Search

Background Continuity of midwifery care is the best maternity care model for women at any risk level, and there is a global imperative to improve access to midwifery-led care. However, diverse perspectives about how best to prepare graduates for working in midwifery continuity of care models persist. The continuity of care experience standard in Australia was anticipated to address this. Aim To challenge the dearth of published information about the structures and processes in midwifery education programs by identifying: the educational value and pedagogical intent of the continuity of care experience; issues with the implementation, completion and assessment of learning associated with continuity of care experience; and discuss curriculum models that facilitate optimal learning outcomes associated with this experience. We discuss the primacy of continuity of care experience in midwifery education programs in Australia. Discussion The inclusion of continuity of care experience in midwifery programs in Australia became mandatory in 2010 requiring 20, however this number was reduced to 10 in 2014. Research has shown the beneficial outcomes of continuity of care experience to both students and women. Continuity of care experience builds mutual support and nurturing between women and students, fosters clinical confidence, resilience, and influences career goals. We require curriculum coherence with both structural and conceptual elements focusing on continuity of care experience. Implications and recommendations Education standards that preference continuity of care experience as the optimal clinical education model with measurable learning outcomes, and alignment to a whole of program philosophy and program learning outcomes is required.

Background Negative birth experiences may have adverse effects on the wellbeing of women and babies. Knowledge about useful interventions to assist women in processing and resolving negative birth experiences is limited. Objective To explore women's experience and preferences of reviewing their birth experience at a special midwifery clinic. Design The study is a qualitative content analysis of women's written text responses to semi-structured questions, included in a retrospective study. Setting A special counselling clinic, ‘Ljaðu mer eyra', at Landspitali University Hospital in Reykjavik, provides women with an opportunity to review their birth experience and discuss their fears about an upcoming birth with a midwife. Sample, recruitment and data collection A questionnaire was sent to all women attending the clinic from 2006–2011 (n = 301). Of the 131 women completing and returning the questionnaire, 125 provided written responses to the open-ended questions. The questionnaire consisted of demographic and reproductive characteristics of women, questions about why they attended the clinic, whether their expectations were fulfilled, helpful components of the interview and open-ended questions about women's views of the process. Data analysis Data on participant characteristics, the reason for attending the clinic, whether the interview fulfilled their expectations and helpful components were analysed using quantitative descriptive data, while written responses to semi-structured questions were analysed using content analysis. Findings The main reasons for attending the clinic were a previous negative birth experience, anxiety about the upcoming birth, and/or loss of control during a prior birth. Two themes and three subthemes were identified. The overarching theme was ‘on my terms' with the subthemes of ‘being recognised', ‘listening is paramount' and ‘mapping the unknown'. The final theme was ‘moving on'. Key conclusions Women want to be recognised and invited to review their birth experience in a tailored conversation on their terms. By fulfilling their expectations of reviewing the birth experience, they regained control and strength to move on. Implications for practice Findings support the importance of recognising women's need to review their birth experiences and offer an intervention to reflect on their perceptions. A discussion of the birth experience should be a routine part of maternity services.

Background Several risk factors for negative birth experience have been identified, but little is known regarding the influence of social and midwifery support on the birth experience over time. Objective The aim of this study was to describe women’s birth experience up to two years after birth and to detect the predictive role of satisfaction with social and midwifery support in the birth experience. Method A longitudinal cohort study was conducted with a convenience sample of pregnant women from 26 community health care centres. Data was gathered using questionnaires at 11–16 weeks of pregnancy (T1, n = 1111), at five to six months (T2, n = 765), and at 18–24 months after birth (T3, n = 657). Data about sociodemographic factors, reproductive history, birth outcomes, social and midwifery support, depressive symptoms, and birth experience were collected. The predictive role of midwifery support in the birth experience was examined using binary logistic regression. Results The prevalence of negative birth experience was 5% at T2 and 5.7% at T3. Women who were not satisfied with midwifery support during pregnancy and birth were more likely to have negative birth experience at T2 than women who were satisfied with midwifery support. Operative birth, perception of prolonged birth and being a student predicted negative birth experience at both T2 and T3. Conclusions Perception of negative birth experience was relatively consistent during the study period and the role of support from midwives during pregnancy and birth had a significant impact on women’s perception of birth experience.

Problem or issue • Rates of elective and unplanned caesarean section continue to increase in high income countries. • Evidence-based clinical guidelines aim to promote and support normal birth but are rarely evaluated. What is already known The Queensland Normal Birth Guideline was developed in consultation with stakeholders and disseminated to public and private hospitals and released in 2012.1 Impact of the Guideline on practice has not been investigated. What this paper adds • Although most midwives (90%) were aware of the guideline, only 71% reported that it routinely guided practice. • Being employed in a public hospital caseload model, and having a strong belief in evidenced based practice predicted guideline use.

Objective to develop a comprehensive model of personal, trauma event-related and workplace-related risk factors for posttraumatic stress subsequent to witnessing birth trauma among Australian midwives. Design a descriptive, cross-sectional design was used. Participants members of the Australian College of Midwives were invited to complete an online survey. Measurements the survey included items about witnessing a traumatic birth event and previous experiences of life trauma. Trauma symptoms were assessed with the Posttraumatic Stress Disorder Symptom Scale Self-Report measure. Empathy was assessed with the Interpersonal Reactivity Index. Decision authority and psychological demand in the workplace were measured with the Job Content Questionnaire. Variables that showed a significant univariate association with probable posttraumatic stress disorder were entered into a multivariate logistic regression model. Findings 601 completed survey responses were analysed. The multivariable model was statistically significant and explained 27.7% (Nagelkerke R square) of the variance in posttraumatic stress symptoms and correctly classified 84.1% of cases. Odds ratios indicated that intention to leave the profession, a peritraumatic reaction of horror, peritraumatic feelings of guilt, and a personal traumatic birth experience were strongly associated with probable Posttraumatic Stress Disorder. Conclusions risk factors for posttraumatic stress following professional exposure to traumatic birth events among midwives are complex and multi-factorial. Posttraumatic stress may contribute to attrition in midwifery. Trauma-informed care and practice may reduce the incidence of traumatic births and subsequent posttraumatic stress reactions in women and midwives providing care.

Background Within the context of an ageing health workforce it is important to gain a greater understanding of the motivations of young people (aged less than 21 years) to choose a career in midwifery. Aim To explore the reasons why young students decided to study midwifery and enrol in one Australian Bachelor of Midwifery program. Method A descriptive exploratory qualitative design was used. Eleven midwifery students aged less than 21 years on enrollment participated in a semi-structured tape-recorded interview. The transcribed interviews were analysed using thematic analysis. Findings Direct and indirect exposure to positive constructions of childbirth as well as the midwives role fuelled young student's fascination with midwifery and drove their desire to enrol. While some young students entered midwifery studies as a result of their ‘love of babies’ others took a more pragmatic ‘wait and see’ approach about their career choice. Many young students however clearly distinguished midwifery from nursing demonstrating an intention to be a midwife rather than a nurse. This decision often took place within the context of opposition from within their family, school and social networks where the public discourse continued to reinforce nursing as the preferred pathway to midwifery. Conclusion Creating opportunities for young people to be exposed to positive constructions of childbirth as well as midwifery role models may increase the number of young students entering midwifery. There is also a need for information to be provided to school careers officers to assist them to understand the distinction between midwifery and nursing.

recent legislative changes in Australia have enabled eligible midwives to provide private primary maternity care with fee rebates through Medicare. This paper (1) discusses these changes affecting midwifery practice; (2) describes Australia's first private midwifery service with visiting rights to hospital for labour and birth care since Medicare funding for midwives was introduced in 2010; and (3) compares outcomes with National Core Maternity Indicators.an audit of all client records (n=323) for the survey period from September 2012 to February 2014 was undertaken. Data were extracted and compared with the 10 perinatal indicators using Chi square statistics.this convenience sample of all-risk women was similar to the national birthing population for age and parity. Compared to national indicators, women were significantly more likely to have spontaneous commencement of labour (79.6% versus 54.8%) (χ(2)=79.88, p.001), lower rates of induction (10.2% versus 26%) (χ(2)=79.88, p.001), and not require pharmacological pain relief (54.8% versus 23.9%) (χ(2)=152.2, p.001). The majority of women had a normal vaginal birth (70.3% versus 55.1%) (χ(2)=28.13, p.001). The caesarean section rate (22% versus 32.3%) was significantly lower (χ(2)=15.64, p.001) than the national rate. Average gestation of neonates was 39.3 weeks; average birth weight was 3525 gms, and fewer required transfer to the special care nursery (8.4% versus 15.3%) (χ(2)=11.89, p.001).this is the first report of maternal and neonatal outcomes for a private midwifery service in Australia since the introduction of access to Medicare for midwives. Maternal and newborn outcomes were statistically better than national rates. Routinely reporting and publishing clinical outcomes needs to become the norm for private maternity care.this private midwifery caseload model has been instrumental in the ground-breaking change to primary maternity services that extends women׳s access to safe midwifery care in Australia. The potential impact of private practicing midwives to align maternity care with the best available evidence is significant.

Background Unexplained late gestation stillbirth is a significant health issue. Antenatal information about foetal movements has been demonstrated to reduce the stillbirth rate in women with decreased foetal movements. Midwives are ideally placed to provide this information to women. Aim To investigate pregnant women's perceptions of information about foetal movements and preferences for receiving information. Methods This prospective, descriptive study was conducted in the antenatal clinic of a large metropolitan maternity hospital. Findings Pregnant women (n = 526) at 34 weeks gestation or later were recruited. Only 67% of women reported receiving information about foetal movements. Women reported that midwives (80%), family (57%), friends (48%) and own mother (48%) provided this information. Midwives were the most preferred source of information. Around half (52%) of the women used the internet for information but only 11% nominated the web as their preferred information source. Conclusion Women prefer to be given as much information about foetal movements as possible. Women favour information from health professionals, mainly from a midwife. Midwives are well-placed to partner with pregnant women and give them unbiased and evidenced based information enabling them to make decisions and choices regarding their health and well-being. While the internet is a prevalent information source, women want to be reassured that it is trustworthy and want direction to reliable pregnancy related websites.

Background developing a student׳s sense of capability, purpose, resourcefulness, identity and connectedness ( five-senses of success ) are key factors that may be important in predicting student satisfaction and progression within their university program. Aim the study aimed to examine the expectations and experiences of second and third year midwifery students enroled in a Bachelor of Midwifery program and identify barriers and enablers to success. Method a descriptive exploratory qualitative design was used. Fifty-six students enroled in either year 2 or 3 of the Bachelor of Midwifery program in SE Queensland participated in an anonymous survey using open-ended questions. In addition, 16 students participated in two year-level focus groups. Template analysis, using the Five Senses Framework, was used to analyse the data set. Findings early exposure to ‘hands on' clinical midwifery practice as well as continuity of care experiences provided students with an opportunity to link theory to practice and increased their perception of capability as they transitioned through the program. Student׳s sense of identity, purpose, resourcefulness, and capability was strongly influenced by the programs embedded meta-values, including a ‘woman centred' approach. In addition, a student׳s ability to form strong positive relationships with women, peers, lecturers and supportive clinicians was central to developing connections and ultimately a sense of success. A sense of connection not only fostered an ongoing belief that challenges could be overcome but that students׳ themselves could initiate or influence change. Conclusions the five senses framework provided a useful lens through which to analyse the student experience. Key factors to student satisfaction and retention within a Bachelor of Midwifery program include: a clearly articulated midwifery philosophy, strategies to promote student connectedness including the use of social media, and further development of clinician׳s skills in preceptorship, clinical teaching and facilitation. Program delivery methods and student support systems should be designed to enable maximum flexibility to promote capability and resourcefulness and embed sense of purpose and identity early in the program.

Background around 20% of women suffer childbirth fear causing them significant distress and often leading to requests for caesarean section. In Sweden, fearful pregnant women are offered counselling, however in Australia no dedicated service caters for the specific needs of these women. Indeed scant research has been conducted in Australia and little is known about women׳s concerns and if these align to those reported in the international literature. Aim to describe the sources, responses and moderators of childbirth fear in a group of pregnant women assessed as having high levels of childbirth fear. Method comparative analysis was used to identify common concepts and generate themes that represented women׳s perspectives of childbirth fear. Data consisted of 43 tape recorded telephone conversations with highly fearful pregnant women who were participating in a large randomised controlled trial known as BELIEF ( B irth E motions, L ooking to I mprove E xpectant F ear). Findings women׳s fears were conceptualised into three themes: fear stimuli; fear responses; and fear moderators. Lack of confidence to birth, fear of the unknown, internalising other women׳s negative stories, perineal tearing and labour pain were common concerns for first time mothers. For multiparous women, not having had personal feelings resolved following their previous birth and negative experiences of last birth influenced current expectations for their upcoming birth. Themes common to both groups were: unmet information and support needs, feelings of loss of control and lack of input in to decision-making. Some women however, chose to avoid birth planning in order to cope during pregnancy. Conclusion Australian women had similar childbirth concerns to those reported in the international literature. However unique to this study was finding two opposing discourses; one of preoccupation with negative events and the other; avoidance of planning for labour and birth. Provision of woman centred maternity models that minimise obstetric intervention, offer personalised conversations following birth, and are sensitive to identifying; listening and assisting women to modify their fears in early pregnancy are required to promote positive anticipation and preparation for birth.

Objective this study examined midwives' perceptions of organisational structures and processes of care when working in a caseload model (Midwifery Group Practice MGP) for socially disadvantaged and vulnerable childbearing women. Design this study used Donabedian's theoretical framework for evaluating the quality of health care provision. Of the 17 eligible midwives, 15 participated in focus group discussions and two others provided written comments. Thematic analysis was guided by three headings; clinical outcomes, processes of care and organisational structure. Findings midwives believed they provided an excellent service to socially disadvantaged and vulnerable childbearing women. Midwives gained satisfaction from working in partnership with women, working across their full scope of practice, and making a difference to the women. However the midwives perceived the MGP was situated within an organisation that was hostile to the caseload model of care. Midwives felt frustrated and distressed by a lack of organisational support for the model and a culture of blame dominated by medicine. A lack of material resources and no identified office space created feelings akin to ‘homelessness'. Together these challenges threatened the cohesiveness of the MGP and undermined midwives' ability to advocate for women and keep birth normal. Key conclusions if access to caseload midwifery care for women with diverse backgrounds and circumstances is to be enhanced, then mechanisms need to be implemented to ensure organisational structures and processes are developed to sustain midwives in the provision of ‘best practice' maternity care. Implications for practice women accessing midwifery caseload care have excellent maternal and newborn outcomes. However there remains limited understanding of the impact of organisational structures and processes of care on clinical outcomes.

Summary Background Midwives require well developed critical thinking to practice autonomously. However, multiple factors impinge on students' deep learning in the clinical context. Analysis of actual case scenarios using root cause analysis may foster students' critical thinking and application of ‘best practice' principles in complex clinical situations. Objective To examine the effectiveness of an innovative teaching strategy involving root cause analysis to develop students' perceptions of their critical thinking abilities. Methods A descriptive, mixed methods design was used. Final 3rd year undergraduate midwifery students ( n =22) worked in teams to complete and present an assessment item based on root cause analysis. The cases were adapted from coroners' reports. After graduation, 17 (77%) students evaluated the course using a standard university assessment tool. In addition 12 (54%) students provided specific feedback on the teaching strategy using a 16-item survey tool based on the domain concepts of Educational Acceptability, Educational Impact, and Preparation for Practice. Survey responses were on a 5-point Likert scale and analysed using descriptive statistics. Open-ended responses were analysed using content analysis. Results The majority of students perceived the course and this teaching strategy positively. The domain mean scores were high for Educational Acceptability (mean=4.3, SD=.49) and Educational Impact (mean=4.19, SD=.75) but slightly lower for Preparation for Practice (mean=3.7, SD=.77). Overall student responses to each item were positive with no item mean less than 3.42. Students found the root cause analysis challenging and time consuming but reported development of critical thinking skills about the complexity of practice, clinical governance and risk management principles. Conclusions Analysing complex real life clinical cases to determine a root cause enhanced midwifery students' perceptions of their critical thinking. Teaching and assessment strategies to promote critical thinking need to be made explicit to students in order to foster ongoing development.

Background Dissatisfaction with childbirth care can have a negative impact on a woman's health and well-being, as well as her relationships with her infant. Aim To investigate the prevalence and associated factors of dissatisfaction with intrapartum care by Jordanian women. Method A descriptive cross-sectional study was used. Participants (n = 320) who were 7 weeks post-partum were recruited from five maternal and child health centres in Irbid city in northern Jordan. Participants provided personal and obstetric information, and completed the Satisfaction with Childbirth Care Scale. Results The majority of women (75.6%) were dissatisfied with their intrapartum care. Dissatisfaction was associated with the attendance of unknown and unwanted persons during childbirth, experiencing labour as more painful than expected, and perceptions of inadequate help from healthcare providers to manage pain during labour. Limitations Findings are limited to Jordanian women accessing public sector perinatal health services. Conclusion The high percentage of women reporting dissatisfaction with intrapartum care in this study is of concern. Women's perception of pain and expectations of staff during labour and birth need to be addressed through education and improved communication by staff. Implications for Nursing and Health Policy Development of national evidence-based policies and quality assurance systems would help reduce the rate of obstetric interventions and give greater emphasis to respect for women's preferences during labour and birth.

Purpose To describe the health service utilisation and birth outcomes of pregnant women with moderate to super-extreme obesity. Background Maternal obesity is increasingly recognised as a key risk factor for adverse outcomes for both women and their babies. Little is known about the service utilisation and perinatal outcomes of women with obesity beyond a body mass index of 40. Method Women with a self-reported pre-pregnancy BMI of 40 or more, who had received care and birthed a baby at the study site between 1 January 2009 and 31 December 2010. Clinical audit was used to identify the health service utilisation and birth outcomes of these women. Results 153 women had a BMI of 40 or more. Women saw 6 different health professionals during pregnancy (1–16). Most of their visits were with a medical practitioner, often with limited experience, and almost all women only saw a midwife once at their booking visit ( n =150, 98.0%). While the majority of women experienced a normal pregnancy, free from any complications, almost half the women in this study experienced a caesarean section ( n =74, 48.4%). Conclusion Clinical audit has been useful in providing additional information which suggests current maternity care provision is not meeting the needs of this group of women. The model of antenatal care provision may be a mediating factor in the birth outcomes experienced by obese women. The development of effective, targeted antenatal care, designed to meet the needs of these women is recommended.

Objective to describe perceptions of participating in a study testing the effectiveness of a perinatal emotional support intervention (Promoting Resilience in Mothers Emotions; PRIME) by women identified as experiencing emotional distress after birth. Design qualitative descriptive approach. Semi-structured telephone interviews with 33 women recruited as part of a larger RCT to test the efficacy of a counselling intervention (PRIME). Women who received either (1) the intervention (counselling (or PRIME)) ( n =16), (2) active control (Parenting support) ( n =12), or (3) matched control (standard care) ( n =5), were interviewed at 12 months postpartum. Thematic analysis of data was used. Findings ‘promoting reflection' and ‘feeling cared for', were phrases that all participants used to describe their experience in the project regardless of group allocation. Women receiving PRIME reported ‘getting in touch with (their) feelings' and ‘moving on' as beneficial outcomes. Two women who received counselling reported ‘having things left unresolved' indicating that their needs had not been met. Some women in both the active control and intervention identified that contact was ‘nice but not hugely helpful or needed'. Implications and conclusions positive outcomes of PRIME were evident and most participants desired postpartum contact. Some women needed additional follow up and targeted assistance. Findings support the importance of providing personalised postnatal care that addresses women's emotional health needs.

Background Young pregnant women who continue a pregnancy are primarily from a socioeconomically deprived background. The risk factors associated with low socio-economic status may independently affect perinatal and neonatal morbidity to a greater extent than the young age of the woman. Young pregnant women are frequently sceptical about health care providers who they can perceive to be judgemental. This may lead to late booking for pregnancy care, attending few appointments, or not attending the health service for any antenatal care. Question Does the way maternity care is provided affect maternal and neonatal outcomes for young women? Method A systematic search of the major health databases. Results Nine research articles met the eligibility criteria: one randomised controlled trial, three prospective cohort studies, two comparative studies with concurrent controls, two comparative studies with historical controls, and one case series. Discussion Providing young women with a non-standard model of maternity care has some beneficial and no known detrimental effects on childbirth outcomes. While there is a dearth of evidence on the effectiveness of a Midwifery Group Practice model of care for young women, there is strong evidence to suggest that a Group Antenatal Care model increases antenatal visit attendance and breastfeeding initiation, and decreases the risk of preterm birth. There is research to indicate that a Young Women's Clinic model may also increase antenatal visit attendance and decrease the incidence of preterm birth. Conclusion More well-designed and resourced midwifery models of care for young women should be implemented and rigorously researched.

Objective to assess Australian midwives' attitudes towards caring for women with emotional distress and their perceptions of the extent to which workplace policies and processes hindered such care. Design a postal survey. Setting members of the Australian College of Midwives. Participants 815 Australian midwives completed the survey. Measurements a modified version of the 17-item REASON questionnaire (McCall et al., 2002) that was originally developed for used by General Practitioners to measure their attitudes towards their role in the management of patients with mental health disorders. Findings An exploratory factor analysis with Varimax rotation identified four factors that reflected midwives' (1) perceptions of systemic problems that hindered emotional care, (2) attitudes towards working with women experiencing emotional health problems, (3) perceived competence in using treatment techniques and (4) attitudes and perceived competence towards the referral of women with depression and anxiety to other health professionals. Key conclusions and implications for practice participating midwives indicated their willingness to offer assistance and acknowledged the importance of providing emotional care to women. In practice, emotional care by midwives is impeded by perceived lack of competency rather than a lack of interest. Midwives' competency in the assessment and care of women with conditions such as depression and anxiety may be enhanced through continuing professional education.

Intimate partner violence (IPV) is a prevalent and common problem yet is rarely screened for, or addressed in, couple relationship education (CRE). The current study examined the prevalence of IPV in 250 couples expecting their first child who were recruited into a study of CRE across the transition to parenthood. The couples were generally highly satisfied with their relationship, yet 32% reported at least one incident of IPV in the past 12 months, and 7% reported that at least one spouse had been injured by IPV. The majority of violence was of low severity (pushing, slapping, or shoving), and the most common pattern was of reciprocal aggression between the partners. Given that even low-severity IPV is associated with significant risk of inury and predicts risk of relationship separation, these high rates of IPV are concerning. CRE providers for expectant couples need to attend to prevention of IPV within their programs.

Objective to describe the development and application of a brief counselling intervention for women who have experienced a traumatic birth. Intervention the birthing trauma counselling model reflecting women's need to establish a therapeutic connection with a midwife, talk about their birth experience and have their feelings validated. Gaps in understanding of events need explanation and explicit connections made between the event and subsequent emotions and behaviours. Developing a rational understanding of birthing events and how labour may have been managed differently assists women to revise their assumptions about maternity care and gain a sense of control. Fostering social support, reinforcing positive approaches to coping and exploring solutions to restoring self-confidence and reducing anxiety may help re-establish psychological equilibrium. Discussion and conclusion the counselling intervention is consistent with trauma theory and draws on cognitive behavioural therapy principles. Midwives are well placed to provide counselling support to women experiencing birth-related distress. Further testing of the intervention in the clinical setting with a large sample is required.

Background: The influence of women's birth preferences on the rising cesarean section rates is uncertain and possibly changing. This review of publications relating to women's request for cesarean delivery explores assumptions related to the social, cultural, and political- economic contexts of maternity care and decision making. Method: A search of major databases was undertaken using the following terms: ''c(a)esarean section'' with ''maternal request,'' ''decision- making,'' ''patient participation,'' ''decision-making-patient,'' ''patient satisfaction,'' ''patient prefer- ence,'' ''maternal choice,'' ''on demand,'' and ''consumer demand.'' Seventeen papers examining women's preferred type of birth were retrieved. Results: No studies systematically examined information provided to women by health professionals to inform their decision. Some studies did not adequately acknowledge the influence of obstetric and psychological factors in relation to women's request for a cesarean section. Other potential influences were poorly addressed, including whether or not the doctor advised a vaginal birth, women's access to midwifery care in pregnancy, information provision, quality of care, and cultural issues. Discussion: The psychosocial context of obstetric care reveals a power imbalance in favorof physicians. Research into decision making about cesarean section that does not account for the way care is offered, observe interactions between women and practitioners, and analyze the context of care should be interpreted with caution. (BIRTH 34:4 December 2007)

BACKGROUND: The cesarean-section rate continues to rise in many countries with routine access to medical services, yet this increase is not associated with improvement in perinatal mortality or morbidity. A large number of commentaries in the medical literature and media suggest that consumer demand contributes significantly to the continued rise of births by cesarean section internationally. The objective of this article was to critically review the research literature concerning women’s preference or request for elective cesarean section published since that critiqued by Gamble and Creedy in 2000. METHODS: A search of key databases using a range of search terms produced over 200 articles, of which 80 were potentially relevant. Of these, 38 were research-based articles and 40 were opinion-based articles. A total of 17 articles fitted the criteria for review. A range of methodologies was used, with varying quality, making meta-analysis of findings inappropriate, and simple summaries of results difficult to produce. Results: The range and quality of studies had increased since 2001, reflecting continuing concern. Women’s preference for cesarean section varied from 0.3 to 14 percent; however, only 3 studies looked directly at this preference in the absence of clinical indications. Women’s preference for a cesarean section related to psychological factors, perceptions of safety, or in some countries, was influenced by cultural or social factors. CONCLUSIONS: Research between 2000 and 2005 shows evidence of very small numbers of women requesting a cesarean section. A range of personal and societal reasons, including fear of birth and perceived inequality and inadequacy of care, underpinned these requests

Registered nurse Papanicolaou (Pap) smear providers (RN PSPs) were introduced to improve women's accessibility to Pap smear services through the National Cervical Screening Program. This pilot study assessed women's attitudes towards RNs as providers.One hundred women attending a Family Planning Queensland (FPQ) centre for a routine appointment with a doctor or registered nurse were recruited. Participants completed an anonymous questionnaire.A response rate of 86% (n = 100) was achieved. Only 15% of participants indicated they had seen a RN for a Pap test prior to this visit and 67% were unaware that registered nurses provided Pap smear services. Participants reported positive attitudes toward RN PSPs (M = 44.53, SD = 7.85, range 13 - 60). The majority of participants considered RN PSPs would be responsive to their needs (92%) and well-qualified to perform Pap smears (70%). The majority (79%) would not hesitate to see a RN PSP for a Pap smear. Some uncertainty existed about the competence of nurses to provide this service (25% of respondents were uncertain). Older women were more likely to report less positive attitudes toward RN PSP (r = -.267, p.05). Women reporting previous awareness of the role of nurses as Pap smear providers were more likely to report positive attitudes (Chi-square = 12.96, p.0001) compared to women with no awareness of this role.While women are positive about RN PSPs, there is a need for promotion and community education about the role of RNs in providing cervical screening services.

This is the first in a series of articles on operative birth and psychological issues. This paper looks at negative childbirth experiences and how they can result in the development of trauma symptoms and post-traumatic stress disorder (PTSD). Psychological trauma symptoms following childbirth are debilitating, and may affect a woman's ability to care for her baby. This study aimed to examine the relationship between type of birth and symptoms of psychological trauma at 4–6 weeks postpartum. 400 Australian women in the last trimester of pregnancy were recruited from three public antenatal clinics. Participants were interviewed about the birth within 72 hours postpartum and telephone interviews conducted at 4–6 weeks postpartum to assess symptoms of psychological trauma. Results showed that women who had an emergency caesarean delivery or operative vaginal delivery were more likely to meet the diagnostic criteria for PTSD than women who had an elective caesarean section or spontaneous vaginal birth.

Adverse childbirth experiences can evoke fear and overwhelming anxiety for some women and precipitate posttraumatic stress disorder. The objective of this study was to assess a midwife‐led brief counseling intervention for postpartum women at risk of developing psychological trauma symptoms. Method: Of 348 women screened for trauma symptoms, 103 met inclusion criteria and were randomized into an intervention (n = 50) or a control (n = 53) group. The intervention group received face‐to‐face counseling within 72 hours of birth and again via telephone at 4 to 6 weeks postpartum. Main outcome measures were posttraumatic stress symptoms, depression, self‐blame, and confidence about a future pregnancy. Results: At 3‐month follow‐up, intervention group women reported decreased trauma symptoms, low relative risk of depression, low relative risk of stress, and low feelings of self‐blame. Confidence about a future pregnancy was higher for these women than for control group women. Three intervention group women compared with 9 control group women met the diagnostic criteria for posttraumatic stress disorder at 3 months postpartum, but this result was not statistically significant. Discussion: A high prevalence of postpartum depression and trauma symptoms occurred after childbirth. Although most women improved over time, the intervention markedly affected participants' trajectory toward recovery compared with women who did not receive counseling. Conclusions: A brief, midwife‐led counseling intervention for women who report a distressing birth experience was effective in reducing symptoms of trauma, depression, stress, and feelings of self‐blame. The intervention is within the scope of midwifery practice, caused no harm to participants, was perceived as helpful, and enhanced women's confidence about a future pregnancy.

This paper reports the findings of a small pilot study undertaken to identify women's perceptions of their Caesarean section and/or their experience of attempting to achieve a vaginal birth after Caesarean. Fifty-nine women replied to a survey designed and distributed by the consumer organisation Birthrites. The survey consisted of 22 closed and open-ended questions. Descriptive statistics and content analysis were used to analyse the data. Six major factors that impacted on women's perceptions of their birthing experience were identified: (i) 'being supported'; (ii) 'violated expectations'; (iii) 'loss of control'; (iv) 'health professionals' language, attitudes and care practices'; (v) 'the labour experience and the cascade of intervention'; and (vi) 'surgical birth and the separation from the baby'. The results support previous work in this area and demonstrate that some women suffer from psychological trauma following an emergency Caesarean section. The experiences of the women in this small study indicate a need for health professionals to not only better understand the distress that may occur but to also develop a greater understanding of the impact of their interactions with women. The study also provides a consumer 'voice' on current routine hospital policies surrounding vaginal birth after Caesarean and confirms the importance of choice, control and continuity of care for all women regardless of their 'risk' status.

Background Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear. Methods Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention (n = 170) or control (n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear (WDEQ-A) from second trimester to 36 weeks’ gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy. Results There were significant differences between groups on postintervention scores for fear of birth (p

Introduction For women with a lower uterine incision without indication for repeat Caesarean section (CS), vaginal birth for their next pregnancy is a safe option. Although these women should be encouraged to consider vaginal birth after a Caesarean section (VBAC) it is not consistently supported in practice. There is relatively little information on the extent to which maternal preference, birthing decisions and outcomes match best available evidence. Aim To describe current VBAC rates for women in Queensland, Australia and compare this to safe, achievable VBAC rates reported in national and international studies. Method Perinatal data from 2004 to 2011 were reviewed to determine current VBAC rates following a primary CS for women birthing in Queensland. These were compared with VBAC rates reported in the literature. Results Queensland has a high overall CS rate and high repeat CS rate compared with the national average. In 2010, Queensland VBAC rates for next birth following primary CS were 14% (range 13–21% public sector, 7–11% private hospitals). This is substantially lower than achievable Australian rates of 24% and international rates. Conclusion Low VBAC rates reflect low numbers of women commencing labour in a pregnancy subsequent to a primary CS. There is unexplained variation in VBAC rates between maternity facilities. Clinical reviews to support evidence-based practice are warranted. What is known about the topic? Repeat CS is a major contributor to high CS rates in industrialised countries. What does this paper add? Following a primary CS, women in Queensland are less likely to commence labour and achieve a vaginal birth compared with rates reported in national and international VBAC studies. What are the implications for practitioners? Maternity clinicians need to be aware of best practice and contextualise the evidence for individual women to improve VBAC rates.

Background Childbirth fear has received considerable attention in Scandinavian countries, and the United Kingdom, but not in Australia. For first-time mothers, fear is often linked to a perceived lack of control and disbelief in the body’s ability to give birth safely, whereas multiparous women may be fearful as a result of previous negative and/or traumatic birth experiences. There have been few well-designed intervention studies that test interventions to address women’s childbirth fear, support normal birth, and diminish the possibility of a negative birth experience. Methods/design Pregnant women in their second trimester of pregnancy will be recruited and screened from antenatal clinics in Queensland, Australia. Women reporting high childbirth fear will be randomly allocated to the intervention or control group. The psycho-educational intervention is offered by midwives over the telephone at 24 and 34 weeks of pregnancy. The intervention aims to review birth expectations, work through distressing elements of childbirth, discuss strategies to develop support networks, affirm that negative childbirth events can be managed and develop a birth plan. Women in the control group will receive standard care offered by the public funded maternity services in Australia. All women will receive an information booklet on childbirth choices. Data will be collected at recruitment during the second trimester, 36 weeks of pregnancy, and 4–6 weeks after birth. Discussion This study aims to test the efficacy of a brief, midwife-led psycho-education counselling (known as BELIEF: Birth Emotions - Looking to Improve Expectant Fear) to reduce women’s childbirth fear. 1) Relative to controls, women receiving BELIEF will report lower levels of childbirth fear at term; 2) less decisional conflict; 3) less depressive symptoms; 4) better childbirth self-efficacy; and 5) improved health and obstetric outcomes. Trial registration Australian New Zealand Controlled Trials Registry ACTRN12612000526875.

Background Childbirth fear is reported to affect around 20% of women. However reporting on levels of symptom severity vary. Unlike Scandinavian countries, there has been limited focus on childbirth fear in Australia. The aim of this paper is to determine the prevalence of low, moderate, high and severe levels of childbirth fear in a large representative sample of pregnant women drawn from a large randomised controlled trial and identify demographic and obstetric characteristics associated with childbirth fear. Method Using a descriptive cross-sectional design, 1,410 women in their second trimester were recruited from one of three public hospitals in south-east Queensland. Participants were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire Version A (WDEQ-A). Associations of demographic and obstetric factors and levels of childbirth fear between nulliparous and multiparous women were investigated. Results Prevalence of childbirth fear was 24% overall, with 31.5% of nulliparous women reporting high levels of fear (score ≥66 on the WDEQ-A) compared to 18% of multiparous women. Childbirth fear was associated with paid employment, parity, and mode of last birth, with higher levels of fear in first time mothers (p