Early Pregnancy Assessment Services in Australia: What psychosocial support is available? A qualitative study

Support sought and offered online for miscarriage: content analysis of a Facebook miscarriage support group

OBJECTIVE

Responses to miscarriage can vary, with many, but not all, people describing inadequate support, feelings of isolation and significant psychological distress. Limited knowledge exists about the support that people seek and offer online following miscarriage. We aimed to explore how people impacted by miscarriage use an online Facebook support group to seek and offer support.

METHODS AND MEASURES

We employed directed content analysis to examine 270 opening posts and 3,484 responding comments within an 'open' Facebook support group for miscarriage. Opening posts and responding comments were coded into five social support categories using an existing support framework.

RESULTS

Informational Support, particularly medical information or advice, was the most commonly sought support in opening posts, followed by Emotional Support, where people expressed their grief-related feelings. In responding comments, Emotional Support and Informational Support were predominantly offered.

CONCLUSION

While not a substitute for appropriate medical care, people impacted by miscarriage seek and offer support online. Health professionals should be aware of this behaviour and discuss potential benefits and risks of online support with patients. A social support framework may usefully guide health professionals in identifying patients' support needs and in knowing how to support patients.

Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services: a scoping review

OBJECTIVE

The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications under 20 weeks' gestation in acute clinical settings in Australia.

INTRODUCTION

In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive, and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care.

INCLUSION CRITERIA

Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review.

METHODS

A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis.

RESULTS

The evidence reviewed (n=23) included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives' and registered nurses' roles and scope of practice in acute early pregnancy care in Australia can be summarized into 4 areas: physical care, psychosocial support, care co-ordination, and communication. Women's access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives' practice focuses more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models.

CONCLUSIONS

This review highlights the inconsistency in midwives' and registered nurses' roles and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of gestation.

REVIEW REGISTRATION

Open Science Framework osf.io/7zchu.

Presentation trends, characteristics and outcomes for women with early pregnancy bleeding in the emergency department: A 10-year data linkage study

BACKGROUND

Women present to the emergency department (ED) with pregnancy complications including bleeding. They seek investigations, treatment and clear discharge and referral pathways.

AIMS

The aim was to identify trends, characteristics, ED care and discharge pathways for women who present to the ED with early pregnancy bleeding.

METHODS

Retrospective data (from 2011 to 2020) were extracted from a regional health district's databank. Data were processed, and deterministic linking was used to produce a final data set. Descriptive statistics were used to identify trends and characteristics. Linear and logistic regression models were used to identify factors that influence health service use, outcomes and discharge pathways.

RESULTS

Over the 10 years, there have been almost 15 000 presentations to the ED for early pregnancy bleeding, from approximately 10 000 women, 0.97% of all ED presentations. The frequency of presentations increased by 19.6% over the study period. The average age of women who presented to the ED was 29.1 years, which increased from 28.5 years (2011) to 29.3 (2020). The median length of stay was less than 4 h, and most women were treated and discharged from the ED. One-third of presentations received neither ultrasound nor pathology, but health service costs increased by 330% from 2014 to 2020.

CONCLUSIONS

Maternal age is increasing, as is the frequency of ED presentations for early pregnancy bleeding, and both factors increase demands on the ED. Findings from this study may inform strategies to improve current care models and improve quality and safety practices within the ED.

Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services in Australia: a scoping review protocol

OBJECTIVE

The objective of this review is to review and synthesize what is documented on the role and scope of practice of midwives and registered nurses working in acute early pregnancy care settings in Australia.

INTRODUCTION

Women experiencing complications before 20 weeks of pregnancy may need to attend an acute care service, often a hospital emergency department. Midwives and registered nurses provide care for women with early pregnancy complications, and it is important that their role and scope of practice is documented. This review will explore the literature relating to acute early pregnancy care in Australia to better understand how midwives' and registered nurses' roles and scope are currently described in this setting.

INCLUSION CRITERIA

Any literature that explores the role and scope of practice of midwives and registered nurses who care for women who present to acute care services in Australia with early pregnancy complications will be considered for inclusion in the review.

METHODS

A 3-step review process will involve a preliminary search of MEDLINE and ProQuest, followed by a more detailed search of a larger selection of databases, using identified keywords and phrases from the initial search. Reference lists of retrieved literature will then be examined for relevant citations. Literature in English will be considered, including relevant gray literature. Search results will be imported into reference and review support software. Data that align with the inclusion criteria will be organized into tabulated and narrative formats for presentation.

DETAILS OF THIS REVIEW PROJECT ARE AVAILABLE AT

Open Science Framework https://osf.io/5bnqz.