Dawn Miller

A survey of New Zealand RANZCOG Fellows on their use of the levonorgestrel intrauterine device in adolescents

Background: The levonorgestrel intrauterine device (LNG‐IUD) is an established treatment for adult women. Although it is being used in adolescents, there is little published research in this age group to date. Recent reviews and editorials have challenged the long‐held views that intrauterine devices should not be used in young women.

GP obstetricians' views of the model of maternity care in New Zealand

The Lead Maternity Carer (LMC) model of maternity care, and independent midwifery practice, was introduced to New Zealand in the 1990s. The LMC midwife or general practitioner obstetrician (GPO) has clinical and budgetary responsibility for womens primary maternity care.

General Practitioners providing obstetric care in New Zealand. What differentiates GPs who continue to deliver babies

AIM To identify factors that have enabled some New Zealand general practitioner obstetricians (GPOs) to continue providing maternity care and factors implicated in decisions to withdraw from maternity care. METHOD Semi-structured interviews and one focus group (n = 3) were conducted with 23 current and former GPOs. Interviews were transcribed and analysed thematically. RESULTS Current and former GPOs practiced maternity care because they enjoyed being involved in the birth process and delivery suite environment. Their maternity practice was framed by a philosophy of lifelong continuity of care for patients. CONCLUSION GPOs still practicing in New Zealand do so because they find maternity care highly rewarding despite their perceptions that the current maternity care model is incompatible with general practice. They have often developed local solutions that support their practice, particularly around shared care arrangements.

Vigorous exercises in the management of primary dysmenorrhea: a feasibility study

Abstract Purpose: To examine the feasibility of using an exercise intervention for reducing menstrual pain associated with primary dysmenorrhea (PD) and to obtain preliminary results to estimate the sample size for a future randomized controlled trial (RCT). Methods: A quasi-experimental design was applied. Ten women 18–45 years with PD were included. The participants underwent vigorous aerobic training at the School of Physiotherapy on a treadmill three times a week for up to 4 weeks followed by aerobic training at home for up to 4 weeks. The feasibility measures were adherence to the intervention programme and intervention prescription, retention and safety. The short form McGill pain questionnaire was used to measure pain at first (T1), second (T2) and third (T3) menstrual cycles following trial entry. Results: Overall adherence was 98%, with 100% adherence to clinic-based intervention and intervention prescription and 96% for home exercise programme. Retention rate was 100%. With respect to pain a large effect size was identified at T2 and T3. No adverse events reported. Conclusions: Results demonstrated that the intervention is applicable and feasible. In addition, the preliminary results show evidence of positive changes after the intervention. The intervention programme’s effectiveness will be studied further, in a future RCT. Implications for Rehabilitation There is a lack of available evidence from randomized controlled trials regarding the use of exercise in alleviating the symptoms associated with primary dysmenorrhea (PD). The preliminary results of this study shows that exercises may be effective in reducing the pain associated with PD indicated by a large effect size. The preliminary findings from this study could also contribute significantly to PD management and introduce new practice opportunities for physiotherapists working in women’s health.

“Tossing Out the Baby with the Bath Water”: New Zealand General Practitioners on Maternity Care

A rapid decline in the number of general practitioners practicing obstetrics followed legislative changes in New Zealand during the early 1990s that changed the maternity care landscape. The resulting repositioning of maternity care professions has seen medical dominance give way to midwifery dominance in the maternity marketplace. Drawing on our research, we suggest that current and former general practitioner obstetricians harbor grievances relating to (1) the loss of obstetrics from the ‘cradle to grave’ philosophy of general practice, and (2) policies encouraging competition between maternity care providers. We argue that these perspectives represent truth games that are generated by the disciplinary blocks of the maternity care professions, and reveal the moral nature of the political economy of maternity care.

Menstrual pain and quality of life in women with primary dysmenorrhea: Rationale, design, and interventions of a randomized controlled trial of effects of a treadmill-based exercise intervention☆

Dysmenorrhea in the absence of pelvic abnormality is termed primary dysmenorrhea (PD). The health burden and social and economic costs of PD are high as it is reported to be the leading cause of recurrent absenteeism from school or work in adolescent girls and young adults. The belief that exercise works for relieving symptoms in women with PD is based on anecdotal evidence and non-experimental studies. There is very limited evidence from randomized controlled trials (RCTs) to support the use of exercise to reduce the intensity of menstrual pain. The objective of this study is to evaluate the effectiveness of exercise to reduce intensity of pain and improve quality of life in women with PD. We describe the study design of a single-blind (assessor), prospective, two-arm RCT, and the participant characteristics of the 70 women recruited in the age-group 18 to 43 years. The primary outcome of the study is pain intensity. The secondary outcomes of the study are quality of life, functional limitation, sleep, global improvement with treatment, and protocol adherence. The outcomes assessments are done at first menstrual period (baseline, Week 0), 2nd menstrual period (Week 4) and at two additional time points (Week 16 and Week 28) during the trial. The results of the study will provide physiotherapists, medical practitioners, and researchers as well as the women who have PD with new insights, knowledge, and evidence about the use of exercise to manage pain in women with PD.