Causal links behind why Australian midwifery care is missed

Exploring Emotional Well-Being and Support of Midwives Who Provide Termination of Pregnancy Care: An International Survey

AIMS

Assess the psychological impact that providing TOP care beyond 12 weeks gestation has on midwives in Australia and New Zealand, improve understanding of TOP care and explore what support midwives have and what they might need to deal with their work experiences.

DESIGN

Online survey.

METHODS

A web-based, self-reported questionnaire with a total of 63 questions collected data from June to October 2022. Two validated psychometric tools were included to assess emotional well-being. Numerical data were analysed using descriptive statistics, frequencies, percentages and means. The STROBE guideline was used for reporting.

RESULTS

Most midwives felt unsupported and affected by their experiences of providing termination of pregnancy care. Recognition and regular post-care debriefing with management were minimal. Lack of staff impacted the ability to provide individualised care. Mental health support was not commonly offered to midwives. Psychometric tools showed burnout and high levels of compassion fatigue, but also compassion satisfaction. To feel supported midwives need a fully staffed workforce, the ability to provide one-on-one care, recognition from managers and team support.

CONCLUSION

Midwives who deliver termination of pregnancy care are unsupported and at high risk of burnout and compassion fatigue. Providing appropriate support is vital to increase midwives' well-being and sustain women's access to safe, high-quality care.

IMPACT

Study addresses a knowledge gap about midwives' support needs when caring for women undergoing termination of pregnancy beyond 12 weeks. Findings show the urgent need to recruit and retain midwifery staff, acknowledge the mental health risks of termination of pregnancy care and implement mental health strategies for midwives. Research benefits midwives who provide termination of pregnancy care, midwife managers, healthcare organisations and professional bodies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

Optimising recovery after perineal trauma: Implementation of an evidence-based patient-centred care and clinical practice guideline

BACKGROUND

Perineal trauma and pain can affect the quality of life of women who experience vaginal birth.

AIM

To investigate the effect of perineal care and pain management on women's postpartum recovery.

METHODS

This was a Quasi-experimental study. In Phase 1 women were treated using our old postnatal perineal care management guideline. In Phase 2 an updated guideline was introduced (regular administration of icepacks and analgesia during the first 24-48 h postpartum). During Phase 1, pregnant women planning a vaginal birth completed a baseline questionnaire. Those who sustained perineal trauma completed a survey at 24-48 h, seven days and 12 weeks after birth. In Phase 2 we continued recruiting participants, using the same procedure, and investigated the efficacy of pain relief approaches using the new guideline.

RESULTS

In Phase 1, 111 women (Group 1), and Phase 2, 146 women (Group 2) were recruited. No statistically significant differences were found between the two groups in terms of the women's pain catastrophising, their partner's responses to pain behaviours, or birth outcomes. At 24-48 h and seven days postpartum, women in Group 2 were less likely than women in Group 1 to be bothered by back or perineal pain, headache, sleeping difficulties and dizziness (p < 0.05). More women in Group 2 received regular paracetamol and perineal icepacks during their hospital stay, with less use of oxycodone in Group 2 than Group 1.

CONCLUSION

The implementation of the guideline's recommendations was associated with decrease back and perineal pain, headache, sleeping difficulties and dizziness during the first seven days postpartum.

How do professional connections and relationships impact midwives' well-being and career sustainability? A Grounded Theory study protocol

Significant attrition and projected workforce shortages within the midwifery profession are global issues. Extensive research has identified that high levels of workplace adversity, chronic stress, and increasing rates of vicarious trauma and moral injury experienced by midwives, underpin this situation. Researchers have explored midwives' intention to stay in the midwifery workforce and identified ways to support students' transition to professional practice. Supportive collegial relationships have been reported to be protective for new and early career midwives' well-being and resilience. However, there is a gap in knowledge and understanding of the impact and significance of professional connections and relationships for midwives across their careers. This article describes a protocol for a study designed to explore and understand how professional connections and relationships impact midwives' well-being and career sustainability. Glaserian Grounded Theory (GT) methodology will be used to conduct the study. Constant comparison will be used to analyze data collected from in-depth interviews with midwives at various stages in their professional careers, with the aim of understanding the significance of professional connections and relationships on their well-being and career sustainability, and in understanding the potential protections and benefits. It is anticipated that the findings and theory generated from this study will have national and international implications and provide evidence about the impacts, including benefits and any potential disadvantages, of professional relationships in sustaining midwifery careers. This will be of significant value to, as well as inform, the development of midwife retention strategies.