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Shafiei T, McLachlan HL, Dennis CL, Nicholson JM, Nguyen T, Shiell A, Nguyen CD, Grimes H, Bee J, Adams C, Callander E, Forster DA. Preventing postnatal depression in new mothers using telephone peer support: protocol for the DAISY (Depression and AnxIety peer Support studY) multi-centre randomised controlled trial. BMJ Open 2024; 14:e087477. [PMID: 38749691 PMCID: PMC11097877 DOI: 10.1136/bmjopen-2024-087477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Postnatal depression affects up to one in six new mothers in Australia each year, with significant impacts on the woman and her family. Prevention strategies can be complicated by a woman's reluctance to seek professional help. Peer support is a promising but inadequately tested early intervention. Very few trials have reported on the efficacy of peer support in the perinatal period and no study has been undertaken in Australia. We will explore if proactive telephone-based peer (mother-to-mother) support, provided to women identified as being at high risk of postnatal depression, impacts on clinically significant depressive symptomatology at 6 months postpartum. METHODS AND ANALYSIS This is a protocol for a single-blinded, multi-centre, randomised controlled trial conducted in Melbourne, Australia. Eligible women will be recruited from either the postnatal units of two maternity hospitals, or around 4 weeks postpartum at maternal and child health centres within two metropolitan council areas. A total of 1060 (530/group) women will be recruited and randomly allocated (1:1 ratio) to either-usual care, to receive the standard community postpartum services available to them, or the intervention group, to receive proactive telephone-based support from a peer volunteer for 6 months, in addition to standard community services. PRIMARY OUTCOME clinically significant depressive symptomatology at 6 months postpartum as measured using the Edinburgh Postnatal Depression Scale. SECONDARY OUTCOMES symptoms of anxiety and/or stress, health-related quality of life, loneliness, perception of partner support, self-rated parenting, child health and development, infant feeding and health service use. The cost-effectiveness of the intervention relative to standard care will also be assessed. ETHICS AND DISSEMINATION Ethics approval has been obtained from La Trobe University, St. Vincent's Hospital, the Royal Women's Hospital, Northern Health, Victorian Department of Health and Human Services and Victorian Department of Education and Training. Written informed consent will be obtained from all participants before randomisation. Trial results will be disseminated through peer-reviewed publications, conference presentations and a higher degree thesis. TRIAL REGISTRATION NUMBER ACTRN12619000684123; Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Cindy-Lee Dennis
- Lawrence S. Bloomburg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jan M Nicholson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Tram Nguyen
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alan Shiell
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cattram D Nguyen
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Heather Grimes
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
- Rural Department of Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Jessica Bee
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Catina Adams
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Emily Callander
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
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Whitburn LY, Cullinane M, Benzie C, Newton MS, McLachlan HL, Forster DA. Women's views and experiences of a new Midwifery Group Practice model in rural Australia. Women Birth 2024; 37:101603. [PMID: 38657332 DOI: 10.1016/j.wombi.2024.101603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Women in rural Australia often have limited maternity care options available, and in Victoria, like many Australian states, numerous small hospitals no longer offer birthing services. AIM To evaluate women's views and experiences of maternity care at a local rural hospital that re-established birthing services with a Midwifery Group Practice (MGP) model of maternity care. METHODS Women who booked into the new MGP model from May 2021 to June 2022 were invited to complete an anonymous online survey and participate in an optional additional semi-structured interview to explore their views and experiences. Descriptive statistics were used for quantitative data, and open-ended survey and interview responses were analysed using a general inductive approach. FINDINGS Sixty-seven percent (44/66) of women completed the survey and five also completed an interview. Women were highly satisfied with the care they received. They felt respected, empowered, and had a sense of agency throughout their pregnancies, labour and birth, and post-birth. They reported low levels of anxiety during labour and birth, and felt that they coped physically and emotionally better than they anticipated. They felt well supported by midwives and highly valued the continuity of care within the MGP model. CONCLUSION Women's voices play a critical role in informing maternity care provision, particularly for those in rural communities who may have limited access to care options. The findings support and expand on existing research regarding the value of midwifery continuity of care models, and can inform other rural maternity services in introducing similar models.
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Affiliation(s)
- Laura Y Whitburn
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Charlie Benzie
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Royal Women's Hospital, Locked Bag 300, Grattan Street & Flemington Road, Parkville, VIC 3052, Australia
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Rodrigo R, Amir LH, Forster DA. Parents' Views on Prolonged Maternal Hospital Stay With Sick Newborn Infants in a Tertiary Neonatal Unit in Sri Lanka. Adv Neonatal Care 2024; 24:162-171. [PMID: 38545806 DOI: 10.1097/anc.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Mothers of infants in most Sri Lankan neonatal units are required to be "inpatients" during the entirety of their infant's stay. This traditional practice is closely aligned to the relatively newer model of family-integrated care. PURPOSE Exploration of parent's views regarding the expectation for mothers to remain in hospital for the entire duration of their infant's neonatal unit stay. METHODS Cross-sectional study of parents of infants admitted to the University neonatal unit of Colombo North Teaching Hospital, Ragama, Sri Lanka, using self-administered questionnaires in 2017. RESULTS We found that 40% (19/48) of mothers and 43% (16/37) of fathers preferred that mothers traveled from home, rather than being inpatients continuously, in order to care for older children, receive psychological support from family, and also due to other practical inconveniences of living in the hospital. The main barriers to women being able to travel from home were the need to safely provide expressed human milk for their hospitalized infants and current hospital administrative and societal attitudes. IMPLICATIONS FOR PRACTICE AND RESEARCH We found that a considerable number of parents with infants in the neonatal intensive care unit in Sri Lanka would like the option of the mother being able travel from home, rather than being confined to hospital. To facilitate this option, changes in hospital protocols and further research into storage and transportation of expressed mother's milk will be required. Improving facilities in hospital and providing more opportunities for families to interact with infants in neonatal intensive care unit will encourage mothers to remain in hospital continuously.
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Affiliation(s)
- Ranmali Rodrigo
- Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Melbourne, Victoria, Australia (Drs Rodrigo, Amir, and Forster); Department of Paediatrics, University of Kelaniya, Ragama, Sri Lanka (Dr Rodrigo); Department of Paediatrics, Mercy Hospital for Women, Heidelberg, Melbourne, Australia (Dr Rodrigo); and Midwifery and Maternity Services Research, The Royal Women's Hospital, Parkville, Melbourne, Australia (Dr Forster)
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Matthews RP, Hyde RL, McLachlan HL, Llewelyn F, Forster DA. Midwifery workforce challenges in Victoria, Australia. A cross-sectional study of maternity managers. Women Birth 2024; 37:144-152. [PMID: 37553273 DOI: 10.1016/j.wombi.2023.07.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND In Australia, there is a lack of accurate data on midwifery workforce staffing and skill mix, which in turn hinders workforce policy and planning. AIM To describe the current staffing levels of the midwifery workforce in Victoria, Australia, explore workforce challenges and assess the impact of COVID-19 pandemic on staffing. DESIGN Cross-sectional. METHODS Midwifery managers in all public and private maternity services in Victoria, Australia were invited to complete a survey exploring midwifery staffing numbers and adequacy. Topics explored included midwifery turnover, recruitment, and skill mix. Descriptive statistics were used. FINDINGS The survey was open March to October 2021, and 56 % (38/68) of managers responded. Of these, 76 % reported inadequate midwifery staff levels, with deficits ranging from one to 19 estimated Full-Time Equivalent (EFT) midwives, with a combined total deficit of 135 EFT. In the 12 months prior to the survey, 73 % of services had found it difficult to recruit midwives, with increased difficulty during the COVID-19 pandemic. Managers were concerned about retaining and recruiting 'experienced' midwives due to an ageing workforce and high turnover due to work/life imbalance and job dissatisfaction. These issues have led to a predominantly early career midwifery workforce and created concern about skill mix. CONCLUSION Victorian maternity services have a midwifery workforce shortage and are experiencing significant skill mix issues. The pandemic has exacerbated these considerable gaps in the workforce. Urgent implementation of retention and recruitment schemes are needed, along with strategies to improve the working conditions for the current workforce.
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Affiliation(s)
- Robyn P Matthews
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia.
| | - Rebecca L Hyde
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Fleur Llewelyn
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
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Moorhead AM, Amir LH, Crawford SB, Forster DA. Breastfeeding outcomes at 3 months for women with diabetes in pregnancy: Findings from the Diabetes and Antenatal Milk Expressing randomized controlled trial. Birth 2024. [PMID: 38193243 DOI: 10.1111/birt.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 10/14/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Women with diabetes in pregnancy have decreased exclusivity and duration of breastfeeding compared with women without diabetes, and their infants are at increased risk of hypoglycemia. Clinicians often suggest pregnant women with diabetes to express breastmilk, and studies have reported increased breastfeeding exclusivity in the early postnatal period for patients who have expressed. Little is known about longer term outcomes. We investigated whether advising low-risk women with diabetes in pregnancy to express beginning at 36 weeks of pregnancy increased exclusivity and maintenance of breastfeeding at 3 months. METHODS We conducted a multicenter, two-group, randomized controlled trial at six hospitals in Melbourne, Australia, between 2011 and 2015. Women were randomized to either standard maternity care or advised to hand express for 10 min twice daily, in addition to standard care. Women were telephoned at 12-13 weeks postpartum and asked a series of questions about feeding their baby, perceptions of their milk supply, and other health outcomes. RESULTS Of 631 women in the study, data for 570 (90%) were analyzed at 12-13 weeks. After adjustment, we found no evidence that women allocated to antenatal expressing were more likely to be giving only breastmilk (aRR 1.07 [95% CI 0.92-1.22]) or any breastmilk (aRR 0.99 [95% CI 0.92-1.06]) at 12-13 weeks postpartum compared with women in the standard care group. CONCLUSION While the practice of antenatal expression for low-risk women with diabetes during pregnancy is promising for increasing exclusivity of breastmilk feeding in hospital, at 12-13 weeks, there was no association with breastfeeding outcomes.
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Affiliation(s)
- Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sharinne B Crawford
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
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Zugna SA, McLachlan HL, Cullinane M, Newton M, Forster DA. Rural and regional maternity managers' and educators' views of the Maternity and Newborn Emergencies (MANE) education program in Victoria, Australia: a qualitative descriptive study. BMC Health Serv Res 2024; 24:8. [PMID: 38172818 PMCID: PMC10765823 DOI: 10.1186/s12913-023-10466-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Australia has one of the lowest perinatal morbidity and mortality rates in the world, however a cluster of perinatal deaths at a regional health service in the state of Victoria in 2015 led to state-wide reforms, including the introduction of the Maternity and Newborn Emergencies (MANE) program. MANE was a 2-day interprofessional maternity education program delivered by external expert facilitators to rural and regional Victorian maternity service providers. An independent evaluation found that the MANE program improved the confidence and knowledge of clinicians in managing obstetric emergencies and resulted in changes to clinical practice. While there is a large volume of evidence that supports the use of interprofessional education in improving clinicians' clinical practice, the impact of these programs on the overall safety culture of a health service has been less studied. Managers and educators have an important role in promoting the safety culture and clinical governance of the heath service. The aim of this study, therefore, was to explore Victorian rural and regional maternity managers' and educators' views and experiences of the MANE program. METHODS Maternity managers and educators from the 17 regional and rural health services across Victoria that received the MANE program during 2018 and 2019 were invited to participate. Semi-structured interviews using mostly open-ended questions (and with a small number of fixed response questions) were undertaken. Qualitative data were transcribed verbatim and analysed thematically. Descriptive statistics were used for quantitative data. RESULTS Twenty-one maternity managers and educators from the 17 health services participated in the interviews. Overall, participants viewed the MANE program positively. Four themes were identified: the value of external facilitation in providing obstetric emergency training; improved awareness and understanding of clinical governance; improved clinical practice; and the importance of maintaining the program. Participants agreed that MANE had improved the confidence (94%) and skills (94%) of clinicians in managing obstetric emergencies, as well as confidence to escalate concerns (94%), and most agreed that it had improved clinical practice (70%) and teamwork among attendees (82%). CONCLUSION Maternity managers and educators were positive about MANE; they considered that it contributed to improving factors that impact the safety culture of health services, with delivery by external experts considered to be particularly important. Given the crucial role of maternity managers and educators on safety culture in health services, as well in program facilitation, these findings are important for future planning of maternity education programs across the state. TRIAL REGISTRATION Trial registration was not required for this study.
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Affiliation(s)
- Stefanie A Zugna
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Michelle Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia
- Royal Women's Hospital, Parkville, VIC, Australia
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Benzie CA, Newton MS, McLachlan HL, Forster DA. Identifying women with a disability in Australian maternity services: Time for a change. Aust N Z J Obstet Gynaecol 2023. [PMID: 37964405 DOI: 10.1111/ajo.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
It is estimated that over 1 billion people worldwide have a disability. In Australia, 9% of women of childbearing age have a disability, but data on disability status for women accessing maternity services are not routinely collected and data collection processes are inconsistent. Maternal disability may affect perinatal outcomes, but to understand what factors might be amenable to interventions to improve outcomes, accurate data collection on disability status is essential. This opinion piece reflects on disability identification within maternity services in Australia, identifying areas for policy and practice change.
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Affiliation(s)
- Charlie A Benzie
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Michelle S Newton
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Helen L McLachlan
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- The Royal Women's Hospital, Melbourne, Victoria, Australia
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McLardie-Hore FE, McLachlan HL, Forster DA, Holmlund S, McCalman P, Newton MS. Comparing the views of caseload midwives working with First Nations families in an all-risk, culturally responsive model with midwives working in standard caseload models, using a cross-sectional survey design. Women Birth 2023; 36:469-480. [PMID: 37407296 DOI: 10.1016/j.wombi.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 07/07/2023]
Abstract
PROBLEM Little is known about midwives' views and wellbeing when working in an all-risk caseload model. BACKGROUND Between March 2017 and December 2020 three maternity services in Victoria, Australia implemented culturally responsive caseload models for women having a First Nations baby. AIM Explore the views, experiences and wellbeing of midwives working in an all-risk culturally responsive model for First Nations families compared to midwives in standard caseload models in the same services. METHODS A survey was sent to all midwives in the culturally responsive (CR) model six-months and two years after commencement (or on exit), and to standard caseload (SC) midwives two years after the culturally responsive model commenced. Measures used included the Midwifery Process Questionnaire and Copenhagen Burnout Inventory (CBI). FINDINGS 35 caseload midwives (19 CR, 16 SC) participated. Both groups reported positive attitudes towards their professional role, trending towards higher median levels of satisfaction for the culturally responsive midwives. Midwives valued building close relationships with women and providing continuity of care. Around half reported difficulty maintaining work-life balance, however almost all preferred the flexible hours to shift work. All agreed that a reduced caseload is needed for an all-risk model and that supports around the model (e.g. nominated social workers, obstetricians) are important. Mean CBI scores showed no burnout in either group, with small numbers of individuals having burnout in both groups. DISCUSSION AND CONCLUSION Midwives were highly satisfied working in both caseload models, but decreased caseloads and more organisational supports are needed in all-risk models.
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Affiliation(s)
- Fiona E McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; The Royal Women's Hospital, Parkville, Victoria 3052 Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; The Royal Women's Hospital, Parkville, Victoria 3052 Australia
| | - Sophia Holmlund
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; Department of Nursing, Umeå University, Umeå, Sweden; Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Pamela McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
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McLardie-Hore FE, Forster DA, McLachlan HL, Shafiei T, Amir LH, Davey MA, Grimes H, Gold L. Is proactive telephone-based breastfeeding peer support a cost-effective intervention? A within-trial cost-effectiveness analysis of the 'Ringing Up about Breastfeeding earlY' (RUBY) randomised controlled trial. BMJ Open 2023; 13:e067049. [PMID: 37290948 PMCID: PMC10254963 DOI: 10.1136/bmjopen-2022-067049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/21/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The 'Ringing Up about Breastfeeding earlY' (RUBY) randomised controlled trial showed increased breastfeeding at 6 months in participants who received the proactive telephone-based peer support breastfeeding intervention compared with participants allocated to receive standard care and supports. The present study aimed to evaluate if the intervention was cost-effective. DESIGN A within-trial cost-effectiveness analysis. SETTING Three metropolitan maternity services in Melbourne, Victoria, Australia. PARTICIPANTS First time mothers intending to breastfeed their infant (1152) and peer volunteers (246). INTERVENTION The intervention comprised proactive telephone-based support from a peer volunteer from early postpartum up to 6 months. Participants were allocated to usual care (n=578) or the intervention (n=574). MAIN OUTCOME MEASURES Costs during a 6-month follow-up period including individual healthcare, breastfeeding support and intervention costs in all participants, and an incremental cost-effectiveness ratio. RESULTS Costs per mother supported were valued at $263.75 (or $90.33 excluding costs of donated volunteer time). There was no difference between the two arms in costs for infant and mothers in healthcare and breastfeeding support costs. These figures result in an incremental cost-effectiveness ratio of $4146 ($1393 if volunteer time excluded) per additional mother breast feeding at 6 months. CONCLUSION Considering the significant improvement in breastfeeding outcomes, this intervention is potentially cost-effective. These findings, along with the high value placed on the intervention by women and peer volunteers provides robust evidence to upscale the implementation of this intervention. TRIAL REGISTRATION NUMBER ACTRN12612001024831.
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Affiliation(s)
- Fiona E McLardie-Hore
- Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Della A Forster
- Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - H L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Mary-Ann Davey
- Obstetrics & Gynaecology, Monash Health, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Heather Grimes
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- La Trobe University Rural Health School, Bendigo, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
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Moorhead AM, Amir LH, Forster DA. Re: "Education and Experiences of Antenatal Breast Milk Expression: A Systematic Review" by Sobik et al. Breastfeed Med 2023. [PMID: 37162748 DOI: 10.1089/bfm.2023.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Australia
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11
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Springall TL, McLachlan HL, Forster DA, Browne J, Chamberlain C. Factors associated with breastfeeding initiation and maintenance for Aboriginal and Torres Strait Islander women in Australia: A systematic review and narrative analysis. Women Birth 2023; 36:224-234. [PMID: 35840537 DOI: 10.1016/j.wombi.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Australian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) women breastfeed at lower rates than non-Aboriginal women. Little is known about factors associated with breastfeeding specific to Aboriginal women and infants. AIM Determine the protective and risk factors associated with breastfeeding for Aboriginal women in Australia. METHODS CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English reporting protective and risk factors associated with breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Ten percent of papers were co-screened, and two reviewers completed data extraction. Narrative data synthesis was used. FINDINGS The initial search identified 12,091 records, with 31 full text studies retrieved, and 17 reports from 14 studies met inclusion criteria. Protective factors included living in a remote area, attending an Aboriginal-specific service, attending a regional service, higher levels of education attainment, increased maternal age, living in larger households, being partnered, and having a higher reported number of stressful events and social health issues. The identified risk factors were smoking in pregnancy, admission to SCN or NICU, and being multiparous. CONCLUSION This review identified factors associated with breastfeeding for Aboriginal women. Government focus, support, and consistent funding are required to plan and implement evidence-based interventions and services for Aboriginal women and infants in urban, rural, remote, and very remote locations. Rigorous research is required to understand the Aboriginal-specific factors associated with breastfeeding to improve rates and health outcomes for Aboriginal women and infants.
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Affiliation(s)
- Tanisha L Springall
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia; School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia; Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia.
| | - Jennifer Browne
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia.
| | - Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia; Centre for Health Equity, The University of Melbourne, Melbourne, Victoria, Australia; NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social Equity, Australia; The Lowitja Institute, Australia.
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12
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McLardie‐Hore FE, McLachlan HL, Newton MS, Bundle G, Druce T, Jackomos M, Forster DA. Accurate identification and documentation of First Nations women and babies attending maternity services: How can we 'close the gap' if we can't get this right? Aust N Z J Obstet Gynaecol 2022; 63:234-240. [PMID: 36529131 PMCID: PMC10952504 DOI: 10.1111/ajo.13641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/24/2022] [Indexed: 02/17/2024]
Abstract
BACKGROUND Policies and strategies addressing the health inequities experienced by First Nations peoples are critical to ensuring the gap in outcomes between First Nations and non-Indigenous peoples is closed. The identification of First Nations peoples is vital to enable the delivery of culturally safe and sensitive health care. Complete and accurate health data are essential for funding and evaluation of such initiatives. AIMS To describe the processes used and accuracy of identification and documentation of First Nations mothers and babies during the period of the implementation of a culturally responsive caseload model of maternity care at three major metropolitan maternity services in Melbourne, Australia. MATERIALS AND METHODS A cross-sectional study was conducted using administrative and clinical data. RESULTS There was variation in when and how First Nations identification was asked and documented for mothers and babies. Errors included 14% of First Nations mothers not identified at the first booking appointment, 5% not identified until after the birth and 11% of First Nations babies not identified in the Victorian Perinatal Data Collection documentation. Changes to documentation and staff education were implemented to improve identification and reduce inaccuracies. CONCLUSIONS To improve disparities in health outcomes, mainstream health services must respond to the needs of First Nations peoples, but improved care first requires accurate identification and documentation of First Nations peoples. Implementing and maintaining accuracy in collection and documentation of First Nations status is essential for health services to provide timely and appropriate care to First Nations people and to support and grow culturally appropriate and safe services.
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Affiliation(s)
- Fiona E. McLardie‐Hore
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- The Royal Women's HospitalParkvilleVictoriaAustralia
| | - Helen L. McLachlan
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Michelle S. Newton
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Gina Bundle
- The Royal Women's HospitalParkvilleVictoriaAustralia
| | - Tanya Druce
- Sunshine HospitalWestern HealthSt AlbansVictoriaAustralia
| | | | - Della A. Forster
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- The Royal Women's HospitalParkvilleVictoriaAustralia
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Cullinane M, Zugna SA, McLachlan HL, Newton MS, Forster DA. Evaluating the impact of a maternity and neonatal emergencies education programme in Australian regional and rural health services on clinician knowledge and confidence: a pre-test post-test study. BMJ Open 2022; 12:e059921. [PMID: 35623751 PMCID: PMC9150162 DOI: 10.1136/bmjopen-2021-059921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Almost 78 000 women gave birth in the state of Victoria, Australia, in 2019. While most births occurred in metropolitan Melbourne and large regional centres, a significant proportion of women birthed in rural services. In late 2016, to support clinicians to recognise and respond to clinical deterioration, the Victorian government mandated provision of an emergency training programme, called Maternity and Newborn Emergencies (MANE), to rural and regional maternity services across the state. This paper describes the evaluation of MANE. DESIGN AND SETTING A quasi-experimental study design was used; the Kirkpatrick Evaluation Model provided the framework. PARTICIPANTS Participants came from the 17 rural and regional Victorian maternity services who received MANE in 2018 and/or 2019. OUTCOME MEASURES Baseline data were collected from MANE attendees before MANE delivery, and at four time points up to 12 months post-delivery. Clinicians' knowledge of the MANE learning objectives, and confidence ratings regarding the emergencies covered in MANE were evaluated. The Safety Attitudes Questionnaire (SAQ) assessed safety climate pre-MANE and 6 months post-MANE among all maternity providers at the sites. RESULTS Immediately post-MANE, most attendees reported increased confidence to escalate clinical concerns (n=251/259). Knowledge in the non-technical and practical aspects of the programme increased. Management of perinatal emergencies was viewed as equally stressful pre-MANE and post-MANE, but confidence to manage these emergencies increased post-delivery. Pre-MANE SAQ scores showed consistently strong and poor performing services. Six months post-MANE, some services showed improvements in SAQ scores indicative of improved safety climate. CONCLUSION MANE delivery resulted in both short-term and sustained improvements in knowledge of, and confidence in, maternity emergencies. Further investigation of the SAQ across Victoria may facilitate identification of services with a poor safety climate who could benefit from frequent targeted interventions (such as the MANE programme) at these sites.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Stefanie A Zugna
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
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14
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McLachlan HL, Newton M, McLardie-Hore FE, McCalman P, Jackomos M, Bundle G, Kildea S, Chamberlain C, Browne J, Ryan J, Freemantle J, Shafiei T, Jacobs SE, Oats J, Blow N, Ferguson K, Gold L, Watkins J, Dell M, Read K, Hyde R, Matthews R, Forster DA. Translating evidence into practice: Implementing culturally safe continuity of midwifery care for First Nations women in three maternity services in Victoria, Australia. EClinicalMedicine 2022; 47:101415. [PMID: 35747161 PMCID: PMC9142789 DOI: 10.1016/j.eclinm.2022.101415] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Strategies to improve outcomes for Australian First Nations mothers and babies are urgently needed. Caseload midwifery, where women have midwife-led continuity throughout pregnancy, labour, birth and the early postnatal period, is associated with substantially better perinatal health outcomes, but few First Nations women receive it. We assessed the capacity of four maternity services in Victoria, Australia, to implement, embed, and sustain a culturally responsive caseload midwifery service. METHODS A prospective, non-randomised research translational study design was used. Site specific culturally responsive caseload models were developed by site working groups in partnership with their First Nations health units and the Victorian Aboriginal Community Controlled Health Organisation. The primary outcome was to increase the proportion of women having a First Nations baby proactively offered and receiving caseload midwifery as measured before and after programme implementation. The study was conducted in Melbourne, Australia. Data collection commenced at the Royal Women's Hospital on 06/03/2017, Joan Kirner Women's and Children's Hospital 01/10/2017 and Mercy Hospital for Women 16/04/2018, with data collection completed at all sites on 31/12/2020. FINDINGS The model was successfully implemented in three major metropolitan maternity services between 2017 and 2020. Prior to this, over a similar timeframe, only 5.8% of First Nations women (n = 34) had ever received caseload midwifery at the three sites combined. Of 844 women offered the model, 90% (n = 758) accepted it, of whom 89% (n = 663) received it. Another 40 women received standard caseload. Factors including ongoing staffing crises, prevented the fourth site, in regional Victoria, implementing the model. INTERPRETATION Key enablers included co-design of the study and programme implementation with First Nations people, staff cultural competency training, identification of First Nations women (and babies), and regular engagement between caseload midwives and First Nations hospital and community teams. Further work should include a focus on addressing cultural and workforce barriers to implementation of culturally responsive caseload midwifery in regional areas. FUNDING Partnership Grant (# 1110640), Australian National Health and Medical Research Council and La Trobe University.
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Affiliation(s)
- Helen L. McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- Corresponding author at: Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia.
| | - Michelle Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Fiona E. McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Pamela McCalman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Marika Jackomos
- Mercy Hospital for Women, Heidelberg, Victoria 3084, Australia
| | - Gina Bundle
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Sue Kildea
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Alice Springs 0870, Australia
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
- Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch, Western Australia 6150, Australia
- The Lowitja Institute, Carlton, Victoria 3053, Australia
| | - Jennifer Browne
- Deakin University Institute for Health Transformation, Geelong, Victoria 3220, Australia
- Victorian Aboriginal Community Controlled Health Organisation, Collingwood, Victoria 3066, Australia
| | - Jenny Ryan
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Jane Freemantle
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria 3630, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Susan E. Jacobs
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
- Murdoch Children's Research Institute, University of Melbourne, Parkville, Victoria 3052, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
| | - Ngaree Blow
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3053, Australia
| | - Karyn Ferguson
- Rural Health Academic Centre, The University of Melbourne, Shepparton, Victoria 3630, Australia
| | - Lisa Gold
- Deakin University Institute for Health Transformation, Geelong, Victoria 3220, Australia
| | - Jacqueline Watkins
- Joan Kirner Hospital, Western Health St Albans, Victoria 3021, Australia
| | - Maree Dell
- Joan Kirner Hospital, Western Health St Albans, Victoria 3021, Australia
| | - Kim Read
- Goulburn Valley Health, Shepparton, Victoria 3644, Australia
| | - Rebecca Hyde
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Robyn Matthews
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
| | - Della A. Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086 Australia
- The Royal Women's Hospital, Parkville, Victoria 3052, Australia
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15
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McLardie-Hore FE, Forster DA, Shafiei T, McLachlan HL. First-time mothers' experiences of receiving proactive telephone-based peer support for breastfeeding in Australia: a qualitative study. Int Breastfeed J 2022; 17:31. [PMID: 35459252 PMCID: PMC9034489 DOI: 10.1186/s13006-022-00476-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 04/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background The RUBY randomised controlled trial was found to be effective in promoting breastfeeding continuation, in the setting of a high income country, through a program of proactive telephone-based peer support in the first 6 months postpartum. This paper explores women’s experiences of receiving the peer support intervention in the RUBY trial. Methods Ten in-depth, face-to-face interviews were conducted between December 2015 and November 2016 in Metropolitan Melbourne, and regional Victoria, Australia. Participants were women who received the peer support intervention in the RUBY trial and were between 11 and 15 months postpartum at the time of interview. Interviews were underpinned by social support theories and were analysed using inductive thematic analysis. Results A global theme of ‘non-judgemental support and guidance’ was identified, which included five organising themes. Four of the organising themes centred on the support from the peer, in which women felt the support was a ‘positive experience with empathy and understanding’, ‘non-judgemental’, ‘practical advice’, and a ‘social connection that was more than just breastfeeding’. In contrast to the support from peers was the theme ‘not all support from family and friends is supportive’. Conclusion Participants, including those who considered that they had adequate and available family and friend support for breastfeeding, valued and appreciated the non-judgemental, empathetic and understanding support from peers. This support, facilitated by the anonymity of the telephone-based program, allowed open and honest conversations, normalising women’s experiences and helping them feel less alone in their challenges with breastfeeding and transition to motherhood. These findings can inform the design, and upscaling, of innovative and sustainable peer support models, ensuring delivery of effective and engaging support with a broad population reach.
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Affiliation(s)
- Fiona E McLardie-Hore
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia. .,Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,Royal Women's Hospital, Melbourne, VIC, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
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16
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Moorhead AM, Amir LH, Forster DA, Crawford SB. 'Is there any point in me doing this?' Views and experiences of women in the Diabetes and Antenatal Milk Expressing (DAME) trial. Matern Child Nutr 2022; 18:e13307. [PMID: 34939318 PMCID: PMC8932693 DOI: 10.1111/mcn.13307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/20/2022]
Abstract
The Diabetes and Antenatal Milk Expressing (DAME) randomised controlled trial (RCT) was conducted in 2011–2015, at six sites in Melbourne, Australia to explore the effect of advising women with diabetes in pregnancy to express breast milk from 36 weeks gestation. Infants whose mothers were randomised to express in pregnancy were more likely to be exclusively breast milk fed during their hospital stay, and there was no evidence of harm. This paper explores women's views and experiences of antenatal expressing. In this two‐arm RCT, 635 women with diabetes in pregnancy who were otherwise of low medical risk were randomised at 36–37 weeks gestation to usual care (not expressing, n = 316), or the intervention, where women were advised to hand express for 10 min twice daily until birth (n = 319). Semistructured face‐to‐face interviews were conducted with 10 women who expressed antenatally. They were asked about their experiences of antenatal expressing, including how they felt about the overall experience, the amount of breast milk they expressed, making time to express, and their experience of breastfeeding. Thematic analysis of the in‐depth interviews identified six themes: (1) learning and adapting expressing, (2) feelings and sensations associated with expressing, (3) support, (4) dis/empowerment, (5) health, and (6) the value of breast milk. Women had both positive and negative experiences of antenatal expressing. If health professionals are advising antenatal expressing to women, it is important they understand the range of outcomes and experiences. Women's experiences of antenatal expressing were both positive and negative; it is important to understand the range of experiences. Women should be advised that some women express little or no breast milk antenatally and therefore be reassured if they are concerned. For women with diabetes in pregnancy, their diabetes management is a significant time burden, and should be considered when discussing antenatal expressing with women. Maternity care providers need to follow‐up with pregnant women advised to express, to provide education, reassurance, and reassess expressing techniques. Maternity care providers need to manage and prioritise the use of expressed breast milk.
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Affiliation(s)
- Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sharinne B Crawford
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
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17
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Muggli E, Hearps S, Halliday J, Elliott EJ, Penington A, Thompson DK, Spittle A, Forster DA, Lewis S, Anderson PJ. A data driven approach to identify trajectories of prenatal alcohol consumption in an Australian population-based cohort of pregnant women. Sci Rep 2022; 12:4353. [PMID: 35288617 PMCID: PMC8921195 DOI: 10.1038/s41598-022-08190-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/09/2022] [Indexed: 01/08/2023] Open
Abstract
Accurate information on dose, frequency and timing of maternal alcohol consumption is critically important when investigating fetal risks from prenatal alcohol exposure. Identification of distinct alcohol use behaviours can also assist in developing directed public health messages about possible adverse child outcomes, including Fetal Alcohol Spectrum Disorder. We aimed to determine group-based trajectories of time-specific, unit-level, alcohol consumption using data from 1458 pregnant women in the Asking Questions about Alcohol in Pregnancy (AQUA) longitudinal study in Melbourne, Australia. Six alcohol consumption trajectories were identified incorporating four timepoints across gestation. Labels were assigned based on consumption in trimester one and whether alcohol use was continued throughout pregnancy: abstained (33.8%); low discontinued (trimester one) (14.4%); moderate discontinued (11.7%); low sustained (13.0%); moderate sustained (23.5%); and high sustained (3.6%). Median weekly consumption in trimester one ranged from 3 g (low discontinued) to 184 g of absolute alcohol (high sustained). Alcohol use after pregnancy recognition decreased dramatically for all sustained drinking trajectories, indicating some awareness of risk to the unborn child. Further, specific maternal characteristics were associated with different trajectories, which may inform targeted health promotion aimed at reducing alcohol use in pregnancy.
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18
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Hay SJ, McLachlan HL, Newton M, Forster DA, Shafiei T. Sources of information during pregnancy and the early parenting period: Exploring the views of women and their partners. Midwifery 2021; 105:103236. [PMID: 34968821 DOI: 10.1016/j.midw.2021.103236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/30/2021] [Accepted: 12/19/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE There are a wide variety of information sources available during pregnancy and the early parenting period, but limited understanding of their usefulness, particularly for partners. We explored the views of both women and their partners regarding sources of information, their frequency of use, and their preferred formats. DESIGN AND SETTING Data were collected as part of a large cluster randomised controlled trial at a tertiary maternity hospital in 2015-2016, in Melbourne, Australia. The overall evaluation was of a parenting kit ('Growing Together'), an evidence-based information source for prospective and new parents covering the period from conception until one year postpartum. This paper uses data collected from women when their baby was two months of age, and women's partners when the baby was six months of age, via postal or online survey. PARTICIPANTS Women were eligible if they booked for pregnancy care at The Royal Women's Hospital during the recruitment period, were having their first baby, able to read and speak English without an interpreter, and <30 weeks pregnant at their first hospital appointment (n = 1034). All eligible women were included unless they opted out. MEASUREMENTS AND FINDINGS In total 92 women were excluded. Of the women sent the two-month survey, 42% (392/941) responded. Partner surveys were returned by 252/791 partners (32%). Respondents received information from a range of sources, most frequently face to face from health professionals through childbirth education or midwife discussion/education, followed by friends and family members. Information received from a health professional was also reported as being the most useful. For both women and their partners, the most important factor related to information was that it was from a trusted and reliable source. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Women and their partners highlighted the importance of quality and access to evidence based resources and information. The internet is frequently favoured by women and their partners due to its convenience, accessibility, and timely access to information. Overall, women and their partners reported information directly from a health care professional to be the most useful and health services should ensure that women and their partners have adequate access to their health care professional.
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Affiliation(s)
- S J Hay
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Drive, Bundoora, Victoria 3086, Australia.
| | - H L McLachlan
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Drive, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, George Singer Building, Kingsbury Drive, Bundoora, Victoria 3086, Australia
| | - M Newton
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Drive, Bundoora, Victoria 3086, Australia; School of Nursing and Midwifery, La Trobe University, George Singer Building, Kingsbury Drive, Bundoora, Victoria 3086, Australia
| | - D A Forster
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Drive, Bundoora, Victoria 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Grattan Street & Flemington Road, Parkville, Victoria 3052, Australia
| | - T Shafiei
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Drive, Bundoora, Victoria 3086, Australia
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19
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Zugna SA, Cullinane M, McLachlan HL, Forster DA. How a crisis at one maternity service became a catalyst for change across the Victorian public hospital system: A discussion paper. Collegian 2021. [DOI: 10.1016/j.colegn.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Grimes HA, McLachlan HL, Forster DA, McLardie-Hore F, Mortensen K, Shafiei T. Implementing a successful proactive telephone breastfeeding peer support intervention: volunteer recruitment, training, and intervention delivery in the RUBY randomised controlled trial. Int Breastfeed J 2021; 16:90. [PMID: 34852839 PMCID: PMC8638340 DOI: 10.1186/s13006-021-00434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The RUBY randomised controlled trial demonstrated the benefit of proactive telephone peer support in promoting breastfeeding continuation in a setting with high breastfeeding initiation, where typically this is difficult to achieve. This paper describes the implementation and delivery of the peer support intervention with a focus on recruitment, training, and support of peer volunteers, and includes a description of the key components of the calls. METHODS Data collection occurred between December 2012 and June 2016 in Melbourne, Australia. Volunteers completed enrolment forms at the training session and recorded data related to each call in a Call Log maintained for each mother supported. Data were summarised using descriptive statistics and responses to open-ended questions analysed using content analysis. RESULTS A total of 693 women expressed interest in the peer support role, with 246 completing training, that is, 95% of whom supported at least one mother. Each supported a mean of two mothers (range 1 to 11). Training session topics included respecting individual values, using positive language, confidence building, active listening, empathetic support, and normal baby behaviour. There were 518 periods of support where at least one call was made between a volunteer and a mother to whom she was allocated. Of the 518 periods of support, 359 Call Logs (69%) were returned. The 359 call logs recorded a total of 2398 calls between peers and mothers. Call length median duration was 12 min (range 1 to 111 min). Volunteers perceived the most valued aspects of the calls were the provsion of 'general emotional support' (51%) and 'general information/discussion about breastfeeding' (44%). During the first call, mothers raised questions about 'nipple pain/ damage' (24%) and 'general breastfeeding information' (23%). At ≥12 weeks postpartum, issues raised related to 'normal infant behaviour' (22%), 'feed frequency' (16%), and 'general breastfeeding information' (15%). Volunteers referred women to other resources during 28% of calls, most commonly to the Australian Breastfeeding Association. CONCLUSIONS Our findings demonstrate that the RUBY trial was feasible and sustainable in terms of recruiting volunteers who were willing to participate in training and who proceeded to provide peer support. Call content was responsive to the evolving breastfeeding information needs of mothers and the provision of emotional support was perceived by volunteers to be important. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN 12612001024831 .
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Affiliation(s)
- Heather A Grimes
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia. .,School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia. .,La Trobe Rural Health School, PO Box 199, Bendigo, Victoria, 3550, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia.,School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia.,School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.,The Royal Women's Hospital, Grattan St and Flemington Roads, Parkville, Victoria, Australia
| | - Fiona McLardie-Hore
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia.,The Royal Women's Hospital, Grattan St and Flemington Roads, Parkville, Victoria, Australia
| | - Kate Mortensen
- Australian Breastfeeding Association, Melbourne, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
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Cramer RL, McLachlan HL, Shafiei T, Amir LH, Cullinane M, Small R, Forster DA. Women's experiences of infant feeding support: Findings from a cross-sectional survey in Victoria, Australia. Women Birth 2021; 34:e505-e513. [PMID: 34420765 DOI: 10.1016/j.wombi.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/16/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate new mothers' experiences of infant feeding support. DESIGN A postal survey developed for this study was sent to all new mothers in ten local government areas in Victoria, Australia when their baby was six months of age. Questions explored infant feeding methods, feeding support services, and experiences of infant feeding support. This survey made up one component of the Supporting breastfeeding In Local Communities (SILC) cluster randomised controlled trial. FINDINGS 997/4127 women (24%) completed the survey between 15 April 2013 and 31 July 2013. Women received infant feeding support from multiple sources, including professionals, family members, and peers. Overall, 88% reported receiving adequate infant feeding support. Women who reported not receiving adequate infant feeding support were less likely to be giving any breast milk at six months compared to those reporting adequate support (OR = 0.59; 95% CI 0.40, 0.88). Adjusting for breastfeeding intention and parity did not alter the association (Adj. OR = 0.60; 95% CI 0.40, 0.90). Women were most satisfied when they received accessible, available, consistent professional infant feeding support provided in a non-judgemental and reassuring way. Women were dissatisfied when there were barriers restricting access to support, or when they received conflicting advice or support that made them feel guilty, pressured or judged. KEY CONCLUSIONS Regardless of infant feeding method, women wanted accessible, non-judgemental support. Given that receiving adequate support was associated with more breast milk feeding at six months, care providers should ensure accessible infant feeding support is available to all new mothers.
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Affiliation(s)
- Rhian L Cramer
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Health, Federation University Australia, Mount Helen, VIC 3350, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/touransh
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/Lisa_H_Amir
| | - Meabh Cullinane
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/mbcullinane
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/small_rhonda
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
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Matthews R, Hyde R, Llewelyn F, Shafiei T, Newton M, Forster DA. Factors associated with midwives' job satisfaction and experience of work: a cross-sectional survey of midwives in a tertiary maternity hospital in Melbourne, Australia. Women Birth 2021; 35:e153-e162. [PMID: 33935006 DOI: 10.1016/j.wombi.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/25/2021] [Accepted: 03/28/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Significant factors affecting the Australian maternity care context include an ageing, predominantly part-time midwifery workforce, increasingly medicalised maternity care, and women with more complex health/social needs. This results in challenges for the maternity care system. There is a lack of understanding of midwives' experiences and job satisfaction in this context. AIM To explore factors affecting Australian midwives' job satisfaction and experience of work. METHODS In 2017 an online cross-sectional questionnaire was used to survey midwives employed in a tertiary hospital. Data collected included characteristics, work roles, hours, midwives' views and experiences of their job. The Midwifery Process Questionnaire was used to measure midwives' satisfaction in four domains: Professional Satisfaction, Professional Support, Client Interaction and Professional Development. Data were analysed as a whole, then univariate and multivariate logistic regression analyses conducted to explore any associations between each domain, participant characteristics and other relevant factors. FINDINGS The overall survey response rate was 73% (302/411), with 96% (255/266) of permanently employed midwives responding. About half (53%) had a negative attitude about their Professional Support and Client Interaction (49%), and 21% felt negatively about Professional Development. The majority felt positively regarding Professional Satisfaction (85%). The main factors that impacted midwives' satisfaction was inadequate acknowledgment from the organisation and needing more support to fulfil their current role. CONCLUSION Focus on leadership and mentorship around appropriate acknowledgement and support may impact positively on midwives' satisfaction and experiences of work. A larger study could explore how widespread these findings are in the Australian maternity care setting.
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Affiliation(s)
- Robyn Matthews
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia.
| | - Rebecca Hyde
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Fleur Llewelyn
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia
| | - Michelle Newton
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
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23
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Rodrigo R, Badanasinghe N, Abayabandara-Herath T, Forster DA, Amir LH. Bacterial Growth in Expressed Mother's Milk Stored and Transported Under Different Simulated Conditions in a Tropical Country. Breastfeed Med 2021; 16:300-308. [PMID: 33404292 DOI: 10.1089/bfm.2020.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Research on how storage and transport of expressed human milk in a tropical country affect the milk bacterial count is limited. Materials and Methods: A cross-sectional descriptive study of 50 mothers of infants in a Sri Lankan tertiary neonatal unit was performed. Expressed mother's milk was divided into three bottles and kept under varied environmental conditions to simulate different storage and transport methods. Initial bacterial culture of milk was performed <30 minutes after expression, with further cultures at predetermined times. Bottles A and B were stored at room temperature and in a cool bag for the first 6 hours, respectively, and then refrigerated; and bottle C was refrigerated for 24 hours, transported in a cool bag for 6 hours, and rerefrigerated until 72 hours. Total colony counts >105 colony-forming units (CFU)/mL of viable microorganisms or >104 CFU/mL of either Enterobacteriaceae or Staphylococcus aureus were considered positive. Results: Initial culture was positive in 30% (15/50) of samples; majority, 87% (13/15), of these were S. aureus. For bottle A, 26% (13/50), 36% (18/50), 34% (17/50), and 26% (13/50) of samples were positive at 4, 6, 24, and 72 hours, respectively. For bottle B, positive cultures were found in 26% (13/50) and 17% (8/47) of samples at 24 and 72 hours, respectively. For bottle C, results were similar to bottle B. Conclusions: Transportation of expressed mother's milk for 4 hours in a tropical climate using a low-cost cool bag, with refrigeration at other times, maintained acceptable bacterial counts for up to 72 hours after expression. Hygienic practices at collection are extremely important as most samples with significant bacterial growth were positive on initial culture.
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Affiliation(s)
- Ranmali Rodrigo
- Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.,Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | | | | | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
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24
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Smithson CA, McLachlan HL, Newton MS, Smith C, Forster DA. Perinatal outcomes of women with a disability who received pregnancy care through a specialised disability clinic in Melbourne, Australia. Aust N Z J Obstet Gynaecol 2021; 61:548-553. [PMID: 33772765 DOI: 10.1111/ajo.13326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Australia, it is estimated that 9.5% of women of childbearing age have a disability; however, little is known about their perinatal outcomes. Disability status is not routinely recorded in perinatal datasets. AIMS To compare the outcomes of women with a disability who received pregnancy care through a specialised disability clinic at the Royal Women's Hospital (the Women's) in Melbourne, Australia with hospital-wide perinatal outcome data. MATERIALS AND METHODS Routinely collected perinatal data for women who received pregnancy care from the 'Women with Individual Needs' (WIN) clinic from 2014-2018 (N = 111) were analysed and then compared with routinely collected electronic hospital data obtained from all women who had given birth at the Women's in 2017 and 2018 (N = 15 024). RESULTS Women who attended the WIN clinic were more likely to have a caesarean section birth (52% vs 32%; P < 0.001) and give birth preterm (17% vs 4%; P < 0.001) than those in the hospital-wide cohort. Their infants were more likely to be low birthweight (20% vs 9%; P < 0.001), require resuscitation (35% vs 11%; P < 0.001), be admitted to the Neonatal Intensive Special Care Unit (29% vs 13%; P < 0.001) and receive formula in hospital (54% vs 28%; P < 0.001) compared to infants in the other group. CONCLUSIONS Routine maternity data collection should include identification of women with a disability to enable appropriate support and to allow further exploration of potential poorer outcomes on a larger sample, to help identify factors amenable to interventions that may improve outcomes.
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Affiliation(s)
- Charlie A Smithson
- Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Michelle S Newton
- Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Cherise Smith
- The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Della A Forster
- The Royal Women's Hospital, Melbourne, Victoria, Australia.,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
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25
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McLardie-Hore FE, McLachlan HL, Shafiei T, Forster DA. Proactive telephone-based peer support for breastfeeding: a cross-sectional survey of women's experiences of receiving support in the RUBY randomised controlled trial. BMJ Open 2020; 10:e040412. [PMID: 33127637 PMCID: PMC7604849 DOI: 10.1136/bmjopen-2020-040412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The Ringing Up about Breastfeeding earlY (RUBY) randomised controlled trial (RCT) of proactive telephone-based peer support for breastfeeding found that infants of women allocated to the intervention were more likely to be receiving breast milk at 6 months of age than those receiving usual care. This study explores women's experiences of receiving the RUBY peer support intervention. DESIGN Cross-sectional survey. SETTING Women were recruited from the postnatal units of three tertiary hospitals in Melbourne, Australia. PARTICIPANTS Women allocated to receive telephone peer support in the RUBY RCT who completed a telephone interview at 6 months postpartum (501/574 (87%) in trial intervention arm) were invited to complete a postal survey on their experience of receiving support. OUTCOMES Experiences of support from the allocated peer, perceived helpfulness, topics discussed, overall satisfaction with the support and frequency and duration of contact were explored. RESULTS Surveys were sent between August 2013 and March 2016, and 72% (360/501) responded of whom 341 recalled receiving peer support. Women reported high levels of perceived helpfulness (79%) and overall satisfaction with the peer support (93%). Discussions included breastfeeding topics (milk supply, attachment), baby care, baby behaviour, and reassurance and emotional support. Women valued the practical and realistic support from another mother, as well as the proactive nature, continuity and accessibility of the support. The empathy, reassurance and encouragement provided helped the mothers to 'cope', to continue breast feeding and to feel empowered. CONCLUSION Most respondents were positive about their experience of receiving proactive telephone peer support for breastfeeding, further supporting the roll-out of this model as a strategy for increasing breastfeeding maintenance to 6 months. Recommendations include flexibility in the scheduling of calls according to individual need, and the use of text messages in conjunction with proactive calls, to enhance and facilitate communication between the peer and the mother. TRIAL REGISTRATION NUMBER ACTRN12612001024831.
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Affiliation(s)
- Fiona E McLardie-Hore
- Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Della A Forster
- Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
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26
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Grimes HA, Forster DA, Shafiei T, Amir LH, McLardie-Hore F, McLachlan HL. Breastfeeding peer support by telephone in the RUBY randomised controlled trial: A qualitative exploration of volunteers' experiences. PLoS One 2020; 15:e0237190. [PMID: 32760148 PMCID: PMC7410279 DOI: 10.1371/journal.pone.0237190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is growing evidence that peer support programs may be effective in supporting breastfeeding mothers. A randomised controlled trial (RCT) (the RUBY study) that tested peer support in the Australian context found that infants of first-time mothers who received proactive telephone peer support were more likely to be receiving breastmilk at six months of age. METHODS This qualitative sub-study of the RUBY RCT explores the experiences and views of peer volunteers who delivered the intervention. Focus groups were conducted with 17 peers from the RUBY RCT between November 2015 and March 2016. All had provided peer support to at least one mother. RESULTS We found that volunteers identified strongly with the mothers' need for support when establishing breastfeeding. Key components of the support were strengthening the mothers' self-belief through affirmation and sharing experiential knowledge. Volunteers found the role rewarding and personally therapeutic although some women reported challenges initiating and maintaining contact with some mothers. Data were analysed using a hybrid approach to thematic analysis combining inductive and deductive techniques. CONCLUSIONS Breastfeeding peer support programs are reliant on recruitment of motivated volunteers who can provide empathetic mother-to-mother support. This study provides important information regarding volunteers' experiences that may support the upscaling of breastfeeding peer support for new mothers. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN 12612001024831.
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Affiliation(s)
- Heather A. Grimes
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing & Midwifery, College of Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
- La Trobe Rural Health School, Bendigo, Victoria, Australia
- * E-mail:
| | - Della A. Forster
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing & Midwifery, College of Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
- The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Lisa H. Amir
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Fiona McLardie-Hore
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - Helen L. McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing & Midwifery, College of Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
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Abstract
INTRODUCTION Over 310 000 women gave birth in Australia in 2016, with approximately 80 000 births in the state of Victoria. While most of these births occur in metropolitan Melbourne and other large regional centres, a significant proportion of Victorian women birth in local rural health services. The Victorian state government recently mandated the provision of a maternal and neonatal emergency training programme, called Maternal and Newborn Emergencies (MANE), to rural and regional maternity service providers across the state. MANE aims to educate maternity and newborn care clinicians about recognising and responding to clinical deterioration in an effort to improve clinical outcomes. This paper describes the protocol for an evaluation of the MANE programme. METHODS AND ANALYSIS This study will evaluate the effectiveness of MANE in relation to: clinician confidence, skills and knowledge; changes in teamwork and collaboration; and consumer experience and satisfaction, and will explore and describe any governance changes within the organisations after MANE implementation. The Kirkpatrick Evaluation Model will provide a framework for the evaluation. The participants of MANE, 27 rural and regional Victorian health services ranging in size from approximately 20 to 1000 births per year, will be invited to participate. Baseline data will be collected from maternity service staff and consumers at each health service before MANE delivery, and at four time-points post-MANE delivery. There will be four components to data collection: a survey of maternity services staff; follow-up interviews with Maternity Managers at health services 4 months after MANE delivery; consumer feedback from all health services collected through the Victorian Healthcare Experience Survey; case studies with five regional or rural health service providers. ETHICS AND DISSEMINATION This evaluation has been approved by the La Trobe University Science, Health and Engineering College Human Ethics Sub-Committee. Findings will be presented to project stakeholders in a deidentified report, and disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Meabh Cullinane
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Michelle S Newton
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Stefanie A Zugna
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
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Biggs LJ, McLachlan HL, Shafiei T, Small R, Forster DA. Peer supporters' experiences on an Australian perinatal mental health helpline. Health Promot Int 2020; 34:479-489. [PMID: 29346557 DOI: 10.1093/heapro/dax097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Perinatal mental health is an important public health issue, and peer support is a potentially important strategy for emotional well-being in the perinatal period. PANDA Perinatal Anxiety & Depression Australia provides support to individuals impacted by perinatal mental health issues via the National Perinatal Anxiety & Depression Helpline. Callers receive peer support from volunteers and counselling from paid professional staff. The views and experiences of PANDA peer support volunteers have not previously been studied. We conducted two focus groups and an online survey to explore the experiences of women providing volunteer peer support on the Helpline. Data collection took place in October and November 2013. Two social theories were used in framing and addressing the study aims and in interpreting our findings: the Empathy-Altruism Hypothesis, and the Helper Therapy Principle. All PANDA volunteers were invited to participate (n = 40). Eight volunteers attended a focus group, and 11 survey responses were received. Descriptive statistics were used to analyse quantitative data. All survey respondents 'strongly agreed' that they felt positive about being part of PANDA. Thematic analysis of data from focus groups and open-ended survey responses identified the following themes: motivated to help others, supported to support callers, helping to make a difference and emotional impacts for volunteers. Respondents described a strong desire to support others experiencing emotional distress as a motivator to volunteer. Although perinatal peer support services are designed to benefit those who receive support, this study suggests volunteers may also experience personal benefits from the role.
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Affiliation(s)
- Laura J Biggs
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083.,School of Nursing & Midwifery, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083.,The Royal Women's Hospital, Locked Bag 300 Grattan St & Flemington Road, Parkville Victoria, Australia 3052
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29
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Homer CSE, Cheah SL, Rossiter C, Dahlen HG, Ellwood D, Foureur MJ, Forster DA, McLachlan HL, Oats JJN, Sibbritt D, Thornton C, Scarf VL. Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study. BMJ Open 2019; 9:e029192. [PMID: 31662359 PMCID: PMC6830673 DOI: 10.1136/bmjopen-2019-029192] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home. DESIGN A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ2 tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance. SETTING All eight Australian states and territories. PARTICIPANTS Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home. MAIN OUTCOME MEASURES Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death). RESULTS Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth. CONCLUSIONS This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.
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Affiliation(s)
- Caroline S E Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Maternal and Child Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Seong L Cheah
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, New South Wales, Australia
| | - David Ellwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Maralyn J Foureur
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Jeremy J N Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Vanessa L Scarf
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Moorhead A, Amir LH, Crawford S, Forster DA. Exploring the views and experiences of women with diabetes in pregnancy in Australia who have been advised to express breast milk antenatally, and implications for clinical practice. Women Birth 2019. [DOI: 10.1016/j.wombi.2019.07.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shafiei T, McLachlan HL, Nicholson JM, Hay S, Newton M, Grimes H, McLardie-Hore F, Forster DA. Exploring the effect of the 'Growing Together' parenting education kit on early parenting - study protocol for a cluster randomised controlled trial. BMC Psychol 2019; 7:39. [PMID: 31234948 PMCID: PMC6591924 DOI: 10.1186/s40359-019-0314-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Significant gaps exist in education for prospective and new parents, especially for some of the most vulnerable families. Prospective parents would like more information during pregnancy to prepare them for parenting, and need access to trusted and quality information. The Royal Women's Hospital (the Women's) in Melbourne, Australia, a large tertiary referral maternity hospital, developed a parenting education kit known as 'Growing Together'. The kit, designed to guide prospective and new parents from conception until 1 year after birth, includes three components: an A4 sized book, a specifically designed 'App' and a children's story book. We aim to evaluate the impact of the kit on a range of outcomes. METHODS A two-arm cluster randomised controlled trial will be used. Antenatal clinic days will be randomised to either the intervention or standard care arms. Women in the intervention arm receive the kit at their antenatal booking visit. Women in the standard care arm receive the standard information resources at the Women's. Analyses will be by intention to treat. INCLUSION CRITERIA primiparous women with adequate English-speaking ability and ≤ 30 weeks' gestation at first pregnancy booking appointment. The primary outcome of the study is the 'experience of motherhood questionnaire' (EMQ), a 20 item validated self-report measure, ranging from 0 to 80, with lower scores indicating better maternal health and wellbeing. To detect a 10% difference in new mothers scoring ≤40 between women who have received the kit (60%) and those who have not (50%), would require 408 per group (total of 816 women) with 95% confidence and 80% power. Allowing for loss to follow up, we aim to recruit 1000 mothers. Secondary outcomes include parents' views and experiences of their care and of the kit during pregnancy and after the birth, parental attachment, knowledge, confidence, wellbeing and health-seeking behaviour; and emotional, developmental and physical health of the infant. Survey data will be collected from mothers at 2, 6 and 12 months postpartum and partners at 6 months. DISCUSSION This study will provide much needed high-level evidence on the impact of a comprehensive education resource for new parents. TRIAL REGISTRATION ANZCTRN12615000270516 - Retrospectively registered (23/03/2015); trial started on 16 March 2015.
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Affiliation(s)
- Touran Shafiei
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia.,School of Nursing and Midwifery, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia
| | - Sarah Hay
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia.,School of Nursing and Midwifery, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia
| | - Michelle Newton
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia.,School of Nursing and Midwifery, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia
| | - Heather Grimes
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia.,La Trobe Rural Health School, La Trobe University, Edwards Rd, Flora Hill, 3055, Australia
| | - Fiona McLardie-Hore
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia.,Royal Women's Hospital, Locked Bag 300 Grattan St & Flemington Rd, Parkville, Victoria, 3052, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, George Singer Building, Kingsbury Dr, Bundoora, Victoria, 3086, Australia.,Royal Women's Hospital, Locked Bag 300 Grattan St & Flemington Rd, Parkville, Victoria, 3052, Australia
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Biggs LJ, McLachlan HL, Shafiei T, Liamputtong P, Forster DA. 'I need help': Reasons new and re-engaging callers contact the PANDA-Perinatal Anxiety and Depression Australia National Helpline. Health Soc Care Community 2019; 27:717-728. [PMID: 30511356 DOI: 10.1111/hsc.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/24/2018] [Indexed: 06/09/2023]
Abstract
In Australia, the PANDA-Perinatal Anxiety & Depression Australia National Helpline (the Helpline) offers support to callers impacted by emotional health challenges in the perinatal period. Callers receive counselling from professional staff and peer support from volunteers. An understanding of factors that contribute to callers' experiences of emotional distress, as well as potential barriers and facilitators to help-seeking, can be used to inform future service design and delivery. A caller intake form is completed by Helpline staff when an individual contacts the service for the first time, or re-engages after a period of non-contact. We analysed all intake forms of individuals calling about their own emotional wellbeing from the middle month of each season in 2014: January, April, July, and October. Content analysis was undertaken, focusing on caller profile, patterns of help-seeking, and reasons for caller engagement. Of the 365 calls, the majority were from women (n = 358, 98%) who were pregnant (n = 59, 16%) or had a child ≤12 months of age (n = 241, 75%). Many were seeking support regarding depression (n = 186, 51%) or anxiety (n = 162, 44%), with a number seeking help for both (n = 71, 20%). Almost a third were identified as being 'at risk', including a number who were experiencing thoughts of suicide or self-harm. Complex interrelating factors contributed to callers' emotional distress, including: stressful life events; pregnancy, birthing and parenting experiences; social isolation; and histories of mental health difficulties. Significant numbers of parents experience emotional health challenges in the perinatal period, but many do not receive adequate treatment. Complex factors contribute to callers' distress, highlighting the need for health professionals to undertake thorough psychosocial assessments during the perinatal period so those that need additional support are identified, and appropriate care provided. Telephone Helplines like PANDAs assist overcoming barriers to care and provide specialised perinatal mental health support to families.
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Affiliation(s)
- Laura J Biggs
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
- School of Nursing Midwifery and Paramedicine, Australian Catholic University, Fitzroy, VIC, Australia
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Pranee Liamputtong
- School of Science and Health, Western Sydney University, Penrith, NSW, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
- The Royal Women's Hospital, Melbourne, VIC, Australia
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Forster DA, McLardie-Hore FE, McLachlan HL, Davey MA, Grimes HA, Dennis CL, Mortensen K, Moorhead AM, Tawia S, Gold L, Shafiei T, Small R, East CE, Amir LH. Proactive Peer (Mother-to-Mother) Breastfeeding Support by Telephone (Ringing up About Breastfeeding Early [RUBY]): A Multicentre, Unblinded, Randomised Controlled Trial. EClinicalMedicine 2019; 8:20-28. [PMID: 31193656 PMCID: PMC6537529 DOI: 10.1016/j.eclinm.2019.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Breastfeeding rates are suboptimal internationally, and many infants are not receiving any breast milk at all by six months of age. Few interventions increase breastfeeding duration, particularly where there is relatively high initiation. The effect of proactive peer (mother-to-mother) support has been found to increase breastfeeding in some contexts but not others, but if it is shown to be effective would be a potentially sustainable model in many settings. We aimed to determine whether proactive telephone-based peer support during the postnatal period increases the proportion of infants being breastfed at six months of age. METHODS RUBY (Ringing Up about Breastfeeding earlY) was a multicentre, two-arm un-blinded randomised controlled trial conducted in three hospitals in Victoria, Australia. First-time mothers intending to breastfeed were recruited after birth and prior to hospital discharge, and randomly assigned (1:1) to usual care or usual care plus proactive telephone-based breastfeeding support from a trained peer volunteer for up to six months postpartum. A computerised random number program generated block sizes of four or six distributed randomly, with stratification by site. Research midwives were masked to block size, but masking of allocation was not possible. The primary outcome was the proportion of infants receiving any breast milk at six months of age. Analyses were by intention to treat; data were collected and analysed masked to group. The trial is registered with ACTRN, number 12612001024831. FINDINGS Women were recruited between Feb 14, 2013 and Dec 15, 2015 and randomly assigned to peer support (n = 574) or usual care (n = 578). Five were not in the primary analysis [5 post-randomisation exclusions]. Infants of women allocated to telephone-based peer support were more likely than those allocated to usual care to be receiving breast milk at six months of age (intervention 75%, usual care 69%; Adj. RR 1·10; 95% CI 1·02, 1·18). There were no adverse events. INTERPRETATION Providing first time mothers with telephone-based support from a peer with at least six months personal breastfeeding experience is an effective intervention for increasing breastfeeding maintenance in settings with high breastfeeding initiation. FUNDING The Felton Bequest, Australia, philanthropic donation and La Trobe University grant.
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Key Words
- ABA, Australian Breastfeeding Association
- ACTRN, Australian New Zealand Clinical Trials Registry number
- AUD, Australian dollar(s)
- Adj. RR, Adjusted relative risk
- Breastfeeding
- CI, Confidence interval
- Clinical trial
- Community-based
- HR, Hazard ratio
- Peer support
- Peer volunteer
- RCT, Randomised controlled trial
- RR, Relative risk
- RUBY, Ringing Up about Breastfeeding earlY
- Telephone intervention
- sd, Standard deviation
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Affiliation(s)
- Della A. Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
- Corresponding author at: Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Fiona E. McLardie-Hore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Helen L. McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Rd, Clayton 3168, Australia
| | - Heather A. Grimes
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario M5T 1P8, Canada
| | - Kate Mortensen
- Monash Nursing and Midwifery, Monash University and Monash Health, Australia
| | - Anita M. Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Susan Tawia
- Australian Breastfeeding Association, Level 3, Suite 2,150 Albert Road, South Melbourne, Victoria 3205, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, Victoria 3220, Australia
| | - Touran Shafiei
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Christine E. East
- Monash Nursing and Midwifery, Monash University and Monash Health, Australia
| | - Lisa H. Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
- Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
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Rodrigo R, Amir LH, Forster DA. Review of guidelines on expression, storage and transport of breast milk for infants in hospital, to guide formulation of such recommendations in Sri Lanka. BMC Pediatr 2018; 18:271. [PMID: 30107831 PMCID: PMC6092763 DOI: 10.1186/s12887-018-1244-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/06/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Sick newborns in neonatal units who are unable to breastfeed are fed expressed breast milk. In Sri Lanka, most mothers stay in hospital throughout baby's stay to provide this milk freshly. In other countries mothers go home, express breast milk at home and bring it to hospital. There are concerns about the safety of transported expressed milk if used in a tropical middle-income country. The aim of this paper is to compare and contrast advice offered by different hospitals and organizations on how to express, store and transport breast milk safely. METHODS We assessed guidelines used by hospital staff of the four Level 3 neonatal units in Melbourne, Australia, National Health Service UK, guidelines and training manuals of the Human Milk Banking Association of North America, the World Health Organization and an information leaflet from Family Health Bureau, Sri Lanka. Information on breast milk expression, storage and transport provided by the guidelines were tabulated under seven topics: general information; container for milk collection; hand expression; using a pump for expression; storage; thawing / warming; and transport of expressed breast milk. The AGREE II tool was used to assess the guidelines written for hospital staff. RESULTS There was considerable agreement on most recommendations provided by these sources, but no single source covered all topics in full. Most recommend hand expression as the initial method for expressing of breast milk, followed by breast pump use, except the Sri Lankan recommendations which strongly discourages the use of breast pumps. Durations of storage under various conditions are generally similar in the different recommendations. Most guidelines recommend a 'cool box' or container with ice or freezer packs for transportation of milk. CONCLUSION A single document containing recommendations on all aspects of expressing, storing and transporting breast milk should be available for each unit, with the same basic information for mothers and the healthcare staff and further technical details for staff if required. The Sri Lankan recommendations need to be updated based on current worldwide practices and further studies are needed to establish a safe method of transport of expressed breast milk in Sri Lanka.
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Affiliation(s)
- Ranmali Rodrigo
- Department of Paediatrics, University of Kelaniya, 6 Thalagolla Road, Ragama, 11010 Sri Lanka
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000 Australia
| | - Lisa H. Amir
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000 Australia
| | - Della A. Forster
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC 3000 Australia
- Royal Women’s Hospital, Locked Bag 300, Parkville, VIC 3052 Australia
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Forster DA, McKay H, Davey MA, Small R, Cullinane F, Newton M, Powell R, McLachlan HL. Women's views and experiences of publicly-funded homebirth programs in Victoria, Australia: A cross-sectional survey. Women Birth 2018; 32:221-230. [PMID: 30104172 DOI: 10.1016/j.wombi.2018.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/15/2018] [Accepted: 07/26/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is critical women's voices are heard if there is to be more widespread implementation of midwifery-led continuity models. Publicly-funded homebirth is one such model, yet there has been limited systematic evaluation from the women's perspective. AIM Examine women's experiences of and views about the two publicly-funded homebirth programs in Victoria, Australia. METHODS A cross-sectional design was used. All eligible women enrolled in the two pilot homebirth programs in metropolitan Melbourne whose infants were eight weeks of age or more during the evaluation period were invited to participate in a postal survey. A structured questionnaire was used, with some open-ended questions to enable extra comments. We explored women's reasons for choosing homebirth; views of care; experience of labour and birth; views on transfer; and overall experience of the homebirth program. Data were analysed using descriptive statistics. Simple thematic analysis was used for open-ended questions. FINDINGS The survey response rate was 71% (96/136). A high percentage of women rated their care as 'Very good': pregnancy 81%; labour and birth 90%; and the early postpartum period 83%. Women reported low levels of anxiety during labour and birth, were able to express their feelings, felt in control, and coped physically and emotionally better than they had expected. They felt well supported by midwives and overall reported very positive experiences of the homebirth programs. CONCLUSIONS These two publicly-funded homebirth pilot programs demonstrated very positive care ratings by women. These findings, along with the clinical outcomes (reported separately), support the continuation and expansion of the program.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Grattan St & Flemington Rd, Parkville, VIC 3052, Australia.
| | - Heather McKay
- Judith Lumley Centre, School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC 3168, Australia.
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Fiona Cullinane
- The Royal Women's Hospital, Locked Bag 300, Grattan St & Flemington Rd, Parkville, VIC 3052, Australia.
| | - Michelle Newton
- Judith Lumley Centre, School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Rhonda Powell
- School of Law, University of Canterbury, Private Bag 4800, Christchurch 8041, New Zealand.
| | - Helen L McLachlan
- Judith Lumley Centre, School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia.
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Cramer RL, McLachlan HL, Shafiei T, Amir LH, Cullinane M, Small R, Forster DA. Implementation and evaluation of community-based drop-in centres for breastfeeding support in Victoria, Australia. Int Breastfeed J 2017; 12:46. [PMID: 29158771 PMCID: PMC5683552 DOI: 10.1186/s13006-017-0136-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background While Australia has high breastfeeding initiation, there is a sharp decline in the first weeks postpartum and this continues throughout the first year. Supporting breastfeeding In Local Communities (SILC) was a three-arm cluster randomised controlled trial to determine whether early home-based breastfeeding support by a maternal and child health nurse (SILC-MCHN), with or without access to a community-based breastfeeding drop-in centre, increased the proportion of infants receiving any breast milk at three, four and six months. The trial was conducted in ten Local Government Areas (LGAs) in Victoria, Australia. The primary aim of this paper is to describe the three drop-in centres established during the trial; and the profile of women who accessed them. The secondary aim is to explore the views and experiences of the drop-in centre staff, and the challenges faced in establishing and maintaining a breastfeeding drop-in centre in the community. Methods Evaluation of the three LGAs with drop-in centres was multifaceted and included observational visits and field notes; data collected from attendance log books from each drop-in centre; a written survey and focus groups with maternal and child health (MCH) nurses who ran the drop-in centres; and semi-structured interviews with MCH coordinators of the participating LGAs. Results The three LGAs developed and ran different models of breastfeeding drop-in centres. They reported challenges in finding convenient, accessible locations. Overall, attendance was lower than expected, with an average of only one attendee per session. Two global themes were identified regarding staff views: implementation challenges, encompassing finding accessible, available space, recruiting volunteers to provide peer support, and frustration when women did not attend; and the work of SILC-MCHNs, including themes of satisfying and rewarding work, juggling roles, and benefits to women, babies and the community. Conclusion Providing community-based breastfeeding support was satisfying for the drop-in centre staff but proved difficult to implement, reflected by the lower than anticipated attendances at all of the drop-in centres. Interventions to increase breastfeeding in complex community settings require sufficient time to build partnerships with the existing services and the target population; to understand when and how to offer interventions for optimum benefit. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12611000898954.
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Affiliation(s)
- Rhian L Cramer
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia.,School of Nursing, Midwifery and Healthcare, Federation University Australia, University Drive, Mount Helen, Ballarat, VIC 3350 Australia
| | - Helen L McLachlan
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia.,School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086 Australia
| | - Touran Shafiei
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia
| | - Meabh Cullinane
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia
| | - Rhonda Small
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia.,Department of Women's and Children's Health, Karolinska Institutet, Retzius väg 13A, Stockholm, Sweden
| | - Della A Forster
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia.,The Royal Women's Hospital, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052 Australia
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Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, East C, Ford R, Amir LH. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. Lancet 2017; 389:2204-2213. [PMID: 28589894 DOI: 10.1016/s0140-6736(17)31373-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/09/2017] [Accepted: 04/13/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia, admission to a neonatal intensive care unit (NICU), and not being exclusively breastfed. Many clinicians encourage women with diabetes in pregnancy to express and store breastmilk in late pregnancy, yet no evidence exists for this practice. We aimed to determine the safety and efficacy of antenatal expressing in women with diabetes in pregnancy. METHODS We did a multicentre, two-group, unblinded, randomised controlled trial in six hospitals in Victoria, Australia. We recruited women with pre-existing or gestational diabetes in a singleton pregnancy from 34 to 37 weeks' gestation and randomly assigned them (1:1) to either expressing breastmilk twice per day from 36 weeks' gestation (antenatal expressing) or standard care (usual midwifery and obstetric care, supplemented by support from a diabetes educator). Randomisation was done with a computerised random number generator in blocks of size two and four, and was stratified by site, parity, and diabetes type. Investigators were masked to block size but masking of caregivers was not possible. The primary outcome was the proportion of infants admitted to the NICU. We did the analyses by intention to treat; the data were obtained and analysed masked to group allocation. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000217909. FINDINGS Between June 6, 2011, and Oct 29, 2015, we recruited and randomly assigned 635 women: 319 to antenatal expressing and 316 to standard care. Three were not included in the primary analysis (one withdrawal from the standard care group, and one post-randomisation exclusion and one withdrawal from the antenatal expressing group). The proportion of infants admitted to the NICU did not differ between groups (46 [15%] of 317 assigned to antenatal expressing vs 44 [14%] of 315 assigned to standard care; adjusted relative risk 1·06, 95% CI 0·66 to 1·46). In the antenatal expressing group, the most common serious adverse event for infants was admission to the NICU for respiratory support (for three [<1%] of 317. In the standard care group, the most common serious adverse event for infants was moderate to severe encephalopathy with or without seizures (for three [<1%] of 315). INTERPRETATION There is no harm in advising women with diabetes in pregnancy at low risk of complications to express breastmilk from 36 weeks' gestation. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia.
| | - Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
| | - Susan E Jacobs
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Peter G Davis
- Royal Women's Hospital, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | | | - Gillian F Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, VIC, Australia; Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | | | | | - Christine East
- School of Nursing and Midwifery, Monash University and Monash Health, Clayton, VIC, Australia
| | - Rachael Ford
- Royal Women's Hospital, Parkville, VIC, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia; Royal Women's Hospital, Parkville, VIC, Australia
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McLachlan HL, Shafiei T, Forster DA. Breastfeeding initiation for Aboriginal and Torres Strait Islander women in Victoria: analysis of routinely collected population-based data. Women Birth 2017; 30:361-366. [PMID: 28365239 DOI: 10.1016/j.wombi.2017.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/02/2017] [Accepted: 02/10/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasing breastfeeding rates is one way of improving the short and long term health of Aboriginal and Torres Strait Islander children (hereafter referred to as Aboriginal). Despite the benefits of breastfeeding and recommendations for strategies to increase breastfeeding among Aboriginal people, there is a lack of available population data. AIM To use population-based data from Victoria, Australia to compare breastfeeding initiation for Aboriginal and non-Aboriginal women and to explore factors associated with breastfeeding initiation of Aboriginal women. METHODS Routinely collected infant feeding data obtained from the Victorian Perinatal Data Collection (VPDC) was used. The VPDC is a mandatory, population-based system where maternal and infant data on all Victorian births are collected. FINDINGS Compared with non-Aboriginal women, Aboriginal women were less likely to attempt to breastfeed their baby (87.2% vs 95.3%; p<0.001); more likely to give formula in hospital (39.6% vs 30.6%; p<0.001) and less likely to give the last feed prior to discharge exclusively from the breast (64.4% vs 75.0% p<0.001). For Aboriginal women, factors associated with not initiating breastfeeding were being single, multiparous, smoking and length of stay. Infant factors were gestation less than 37 weeks and low birthweight (<2,500g). CONCLUSION In Victoria, breastfeeding initiation is lower for Aboriginal women compared with non-Aboriginal women. Further research is needed to explore the effectiveness of interventions that may increase breastfeeding for Aboriginal women.
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Affiliation(s)
- Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia; School of Nursing and Midwifery La Trobe University, Melbourne, Victoria, Australia.
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia; The Royal Women's Hospital,Parkville, Vic, Australia
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Ridgway L, Cramer R, McLachlan HL, Forster DA, Cullinane M, Shafiei T, Amir LH. Breastfeeding Support in the Early Postpartum: Content of Home Visits in the SILC Trial. Birth 2016; 43:303-312. [PMID: 27417659 PMCID: PMC5248617 DOI: 10.1111/birt.12241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Supporting breastfeeding In Local Communities (SILC) cluster randomized controlled trial evaluated whether a home visit focussed on infant feeding early in the postpartum period increased the percentage of infants breastfeeding at 4 months in low socioeconomic areas of Victoria, Australia. The visits were offered to women identified as at risk of early breastfeeding cessation after discharge home with a new baby. This paper describes the content of the home visits. METHODS SILC visited 1,043 women from September 2012 to March 2013, and completed a data sheet for each visit documenting topics discussed, as well as what support and resources were offered. Frequencies and percentages are presented. RESULTS Home visits most commonly included the provision of reassurance to women (91%). Topics discussed included general breastfeeding information (83%), supply and demand (83%), positioning (79%), and feeding frequency (78%). Newborn feeding/behavior (57%), expression of breastmilk (54%), nipple pain (41%), low breastmilk supply (41%), and the use of nipple shields (18%) were also prominent topics. The issues and support needs of women were similar across locations (rural, regional or metropolitan) and regardless of maternal parity or age. There was some variation in the resources suggested in different localities. CONCLUSIONS New mothers require help and reassurance independent of whether this is their first or subsequent child, reinforcing the need for support, breastfeeding information, and education about normal neonatal behavior. Key aspects of support are reassurance, normalization of infant behavior, and education.
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Affiliation(s)
- Lael Ridgway
- School of Nursing & MidwiferyLa Trobe UniversityBundooraVic.Australia
| | - Rhian Cramer
- Judith Lumley CentreLa Trobe UniversityMelbourneVic.Australia,School of NursingMidwifery and HealthcareFederation UniversityMt HelenVic.Australia
| | - Helen L. McLachlan
- Judith Lumley Centre & School of Nursing & MidwiferyLa Trobe UniversityMelbourneVic.Australia
| | - Della A. Forster
- Judith Lumley CentreLa Trobe UniversityMelbourneVic.Australia,The Royal Women's HospitalParkvilleVic.Australia
| | - Méabh Cullinane
- Judith Lumley CentreLa Trobe UniversityMelbourneVic.Australia
| | - Touran Shafiei
- Judith Lumley CentreLa Trobe UniversityMelbourneVic.Australia
| | - Lisa H. Amir
- Judith Lumley CentreLa Trobe UniversityMelbourneVic.Australia
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Newton MS, McLachlan HL, Forster DA, Willis KF. Understanding the ‘work’ of caseload midwives: A mixed-methods exploration of two caseload midwifery models in Victoria, Australia. Women Birth 2016; 29:223-33. [DOI: 10.1016/j.wombi.2015.10.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 11/25/2022]
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Forster DA, McKay H, Powell R, Wahlstedt E, Farrell T, Ford R, McLachlan HL. The structure and organisation of home-based postnatal care in public hospitals in Victoria, Australia: A cross-sectional survey. Women Birth 2016; 29:172-9. [DOI: 10.1016/j.wombi.2015.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/17/2015] [Accepted: 10/04/2015] [Indexed: 11/15/2022]
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Forster DA, McLachlan HL, Davey MA, Biro MA, Farrell T, Gold L, Flood M, Shafiei T, Waldenström U. Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth 2016; 16:28. [PMID: 26841782 PMCID: PMC4739100 DOI: 10.1186/s12884-016-0798-y] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/05/2016] [Indexed: 12/15/2022] Open
Abstract
Background Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women’s satisfaction with care across the maternity continuum. Methods Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating. Results Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88 % in the caseload group and 74 % in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95 % CI 2.79, 4.03), intrapartum care (OR 2.14; 95 % CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95 % CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95 % CI 2.64, 3.85). Conclusion For women at low risk of medical complications, caseload midwifery increases women’s satisfaction with antenatal, intrapartum and postpartum care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. .,The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia. .,School of Nursing and Midwifery, La Trobe University, Bundoora, 3086, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia.
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Clayton, 3800, Australia.
| | - Tanya Farrell
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, 3125, Australia.
| | - Maggie Flood
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia.
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, 215 Franklin St., Melbourne, 3000, Australia.
| | - Ulla Waldenström
- Department of Women's and Children's Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden.
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McLachlan HL, Forster DA, Amir LH, Cullinane M, Shafiei T, Watson LF, Ridgway L, Cramer RL, Small R. Supporting breastfeeding In Local Communities (SILC) in Victoria, Australia: a cluster randomised controlled trial. BMJ Open 2016; 6:e008292. [PMID: 26832427 PMCID: PMC4746449 DOI: 10.1136/bmjopen-2015-008292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Breastfeeding has significant health benefits for mothers and infants. Despite recommendations from the WHO, by 6 months of age 40% of Australian infants are receiving no breast milk. Increased early postpartum breastfeeding support may improve breastfeeding maintenance. 2 community-based interventions to increase breastfeeding duration in local government areas (LGAs) in Victoria, Australia, were implemented and evaluated. DESIGN 3-arm cluster randomised trial. SETTING LGAs in Victoria, Australia. PARTICIPANTS LGAs across Victoria with breastfeeding initiation rates below the state average and > 450 births/year were eligible for inclusion. The LGA was the unit of randomisation, and maternal and child health centres in the LGAs comprised the clusters. INTERVENTIONS Early home-based breastfeeding support by a maternal and child health nurse (home visit, HV) with or without access to a community-based breastfeeding drop-in centre (HV+drop-in). MAIN OUTCOME MEASURES The proportion of infants receiving 'any' breast milk at 3, 4 and 6 months (women's self-report). FINDINGS 4 LGAs were randomised to the comparison arm and provided usual care (n=41 clusters; n=2414 women); 3 to HV (n=32 clusters; n=2281 women); and 3 to HV+drop-in (n=26 clusters; 2344 women). There was no difference in breastfeeding at 4 months in either HV (adjusted OR 1.04; 95% CI 0.84 to 1.29) or HV+drop-in (adjusted OR 0.92; 95% CI 0.78 to 1.08) compared with the comparison arm, no difference at 3 or 6 months, nor in any LGA in breastfeeding before and after the intervention. Some issues were experienced with intervention protocol fidelity. CONCLUSIONS Early home-based and community-based support proved difficult to implement. Interventions to increase breastfeeding in complex community settings require sufficient time and partnership building for successful implementation. We cannot conclude that additional community-based support is ineffective in improving breastfeeding maintenance given the level of adherence to the planned protocol. TRIAL REGISTRATION NUMBER ACTRN12611000898954; Results.
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Affiliation(s)
- Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
- School of Nursing and Midwifery, Bundoora, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Meabh Cullinane
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Lyndsey F Watson
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Lael Ridgway
- School of Nursing and Midwifery, Bundoora, Victoria, Australia
| | - Rhian L Cramer
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
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McLachlan HL, Forster DA, Davey MA, Farrell T, Flood M, Shafiei T, Waldenström U. The effect of primary midwife-led care on women's experience of childbirth: results from the COSMOS randomised controlled trial. BJOG 2015; 123:465-74. [DOI: 10.1111/1471-0528.13713] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- HL McLachlan
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - DA Forster
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
- The Royal Women's Hospital; Parkville Vic. Australia
| | - M-A Davey
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Department of Health; Melbourne Vic. Australia
| | - T Farrell
- The Royal Women's Hospital; Parkville Vic. Australia
| | - M Flood
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - T Shafiei
- Judith Lumley Centre and School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
| | - U Waldenström
- Department of Women's and Children's Health; Division of Reproductive and Perinatal Health; Karolinska Institutet; Stockholm Sweden
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Biggs LJ, Shafiei T, Forster DA, Small R, McLachlan HL. Exploring the views and experiences of callers to the PANDA Post and Antenatal Depression Association Australian National Perinatal Depression Helpline: a cross-sectional survey. BMC Pregnancy Childbirth 2015; 15:209. [PMID: 26347275 PMCID: PMC4562185 DOI: 10.1186/s12884-015-0594-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/15/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Anxiety and depression are common in the perinatal period. Telephone interventions, including telephone peer support and counselling, have been developed to support those experiencing perinatal mental illness. PANDA Post and Antenatal Depression Association provides support to women and men experiencing perinatal mental illness via the Australian National Perinatal Depression Helpline, encompassing both volunteer peer support and professional counselling. This study aimed to explore the experiences of callers to the Helpline. METHODS A cross-sectional survey design was used. All new callers from 1(st) May to 30(th) September 2013 were invited to participate. The survey, adapted from a previous survey of PANDA callers, included 23 questions using Likert-type scales, demographic and open-ended questions. Thematic network analysis was undertaken for responses to open-ended questions. RESULTS 124 responses were received (124/405; 30% response). The majority of callers had called the Helpline regarding themselves (90%), with over one third (33%) of all callers seeking crisis support and help. Ninety-nine per cent of respondents 'agreed' or 'strongly agreed' that staff and/or volunteers understood their concerns, and 97% 'agreed' or 'strongly agreed' that overall PANDA had helped them. Callers described the PANDA service as uniquely tailored to the perinatal period, providing accessible, non-judgemental understanding and support, with a global theme from open-ended comments describing PANDA as 'a safe space to be heard and receive support without judgement'. Recommendations for service changes included increased hours of availability. CONCLUSIONS Callers reported positive experiences of accessing support from the PANDA National Perinatal Depression Helpline. The Helpline was described as an accessible and acceptable telephone support for individuals experiencing perinatal mental illness. Recommendations for changes to the service included an increase in hours of operation to enable greater responsiveness at times of need, reduced waiting times, and access to continuity with the same volunteer and/or telephone counsellor. The findings of the study will be useful in informing future service provision, review, and implementation.
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Affiliation(s)
- Laura J Biggs
- Judith Lumley Centre, La Trobe University, Level 3, 215 Franklin St, Melbourne, 3000, Australia.
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Level 3, 215 Franklin St, Melbourne, 3000, Australia.
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Level 3, 215 Franklin St, Melbourne, 3000, Australia. .,The Royal Women's Hospital, Locked Bag 300 Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Level 3, 215 Franklin St, Melbourne, 3000, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Level 3, 215 Franklin St, Melbourne, 3000, Australia. .,School of Nursing & Midwifery, La Trobe University, Cnr Plenty Rd & Kingsbury Dr, Bundoora, VIC, 3083, Australia.
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Forster DA, Johns HM, McLachlan HL, Moorhead AM, McEgan KM, Amir LH. Feeding infants directly at the breast during the postpartum hospital stay is associated with increased breastfeeding at 6 months postpartum: a prospective cohort study. BMJ Open 2015; 5:e007512. [PMID: 25953728 PMCID: PMC4431142 DOI: 10.1136/bmjopen-2014-007512] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore whether feeding only directly from the breast in the first 24-48 h of life increases the proportion of infants receiving any breast milk at 6 months. DESIGN A prospective cohort study. SETTING Three maternity hospitals in Melbourne, Australia. PARTICIPANTS 1003 postpartum English-speaking women with a healthy singleton term infant, who intended to breast feed, were recruited between 2009 and 2011. Women were excluded if they or their infant were seriously ill. 92% (n=924) were followed up at 6 months postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Main exposure variable - type of infant feeding in hospital up to time of study recruitment (24-48 h postpartum), categorised as 'fed directly at the breast only' or 'received at least some expressed breast milk (EBM) or infant formula'. Primary outcome - proportion of infants receiving any breast milk feeding at 6 months postpartum. Secondary outcomes - proportion of infants receiving only breast milk feeding at 6 months; breast milk feeding duration; and maternal characteristics associated with giving any breast milk at 6 months. RESULTS Infants who had fed only at the breast prior to recruitment were more likely to be continuing to have any breast milk at 6 months than those who had received any EBM and/or infant formula (76% vs 59%; adjusted OR 1.76, 95% CI 1.24 to 2.48 (adjusted for parity, type of birth, breastfeeding intention, breastfeeding problems at recruitment, public/private status, epidural for labour or birth, maternal body mass index and education)). CONCLUSIONS Healthy term infants that fed only directly at the breast 24-48 h after birth were more likely to be continuing to breast feed at 6 months than those who received any EBM and/or formula in the early postpartum period. Support and encouragement to initiate breastfeeding directly at the breast is important.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, Melbourne, Victoria, Australia Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Helene M Johns
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, Melbourne, Victoria, Australia Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Helen L McLachlan
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, Melbourne, Victoria, Australia School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Anita M Moorhead
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, Melbourne, Victoria, Australia Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Kerri M McEgan
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother and Child Health Research), La Trobe University, Melbourne, Victoria, Australia
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Biggs L, Shafiei T, Forster DA, Small R, McLachlan HL. Experiences of callers to the PANDA National Perinatal Depression Helpline. Women Birth 2015. [DOI: 10.1016/j.wombi.2015.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Newton MS, McLachlan HL, Willis KF, Forster DA. Comparing satisfaction and burnout between caseload and standard care midwives: findings from two cross-sectional surveys conducted in Victoria, Australia. BMC Pregnancy Childbirth 2014; 14:426. [PMID: 25539601 PMCID: PMC4314764 DOI: 10.1186/s12884-014-0426-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/11/2014] [Indexed: 12/05/2022] Open
Abstract
Background Caseload midwifery reduces childbirth interventions and increases women’s satisfaction with care. It is therefore important to understand the impact of caseload midwifery on midwives working in and alongside the model. While some studies have reported higher satisfaction for caseload compared with standard care midwives, others have suggested a need to explore midwives’ work-life balance as well as potential for stress and burnout. This study explored midwives’ attitudes to their professional role, and also measured burnout in caseload midwives compared to standard care midwives at two sites in Victoria, Australia with newly introduced caseload midwifery models. Methods All midwives providing maternity care at the study sites were sent questionnaires at the commencement of the caseload midwifery model and two years later. Data items included the Midwifery Process Questionnaire (MPQ) to examine midwives’ attitude to their professional role, the Copenhagen Burnout Inventory (CBI) to measure burnout, and questions about midwives’ views of caseload work. Data were pooled for the two sites and comparisons made between caseload and standard care midwives. The MPQ and CBI data were summarised as individual and group means. Results Twenty caseload midwives (88%) and 130 standard care midwives (41%) responded at baseline and 22 caseload midwives (95%) and 133 standard care midwives (45%) at two years. Caseload and standard care midwives were initially similar across all measures except client-related burnout, which was lower for caseload midwives (12.3 vs 22.4, p = 0.02). After two years, compared to midwives in standard care, caseload midwives had higher mean scores in professional satisfaction (1.08 vs 0.76, p = 0.01), professional support (1.06 vs 0.11, p <0.01) and client interaction (1.4 vs 0.09, p <0.01) and lower scores for personal burnout (35.7 vs 47.7, p < 0.01), work-related burnout (27.3 vs 42.7, p <0.01), and client-related burnout (11.3 vs 21.4, p < 0.01). Conclusion Caseload midwifery was associated with lower burnout scores and higher professional satisfaction. Further research should focus on understanding the key features of the caseload model that are related to these outcomes to help build a picture of what is required to ensure the long-term sustainability of the model.
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Affiliation(s)
- Michelle S Newton
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia. .,Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, VIC, 3000, Australia.
| | - Helen L McLachlan
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, 3086, Australia. .,Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, VIC, 3000, Australia.
| | - Karen F Willis
- Faculty of Health Sciences, Australian Catholic University, 215 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, VIC, 3000, Australia. .,The Royal Women's Hospital, Cnr Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia.
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Forster DA, Savage TL, McLachlan HL, Gold L, Farrell T, Rayner J, Yelland J, Rankin B, Lovell B. Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial. BMC Health Serv Res 2014; 14:569. [PMID: 25421495 PMCID: PMC4279591 DOI: 10.1186/s12913-014-0569-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women. METHODS A feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care. English-speaking women at low risk of medical complications were recruited around 26 weeks gestation to explore their willingness to participate in a study of a new, flexible model of care that involved antenatal planning for early postpartum discharge with additional home-based postnatal care. The earlier women were discharged from hospital, the more home-based visits they were eligible to receive. Program uptake was measured, women's views obtained by a postal survey sent at eight weeks postpartum and clinical data collected from medical records. RESULTS Study uptake was 39% (109/277 approached). Most women (n=103) completed a postnatal care plan during pregnancy; 17% planned to leave hospital within 12 hours of giving birth and 36% planned to stay 48 hours. At eight weeks postpartum most women (90%) were positive about the concept and 88% would opt for the same program again. Of the 28% who stayed in hospital for the length they had planned, less than half (43%) received the appropriate number of home visits, and only 41% were given an option for the timing of the visit. Most (62%) stayed in hospital longer than planned (probably due to clinical complications); 11% stayed shorter than planned. CONCLUSIONS Women were very positive about individualised postnatal care planning that commenced during pregnancy. Given the hospital stay may be impacted by clinical factors, individualised care planning needs to continue into the postnatal period to take into account circumstances which cannot be planned for during pregnancy. However, individualised care planning during the postnatal period which incorporates a high level of flexibility may be challenging for organisations to manage and implement, and a randomised controlled trial of such an approach may not be feasible.
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Affiliation(s)
- Della A Forster
- Judith Lumely Centre, La Trobe University, 215 Franklin St, Melbourne, 3000, Australia.
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
| | - Tracey L Savage
- Judith Lumely Centre, La Trobe University, 215 Franklin St, Melbourne, 3000, Australia.
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
- Yale New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA.
| | - Helen L McLachlan
- Judith Lumely Centre, La Trobe University, 215 Franklin St, Melbourne, 3000, Australia.
- School of Nursing and Midwifery, La Trobe University, Melbourne Campus, Kingsbury Drive, Bundoora, Vic, 3086, Australia.
| | - Lisa Gold
- Deakin Health Economics, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia.
| | - Tanya Farrell
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
| | - Jo Rayner
- School of Nursing and Midwifery, La Trobe University, Melbourne Campus, Kingsbury Drive, Bundoora, Vic, 3086, Australia.
| | - Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Bree Rankin
- Drug Strategy Analysis Unit, Population 846 Health Division, Department of Health and Ageing, Canberra, Australia.
| | - Belinda Lovell
- The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, 3052, Australia.
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Forster DA, Jacobs S, Amir LH, Davis P, Walker SP, McEgan K, Opie G, Donath SM, Moorhead AM, Ford R, McNamara C, Aylward A, Gold L. Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial. BMJ Open 2014; 4:e006571. [PMID: 25358679 PMCID: PMC4216858 DOI: 10.1136/bmjopen-2014-006571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/02/2014] [Accepted: 10/06/2014] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact. METHODS AND ANALYSIS Women will be recruited from 34 weeks gestation to a multicentre, two arm, unblinded randomised controlled trial. The intervention starts at 36 weeks. Randomisation will be stratified by site, parity and diabetes type. Women allocated to the intervention will be taught expressing and encouraged to hand express twice daily for 10 min and keep an expressing diary. The sample size of 658 (329 per group) will detect a 10% difference in proportion of babies admitted to SCN/NICU (85% power, α 0.05). Data are collected at recruitment (structured questionnaire), after birth (abstracted from medical record blinded to group), and 2 and 12 weeks postpartum (telephone interview). DATA ANALYSIS the intervention group will be compared with the standard care group by intention to treat analysis, and the primary outcome compared using χ(2) and ORs. ETHICS AND DISSEMINATION Research ethics approval will be obtained from participating sites. Results will be published in peer-reviewed journals and presented to clinicians, policymakers and study participants. TRIAL REGISTRATION NUMBER Australian Controlled Trials Register ACTRN12611000217909.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan Jacobs
- Royal Women's Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
| | - Peter Davis
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Kerri McEgan
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Gillian Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anita M Moorhead
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rachael Ford
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | | | | | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
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