Elaine Dietsch

Australian Aboriginal kinship: a means to enhance maternal well-being.

BACKGROUND The relocation of women from their rural communities to birth in a centralised hospital is becoming increasingly common as maternity units close in rural areas of Australia. The significance for Aboriginal women when they are denied the support of kin around the time of birth but have that support re-established postnatally is explored. METHODS This paper gathered data from multiple sources including in-depth interviews with three Aboriginal mothers and one partner; observational field notes; and during debriefing, the knowledge and experience of an Aboriginal midwife. Thematic analysis was utilised to both explore and critique the collected data. FINDINGS AND DISCUSSION Aboriginal women are particularly disadvantaged by maternity unit closures in rural areas of the south eastern Australian state of New South Wales (NSW). However, contrary to the expectation that this would result in postnatal mental health problems, the support the Aboriginal participants in this study received from kin may have had a mediating effect which enhanced their well-being and possibly prevented mental ill health. RECOMMENDATIONS Recommendations relate to strategies and policies that have the potential to increase community governance and feelings of cultural safety for Aboriginal childbearing women living in rural areas. CONCLUSION While the practice of forcing Aboriginal women to relocate around the time of birth has a negative impact on perinatal health outcomes, kinship support may be a mediating factor.

‘Too scary to think about’: First time mothers’ perceptions of the usefulness of antenatal breastfeeding education

BACKGROUND The purpose of this pilot study was to uncover the perceived usefulness of a contemporary antenatal education strategy for mothers experience of breastfeeding initiation. RESEARCH QUESTION How useful do first time mothers perceive an antenatal education strategy to be for initiating breastfeeding? PARTICIPANTS AND METHODS This was a simple descriptive pilot study with ten first time mothers as participants; all of whom were booked into an Australian private maternity unit for antenatal breastfeeding education, labour, birth and postpartum care. Semi-structured interviews were transcribed verbatim and thematically analysed. FINDINGS AND DISCUSSION Antenatal education was beneficial for informing first time mothers of the practical skills required to positively initiate breastfeeding. However, this antenatal education strategy was not enough to reduce anxiety and foster the participants sense of self-confidence in their ability to breastfeed their newborns. IMPLICATIONS FOR PRACTICE Recommendations are made to focus antenatal breastfeeding strategies on first, a strength based model that builds confidence in womens ability to successfully breastfeed. Second, in the interests of fully informed consent, women are to be advised about the physiological connection between pregnancy, labour, birth and breastfeeding and the impact that interventions such as synthetic oxytocin, caesarean section and epidural anaesthesia are likely to have on the initiation of breastfeeding.

Environmental Education and the Health Professions: Framing Climate Change as a Health Issue.

The likelihood of adverse health impacts from climate change is high. Actions to reduce emissions, however, not only mitigate climate change but often have more immediate health co-benefits. One substantial co-benefit is gained through reductions of the high health costs of pollution from fossil fuel power stations, particularly coal. Evidence indicates that the combustion of coal for electricity is responsible for over 200,000 deaths globally per year. Reducing such deaths is a health co-benefit of greenhouse mitigation actions that promote renewable energy or energy efficiency. Together, health co-benefits of mitigation and the health risks of climate change strengthen the calls from climate action networks for cleaner energy production and for other initiatives to reduce greenhouse emissions. The purpose of this scholarly review is to highlight the value of reframing climate change as a health issue to environmental movements and to environmental education and environmental education research. The purpose is also to highlight the potential for further collaboration between formal and informal environmental educators/researchers and the health professions. Health professionals and health educators would bring new voices for climate action to public and policy discourse as well as facilitate mitigation in their organisations and communities.

Learning lessons from a traditional midwifery workforce in Western Kenya

OBJECTIVE To learn lessons from a traditional midwifery workforce in Western Kenya. DESIGN With the assistance of an interpreter, qualitative data was collected during in-depth individual and group interviews with traditional midwives. English components of the interviews were transcribed verbatim and the data thematically analysed. SETTING A rural, economically disadvantaged area of Western Kenya. PARTICIPANTS 84 participants who practise as traditional midwives. FINDINGS It was common for these traditional midwives to believe they had received a spiritual gift which enabled them to learn the skills required from another midwife, often but not always their mother. The participants commenced their midwifery practice by learning through an apprenticeship or mentoring model but they anticipated their learning to be lifelong. Lifelong learning occurred through experiential reflection and reciprocal learning from each other. Learning in colleges, hospitals and through seminars facilitated by non-government organisations was also desired and esteemed by the participants but considered a secondary, though more authoritative source of learning. KEY CONCLUSIONS The primary learning strategies used by the participants enabled them to have confidence in physiological birth; birthing women; and their own skills as traditional midwives. IMPLICATIONS FOR PRACTICE Learning from women and continued professional reflection are ways of learning for midwives that may increase their confidence in women, birthing and their midwifery skills. These attributes are essential for midwives, regardless of their workforce context.

Childbearing traditions of Indian women at home and abroad: An integrative literature review

BACKGROUND The percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia. AIM To explore childbearing practices in India and Indian womens experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia. METHOD An integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian womens childbearing traditions. FINDINGS Five themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs. CONCLUSION Indian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women.

Parents’ Experience of Time Distortion Following Diagnosis of a Serious or Lethal Fetal Anomaly

PURPOSE: To explore the experience of couples who continued pregnancy following a diagnosis of serious or lethal fetal anomaly. STUDY DESIGN: Thirty-one male and female participants were recruited from a high-risk maternal–fetal medicine clinic in Washington State. Data were collected using in-depth interviews during pregnancy and after the birth of their baby. Transcribed interviews were thematically analyzed through the phenomenological lens of Merleau-Ponty. FINDINGS: Participants described how time became reconfigured and reconstituted as they tried to compress a lifetime of love for their future child into a limited period. Participants’ concepts of time became distorted and were related to their perceptual lived experience rather than the schedule-filled,regimented, linear clock time that governed the health professionals. CONCLUSION: Living in distorted time may be a mechanism parents use to cope with overwhelming and disorienting feelings when their unborn baby is diagnosed with a fetal anomaly.

Ankyloglossia (Tongue-Tie)—To Snip or Not to Snip: An Integrative Literature Review

PURPOSE: Ankyloglossia (commonly referred to as tongue-tie), is increasingly being reported as a significant contributory factor to difficulties experienced in establishing the mother–infant breastfeeding relationship. Frenotomy as a management option is contributing to international interest and interdisciplinary controversy. The aim of this article was to identify and examine the evidence in relation to frenotomy to inform practice for newborns diagnosed with symptomatic ankyloglossia. DESIGN: An integrated literature review, informed by Whittemore and Knafl (2005) was used to identify and evaluate contemporary evidence. MAJOR FINDINGS: There is a marked difference in opinion between health disciplines regarding frenotomy as a treatment option for ankyloglossia. There is agreement that support from a trained professional such as a lactation consultant prior to undergoing any invasive procedures to treat ankyloglossia is essential. Controversy persists however as to whether the condition will resolve spontaneously without treatment. CONCLUSION: Although frenotomy does seem to resolve breastfeeding difficulties, little is known regarding long-term consequences for the baby and optimal timing for the procedure. This review indicates a need for education of professionals and standardization of assessment processes along with ongoing research to identify efficacy and optimal timing of frenotomy when used.