercise. Those midwives who had spent longer in the profession and exercised scored low burnout levels., Conclusion: The impact of years in the profession, shifts worked, how many women with multiple psychosocial issues were included in their workload and the midwife's level of exercise significantly affected how these midwives dealt with burnout and provided care for women. As the response rate was low, and the study cannot be generalised to the entire midwifery workforce but provides important insights for further research. Understanding factors related to burnout can benefit health care institutions financially and in terms of human costs, especially in view of consistent international shortages of midwives., (Copyright © 2011 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Research Problem: To investigate the impact of conducting structured antenatal psychosocial assessments (SAPSA) on midwives' emotional wellbeing. The SAPSA includes screening and assessment tools for domestic violence, childhood trauma, drug and alcohol use, depression, and vulnerability factors., Participants and Methods: Registered midwives who had conducted the SAPSA with women during the first hospital booking visit at two hospitals in NSW. Data was collected by means of focus group interviews., Results: Four sub-themes were identified that directly impacted upon the midwives' emotional wellbeing: cumulative complex disclosures, frustration and stress, lack of support for midwives and unhealthy coping strategies., Discussion and Conclusions: There was a cumulative emotional effect with some midwives utilising unhealthy strategies to cope with feelings of frustration, inadequacy and vicarious trauma. Establishment of structured referral pathways for women and supportive systems for midwives is essential prior to implementing the SAPSA.