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Abstract
A transformative approach to maternal health promotion should be mother-centred, context-driven and grounded in lived experiences. Health promotion can achieve this by drawing on its disciplinary roots to extend and reorient maternal health promotion towards an approach of non-stigmatizing and equitable health promotion that has mothers' well-being at the centre, particularly giving credit to marginalized, 'non-normative' maternities. This article draws on data from 18 workshops EN conducted across Aotearoa New Zealand, including 268 maternal health stakeholders. Drawing on design thinking, participants reimagined what a maternal health promotion approach informed by the Ottawa Charter action areas could comprise. The five themes included building connected systems close to home, developing mothering/parenting skills, addressing upstream determinants, mother-centred care and funding, and creating a collective mothering village. We discuss how these areas could better meet the unique challenges of transitioning to motherhood. Rather than focussing only on individual behaviours, many ideas reveal broader environmental and structural determinants. We link the themes to current literature and advance the agenda for centring the maternal in maternal health promotion.
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Affiliation(s)
| | - Anna Reed
- School of Health, Te Herenga Waka—Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand
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Hetherington E, McDonald S, Williamson T, Tough S. Trajectories of social support in pregnancy and early postpartum: findings from the All Our Families cohort. Soc Psychiatry Psychiatr Epidemiol 2020; 55:259-267. [PMID: 31256206 DOI: 10.1007/s00127-019-01740-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 06/24/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Low social support during the perinatal period can increase the risk of postpartum depression and anxiety after giving birth but little is known about women's trajectories of social support during this time. This study will identify trajectories of social support among women from second trimester to 4-month postpartum, and the characteristics associated with different trajectories. METHODS Data from the All Our Families longitudinal birth cohort was used to assess women's perceived social support during their second trimester, third trimester, and at 4-month postpartum (n = 3387). Group-based trajectory modeling was used to determine the number of groups, shape of trajectories, and proportion of women with differing trajectories. Multinomial regression was used to compare probability of group membership. RESULTS Six distinct trajectory groups were identified, with the majority of participants belonging to groups with stable, high social support (60.6%). Only 2.7% of women had consistently low levels of social support, and 2.3% had rising levels. Membership in groups with lower levels of social support was associated with lower incomes and minority ethnicity. Women whose support improved over time may be more likely to be employed in pregnancy than those whose support remained low. CONCLUSION Trajectories of social support are relatively stable in pregnancy and early postpartum. Socio-demographic indicators of vulnerability predict initial levels of support, and participating in the workforce may help improve perception of support over time.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada.
| | - Sheila McDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr. NW, Calgary, AB, T2N 4N1, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Navodani T, Gartland D, Brown SJ, Riggs E, Yelland J. Common maternal health problems among Australian-born and migrant women: A prospective cohort study. PLoS One 2019; 14:e0211685. [PMID: 30742634 PMCID: PMC6370277 DOI: 10.1371/journal.pone.0211685] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrant women of non-English speaking background make up an increasing proportion of women giving birth in high income countries, such as Australia, Canada and the United Kingdom. The aim of this study was to assess the prevalence of common physical and psychosocial health problems during pregnancy and up to 18 months postpartum among migrant women of non-English speaking background compared to Australian-born women. METHODS Prospective pregnancy cohort study of 1507 nulliparous women. Women completed self-administered questionnaires or telephone interviews in early and late pregnancy and at 3, 6, 9, 12 and 18 months postpartum. Standardised instruments were used to assess incontinence, depressive symptoms and intimate partner violence. FINDINGS Migrant women of non-English speaking background (n = 243) and Australian-born mothers (n = 1115) reported a similar pattern of physical health problems during pregnancy and postpartum. The most common physical health problems were: exhaustion, back pain, constipation and urinary incontinence. Around one in six Australian-born women (16.9%) and more than one in four migrant women (22.5%) experienced intimate partner abuse in the first 12 months postpartum. Compared to Australian-born women, migrant women were more likely to report depressive symptoms at 12 and 18 months postpartum. CONCLUSION Physical and mental health problems are common among women of non-English speaking background and Australian-born women, and frequently persist up to 18 months postpartum. Migrant women experience a higher burden of postpartum depressive symptoms and intimate partner violence, and may face additional challenges accessing appropriate care and support.
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Affiliation(s)
- Tharanga Navodani
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Ministry of Health, Colombo, Sri Lanka
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie J. Brown
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Jane Yelland
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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Le HND, Gold L, Mensah FK, Cook F, Bayer JK, Hiscock H. Health service use and costs for infant behaviour problems and maternal stress. J Paediatr Child Health 2016; 52:402-9. [PMID: 27145503 DOI: 10.1111/jpc.13095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/20/2015] [Accepted: 10/23/2015] [Indexed: 11/28/2022]
Abstract
AIM We aim to describe health service (HS) use in the first 6 months post-partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms. METHODS Participants were 781 infants and mothers in Melbourne, Australia. Mothers reported infant feeding, sleeping and crying problems, depressive symptoms and health service use. Costs were valued in 2012 Australian dollars. RESULTS The most common services used were maternal child health nurses, general practitioners (GP) and allied health. Infant feeding problems were associated with increased costs for services relevant to infant behaviour including maternal child health nurses (P = 0.007), GP (P = 0.008) and paediatricians (P = 0.03). Maternal depressive symptoms were associated with increased costs for services relevant to depressive symptoms including parenting centres (P = 0.04), GP (P = 0.004), psychiatrists (P = 0.02) and psychologists (P = 0.001). Mothers who completed high school had higher service costs for infant problems than those with lower education (P = 0.02). Single mothers had higher costs for services used for their depressive symptoms than partnered mothers (P < 0.001). Mothers with English as a second language had lower service costs for their depressive symptoms (P = 0.02). CONCLUSIONS Infant feeding problems and maternal depressive symptoms are associated with higher costs for health services relevant to these conditions. Cost-effective strategies to manage these conditions are needed with accessibility being ensured for mothers who are experiencing social adversity.
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Affiliation(s)
- Ha N D Le
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Fallon Cook
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Parenting Research Centre, Melbourne, Victoria, Australia
| | - Jordana K Bayer
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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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] [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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Hooker L, Taft A, Small R. Reflections on maternal health care within the Victorian Maternal and Child Health Service. Aust J Prim Health 2016; 22:77-80. [DOI: 10.1071/py15096] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/28/2015] [Indexed: 11/23/2022]
Abstract
Women suffer significant morbidity following childbirth and there is a lack of focussed, primary maternal health care to support them. Victorian Maternal and Child Health (MCH) nurses are ideally suited to provide additional care for women when caring for the family with a new baby. With additional training and support, MCH nurses could better fill this health demand and practice gap. This discussion paper reviews what we know about maternal morbidity, current postnatal services for women and the maternal healthcare gap, and makes recommendations for enhancing MCH nursing practice to address this deficit.
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Hawe P, Riley T, Gartrell A, Turner K, Canales C, Omstead D. Comparison communities in a cluster randomised trial innovate in response to 'being controlled'. Soc Sci Med 2015; 133:102-10. [PMID: 25863725 DOI: 10.1016/j.socscimed.2015.03.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We conducted qualitative interviews among primary health care teams and community agencies in eight communities in Victoria, Australia which had (1) agreed to be part of a universal primary care and community development intervention to reduce post natal depression and promote maternal health; and (2) were randomised to the comparison arm. The purpose was to document their experience with and interpretation of the trial. Although 'control' in a controlled trial refers to the control of confounding of the trial result by factors other than allocation to the intervention, participants interpreted 'control' to mean restrictions on what they were allowed to do during the trial period. They had agreed not to use the Edinburgh Post Natal Depression Scale or the SF 36 in clinical practice and not to implement any of the elements of the intervention. We found that no elements of the intervention were implemented. However, the extension of the trial from three to five years made the trial agreement a strain. The imposition of trial conditions also encouraged a degree of lateral thinking and innovation in service delivery (quality improvement). This may have potentially contributed to the null trial results. The observations invite interrogation of intervention theory and consequent rethinking of the way contamination in a cluster trial is defined.
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Affiliation(s)
- Penelope Hawe
- Menzies Centre for Health Policy, University of Sydney, Australia; The Australian Prevention Partnership Centre, Australia.
| | - Therese Riley
- Judith Lumley Centre, LaTrobe University (Now based at Centre of Excellence in Intervention and Prevention Science, Melbourne), Australia
| | - Alexandra Gartrell
- Judith Lumley Centre, Now based at School of Geography and Environmental Sciences, Monash University, Australia
| | - Karen Turner
- Centre for Health and Society, Melbourne School of Population and Global Health, University of Melbourne (Now based at Department of Anthropology, School of Social and Political Sciences, University of Melbourne, Australia
| | - Claudia Canales
- O'Brien Institute of Public Health, University of Calgary, Canada
| | - Darlene Omstead
- O'Brien Institute of Public Health, University of Calgary, Canada
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