Jan Pincombe

The role of the midwife in Australia: views of women and midwives

OBJECTIVE to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. DESIGN a multi-method approach with qualitative data collected from surveys with women and interviews with midwives. SETTING participants represented each state and territory in Australia. PARTICIPANTS midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. KEY CONCLUSIONS midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. IMPLICATIONS FOR PRACTICE a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role.

Understanding the emerging relationship between complementary medicine and mainstream health care: A review of the literature

The history of the relationship between complementary medicine (CM) and mainstream health care has shifted from the early days of pluralism, through hostility and exclusion, to one of grudging acceptance. The current situation is one of a tacit acknowledgement and in some cases open endorsement by biomedicine for a number of forms of CM practice, largely driven by the popularity of CM to consumers in our increasingly market driven health care system. How this relationship is ultimately worked out will impact both on the practice of CM and biomedicine, and on the health care choices available to consumers. In this article we review the research and commentary literature on the current and emerging relationship between biomedicine and CM. In particular we explore the ways in which mainstream inclusion of CM is discussed in the literature, and the biomedical and CM perspectives of mainstream CM inclusion. Finally we discuss the implications of the emerging relationship for CM, and CM practitioners and consumers.

An evaluation of Midwifery Group Practice: Part II: Women’s satisfaction

BACKGROUND Midwifery Group Practice (MGP) is a continuity of midwifery care model for women of all levels of pregnancy risk available at a tertiary metropolitan hospital in Australia. This paper presents Part II of the demonstration study exploring the effectiveness of MGP, and reports on womens satisfaction with the model of care. METHODS A Maternal Satisfaction Questionnaire was developed and sent to all women (n=120) enrolled in MGP over a three-month period. The questionnaire comprised two open-ended questions asking women to list up to three things they liked and did not like about MGP, and a structured section exploring levels of satisfaction through a five-point Likert response format. The open-ended questions were analysed using qualitative content analysis, and analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from -2 (very negative attitudes) to +2 (very positive attitudes). RESULTS Of the 120 women who were sent a Maternal Satisfaction Questionnaire, 84 returned their questionnaire (70% response rate). Three overarching themes were identified in the content analysis of open-ended questions, namely: Continuity of care; Accessibility; and Personal and professional attributes of the midwife. Analysis of the structured part of the questionnaire showed that women were satisfied with the care they received in MGP, as indicated by positive scores on all questions. CONCLUSIONS Women being cared for in MGP are satisfied with their care.

Sleep, stress and compensatory behaviors in Australian nurses and midwives

OBJECTIVE To describe sleep, stress and compensatory behaviors in nurses and midwives. METHODS The study included 41 midwives and 21 nurses working in Australian hospitals between 2005 and 2009. Participation was voluntary. All participants recorded on a daily basis their work and sleep hours, levels of stress and exhaustion, caffeine intake and use of sleep aids for a month (1,736 days, 1,002 work shifts). RESULTS Participants reported moderate to high levels of stress and exhaustion on 20-40% of work days; experienced sleep disruption on more than 50% of work days; struggled to remain awake on 27% of work days; and suffered extreme drowsiness or experienced a near accident while travelling home on 9% of workdays. Age, perceived sleep duration and work hours were significant predictors of caffeine intake. About 60% of participants reported using sleep aids (about 20% reported taking prescription medications and 44% of nurses and 9% of midwives reported alcohol use as a sleep aid at least once during the study). Stress and workdays were significant predictors of sedative use. Overall, 22% reported being indifferent or mildly dissatisfied with their job. CONCLUSIONS Sleep problems, high levels of stress and exhaustion and low job satisfaction are prevalent among nurses and midwives. The use of alcohol and sleeping pills as sleep aids, and the use of caffeine to help maintain alertness is also common. Nurses and midwives may use caffeine to compensate for reduced sleep, especially on workdays, and sleeping pills to cope with their daily work-related stress.OBJETIVO: Descrever sono, estresse e comportamentos compensatorios em enfermeiras e parteiras. METODOS: O estudo incluiu 41 enfermeiras 21 parteiras em hospitais australianos de 2005 a 2009. A participacao foi voluntaria. Os participantes registraram diariamente as horas de trabalho, sono, stress e niveis de exaustao, cafeina e uso de ajuda para dormir durante um mes (1.736 dias, 1.002 turnos). RESULTADOS: Os participantes relataram de moderados a elevados niveis de stress e de exaustao em 20%-40% dos dias de trabalho; experimentaram disturbios do sono em mais de 50% dos dias de trabalho; relataram esforco para permanecer acordado em 27% dos dias de trabalho; e sofreram sonolencia extrema ou acidente perto de casa em 9% dos dias de trabalho. Idade, duracao do sono percebida e jornadas foram preditores significativos da ingestao de cafeina. Aproximadamente 60% dos participantes relataram utilizar a ajuda para dormir: cerca de 20% relataram uso de medicacao prescrita e 44% das enfermeiras e 9% das parteiras consumiam alcool como auxilio para dormir pelo menos uma vez durante o estudo. Estresse e dias de trabalho foram preditores significativos do uso de sedativos. Em geral, 22% relataram ser indiferente, ou ligeiramente insatisfeito com seu trabalho. CONCLUSOES: Problemas no sono, estresse e exaustao elevados e diminuicao na satisfacao no trabalho sao prevalentes. Sao comuns o uso de alcool e de medicamentos para dormir, e consumo de cafeina para se manter alerta. Enfermeiras e parteiras parecem usar a cafeina para compensar a reducao do sono, especialmente em dias de trabalho, e usar soniferos para compensar o estresse diario.

Enhancing Fathers' Educational Experiences During the Early Postnatal Period

Since the 1970s, men have been encouraged to actively participate in the childbirth process, resulting in a shared experience for couples. Nevertheless, after the baby is born, many fathers find themselves displaced, unsure of how to embrace the transition to parenthood. The shift in cultural practice and evolving needs of families calls for the recognition of fathers as well as mothers in the provision of midwifery services. Innovative strategies must be considered to enhance postnatal education that is father-inclusive and responsive to the needs of families in the 21st century. This article introduces one strategy created from an action research study conducted to develop, implement, and evaluate strategies to improve postnatal education for parents.

An Examination of Maternity Staff Attitudes Towards Implementing Baby Friendly Health Initiative (BFHI) Accreditation in Australia

Background The Baby Friendly Hospital Initiative (BFHI) influences health care practices and increases the initiation and duration of exclusive breastfeeding. Consistent definitions enable the accurate monitoring of breastfeeding rates and behaviour. This information refines policy and helps reach national breastfeeding targets. Only 21% (66/317) of Australian hospitals are BFHI accredited. Objective To examine the factors perceived to promote or hinder BFHI accreditation. Method Focus group interviews explored opinions of 31 participants, in differing roles and levels of employment, across midwifery, medical, nursing and ancillary staff at six South Australian maternity hospitals. Results The results suggest that staffs’ understanding and personal views are often discordant with BFHI aims. Perceived difficulties include the accreditation process, hospital dynamics, and the Ten Steps implementation plus a bottle feeding culture and maternal employment that impact upon continued breastfeeding. Conclusions Upper management support, specific funding, a dedicated co-ordinator with “area leaders”, development of a specific breastfeeding policy incorporating various disciplines and staff, containing detailed protocols that comply with the International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly (WHA) resolutions, are all required. Staff and mothers require multiple modes of education to understand the BFHI, including sponsorship for training of lactation consultants. Full implementation of BFHI across Australia will assist the development of nationally accepted breastfeeding definitions, improve monitoring and evaluation of rates and practices, and improve breastfeeding outcomes.

Antenatal breast expression: A critical review of the literature

OBJECTIVE to critically review literature related to the practice of antenatal breast expression (ABE) and the reasons for this practice. METHOD a critical review of available literature was undertaken by accessing Internet and library resources. Articles were to be documented in English. No restrictions were placed on dates due to the important historical background of this topic. Keywords used to refine the search included antenatal breast expression, colostrum, antenatal breast-feeding education and midwives and International Board Certified Lactation Consultants (IBCLC). FINDINGS the literature search discovered ABE has been performed historically to prepare breasts for breast-feeding postnatally. It is presently being taught to store colostrum to prevent neonatal hypoglycaemia or hasten production of Lactogenesis 2. Studies relating to nipple stimulation were also critically appraised due to concerns of premature labour. CONCLUSIONS the safety and efficacy of ABE has yet to be demonstrated. The three studies related to the benefits teaching of this skill were small in size with methodological flaws. Trials related to nipple stimulation were also found to have substantial limitations. The reasons for and physicality of performing ABE vs. nipple stimulation differed markedly. While recent teaching of ABE has been encouraged through available commentaries, case studies and policies (in view of the documented positive effects of early colostrum administration), the benefits of this practice are yet to be substantiated. IMPLICATIONS FOR PRACTICE large, credible RCTs are needed to confirm efficacy and safety of this technique. A survey exploring the prevalence of ABE practices is also indicated and to explore the information currently provided by midwives to women in their care.

The development of National ACMI standards for the accreditation of three-year Bachelor of Midwifery programs

Prior to 2002 Australians who wished to become midwives were expected to complete and undergraduate nursing degree and then apply for admission to a university-based post-nursing program in midwifery, usually requiring an additional year of study. Graduates were, therefore, qualified to practice in either profession. Many organisations, coalitions and individuals have contributed to the arduous struggle to ensure that midwives are educated in ways that allow them to confidently and competently fulfill their role as the World Health Organisation defines it. Indeed, in some states, universities and Nurses Boards recognising the need for multiple routes of entry to practice have introduced three-year undergraduate midwifery degrees. So far this has taken place in South Australia and Victoria but other states intend to follow this initiative. In this paper the background to the development of the ACMI National Bachelor of Midwifery Taskforce and the midwifery Program Standards will be discussed. A brief description of the Program Standards is presented to show how they can be used to ensure that 21st century midwives are capable of competently and confidently responding to the changing needs of maternity service providers and consumers. Finally, the authors argue that it is crucial that employers and clinicians have access to a standardised, objective means to evaluate midwifery programs, and believe that the Standards provide the means to do this.

Carers of the terminally ill: An Australian study

This paper reports on the results of an Australian community-based palliative care research project which investigated and compared the effectiveness of existing support systems for paid (community nurses) and unpaid (primary carers) care givers in a regional health care center in New South Wales, Australia. In particular it looked at the needs, concerns, effects, and perceived adequacy of support system on carers. Methodology employed in the study relied on both qualitative and quantitative methods. Qualitative data was obtained by using a questionnaire which obtained demographic data about the carers. In addition, a series of taped open-ended questions were posed to the carers on the impact and experience of caring for the terminally ill. Taped interviews were analyzed using content analysis and elicitation of themes. Qualitative techniques utilized the Inventory of Socially Supportive Behaviors (ISSB). Examination of data collected using simple frequencies and percentages allowed cross examination of paid care givers and the questionnaire was used to assess perceived support of both sets of participants. A Wilcoxan Signed Rank non-

Actigraph Estimates of the Sleep of Australian Midwives: The Impact of Shift Work

Midwives often work night and rotating shift schedules, which can lead to sleep disturbances, increased fatigue, and greater likelihood of accidents or errors. This study investigated the sleep of midwives (n = 17) in an Australian metropolitan hospital. Midwives completed work and sleep logbooks and wore wrist actigraphs for 28 days. Midwives worked combinations of morning, afternoon, and/or night shifts on constant (n = 6) or rotating schedules (n = 11). They obtained less than recommended amounts of sleep, getting only 6–7 hr per 24-hr period. Morning shifts were associated with the lowest sleep durations, lowest subjective sleep quality, and highest postsleep fatigue ratings. Despite the significantly higher amount of wake after sleep onset (51 min), the sleep before afternoon shifts had significantly lower postsleep fatigue ratings and was rated as significantly higher quality than sleep before other shifts or days off. Those who were married or living with a partner reported significantly more sleep and lower postsleep fatigue than those who were separated or divorced (p < .05). Seventy-one percent of midwives took naps, primarily before night shifts, with nearly 40% of nightshifts preceded by a nap. Average nap durations were nearly 1.5 hr. Midwives reported feeling moderately to very physically or mentally exhausted on 22–50% of all shifts and days off. Exhaustion was most common on night shift. This study suggests that midwives may be suffering from chronic sleep loss and as a consequence may be at risk of impairments in functioning that accompany fatigue.