The profile of women who consult midwives in Australia

“Never let a good crisis go to waste”: Positives from disrupted maternity care in Australia during COVID-19

Objective

Due to the COVID-19 pandemic, a number of changes to maternity care were rapidly introduced in all countries, including Australia, to reduce the risk of infection for pregnant women and their care providers. While many studies have reported on the negative effects of these changes, there is a paucity of evidence on factors which women and their providers perceived as positive and useful for future maternity care.

Design

Data was analysed from the Birth in the time of COVID-19 (BITTOC 2020) study survey. Conventional content analysis and descriptive statistics were used to analyse the data and examine which aspects of COVID-amended care women experienced as positive. Data from women were compared to data from midwives.

Setting

This project took place in Australia in 2020-2021.

Participants

The survey was distributed to women who gave birth and midwives who worked in Australia during the COVID-19 pandemic (March 2020 onwards).

Measurements and findings

Women reported a variety of positives from their maternity care during COVID-19. These included both care-related factors as well as contextual factors. The most commonly mentioned positives for pregnant and postnatal women were care-related, namely fewer visitors in hospital, having increased access to telehealth services. These were also the most commonly reported positives by midwives. Having midwifery continuity of care models, giving birth at home and having their partner work from home were also highlighted by women as positives.

Key conclusions

Despite the negative effect of COVID-19-related restrictions on maternity care, a variety of changes were viewed as positive by both women and midwives, with strong agreement between the two groups.

Implications for practice

These findings provide evidence to support the inclusion of these positive elements of care and ensure that the lessons learned from the pandemic are utilised to improve maternity care in Australia going forward.

Type of health care workers and quality of antenatal and delivery care in communities of Myanmar: An experience- and vignette-based study

BACKGROUND

Understanding who provides antenatal and delivery care services and the quality of care in communities with high maternal deaths is essential for planning the efficient utilization of a limited health care workforce.

OBJECTIVES

To identify the types of health care workers for antenatal and delivery care in these communities, and assess the quality of care using vignettes of women with hypertensive disorder in pregnancy (HDP) and postpartum hemorrhage (PPH) from the provider's perspectives in Myanmar.

METHODS

A cross-sectional study was conducted in three townships of Myanmar during May to September 2016. Health assistants, lady health visitors, midwives, and auxiliary midwives rated the type of providers and quality of care based on four HDP vignettes and four PPH vignettes. The agreements of their assessments were analysed using prevalence-adjusted bias-adjusted kappa and Cramer's V coefficient.

RESULTS

Almost perfect agreement was found that midwives were the providers who provided and who should provide all routine antenatal and delivery care services. Less than 80% of the participants perceived good quality antenatal care (ANC) and delivery care for HDP and PPH, particularly in vignettes featuring cases of pre-existing hypertension or PPH with history of hospitalization. More than 85% of the participants rated quality of care for managing complications as good. Variations of ratings among the providers ranged from small to medium (Cramer's V = .22-.40).

CONCLUSION

Midwives were key providers of ANC and delivery care in the local communities in Myanmar, but the quality of ANC for women with HDP and PPH was poor and needs improvement.

Support needs of breast-feeding women: views of Australian midwives and health nurses

OBJECTIVE

to explore the views of midwives and maternal-child health nurses regarding factors that influence breast feeding initiation and continuation, focusing on how support for women could be improved to increase breast feeding duration.

DESIGN

a focus group study.

SETTING

hospital or domiciliary (home-visiting) midwives and community-based maternal and child health (MCH) nurses in one region of Victoria, Australia.

METHODS

twelve MCH nurses and five midwives who provided supportive services to women in the immediate postnatal period attended one of three audio-recorded focus groups. Thematic findings were identified.

FINDINGS

four key themes were: 'Guiding women over breast-feeding hurdles', 'Timing, and time to care'; 'Continuity of women's care' and 'Imparting professional knowledge'. Given the a pattern of hospital discharge of mother and infant on day one or day two after birth, participants thought the timing of immediate postnatal breast-feeding support was critical to enable women to initiate and continue breast feeding. Community-based MCH nurses reported time gaps in uptake of new mother referrals and time-pressured face-to-face consultations. Both groups perceived barriers to continuity of women's care.

CONCLUSIONS

health services subscribe to the Baby Friendly Health Initiative and government policies which support breast feeding, however providers described time pressures and a lack of continuity of women's care, including during transition from hospital to community services.

IMPLICATIONS FOR PRACTICE

there is a need to examine administration of service delivery and how domiciliary and community nurses can collaborate to establish and maintain supportive relationships with breast feeding women.

'It's those first few weeks': Women's views about breastfeeding support in an Australian outer metropolitan region

OBJECTIVE

To examine factors that influence the establishment and continuation of breastfeeding among women living in a southern region of Victoria.

METHOD

Sequential mixed methods design including paper-based survey and focus group enquiry.

FINDING

Women who had breastfed their infants (n=170) reported reliance on midwives, lactation consultants and maternal and child health nurses for breastfeeding advice and support in the immediate and medium postnatal periods. Women who chose a private hospital appeared to receive less immediate postnatal support than those in a public hospital. Access to individual guidance from midwives and MCH nurses was regarded as critical to overcoming breastfeeding difficulties, in the face of the alternative suggested by people to 'give up'. They described themes of: 'Women's experience of nurses/midwives', 'Expectations versus reality', 'Not giving up despite difficulties', and 'Breastfeeding support'. Sources of lay support were not universal.

CONCLUSION

The duration of breastfeeding might be extended by early problem resolution. To enhance breastfeeding participation, further examination of the extent and timeliness of service provision by health service providers is necessary.