Jan Taylor

The role of anxiety and other factors in predicting postnatal fatigue: from birth to 6 months.

OBJECTIVE to explore the role of anxiety and other factors in predicting postnatal fatigue from birth to 6 months. DESIGN a prospective longitudinal correlational survey design. SETTING Canberra, Australian Capital Territory, Australia. PARTICIPANTS 504 well women, 233 primipara and 271 multipara, aged 20-40 years who gave birth during the study period. MEASUREMENT the Postpartum Fatigue Scale, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the Support Behavior Inventory were used to measure the relationship between the predictive factors and the intensity of fatigue at the various time points. FINDINGS an explanatory model of fatigue development was applied to all participants, and then to primiparas and multiparas, explaining 27-44% of the variance in fatigue from 1 to 24 weeks in the total sample (p>.001). State anxiety was a consistently strong predictor of fatigue intensity across time and group. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE the contribution that state anxiety made to the development of fatigue in this group of low risk women highlights the importance of assessing symptoms of anxiety in all childbearing women. Focusing on depressive symptoms limits the extent to which anxiety symptoms, which occur in parallel with depressive symptoms, are addressed. Anxiety is a normal response to the changes in roles and responsibilities that occur following birth. However the belief that all new mothers worry excessively and that anxiety is not as harmful as depression may have influenced the way midwives and maternal child health nurses view postnatal anxiety. Assessment of anxiety, and use of interventions such as cognitive and behavioural strategies and self-care practices, can be used to assist women to reduce anxiety levels.

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital

BACKGROUND There is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth. AIM The aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital. METHODS A retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fishers exact test. Continuous data were analysed using Students t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05. RESULTS Data for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p=0.002) and spontaneous vaginal birth (38% vs. 22.4% p=<0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p=0.050) and caesarean sections (18.8% vs. 22.5% p=0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes. CONCLUSION Strategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.

Sense of Coherence and Childbearing: A Scoping Review of the Literature

OBJECTIVE: To undertake a scoping review of the literature to understand how a woman’s sense of coherence (SOC) score affects her childbearing. METHOD: Ovid MEDLINE, CINAHL, Cochrane, and Web of Science databases were searched to identify articles published in English from 2000 to 2014 using combinations of specified search terms. Included articles were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Critical Appraisal Skills Programme. FINDINGS: This scoping review identified 15 studies focusing on SOC scores and childbearing. Childbearing women with strong SOC were less likely to smoke and more likely to seek out useful support compared to women with low SOC. Women with strong SOC demonstrated increased emotional health, experiencing less depression, anxiety, stress, and posttraumatic stress disorder. Women with strong SOC were more likely to experience uncomplicated birth and birth at home, identify normal birth as their preferred birth option in pregnancy and identify a desire to avoid epidural anesthesia in labor compared to women with low SOC. CONCLUSION: This scoping review of the literature identified significant associations between strong SOC and positive childbearing, including increased emotional health, improved health behaviors, and increased normal birth choices and outcomes.

Embedding continuity of care experiences: An innovation in midwifery education

Midwife-led continuity of care models demonstrate a number of benefits to women with no adverse effects. These benefits include a reduction in childbirth interventions, an increase in spontaneous vaginal births for women of low and increased risk (Begley et al., 2011; Hartz et al., 2013; Sandall et al., 2015) and a reduction in rates of caesarean sections in women of low risk (McLachlan et al., 2012). This model of care also demonstrates increased satisfaction for women when compared to other models of maternity care (Sandall et al., 2015). Given the significant benefits to women, the inclusion of a requirement for students to experience midwife-led continuity of care models was considered to be fundamental to all midwifery education programs. Prior to the introduction of Bachelor of Midwifery programs in Australia in 2002 there were no requirements for midwifery students to experience midwifery continuity of care. Indeed, there were very few continuity of midwifery care models in Australia (Gray, 2010) and students therefore gained their midwifery knowledge, skills and abilities by working with women in models of care with little exposure to the concept of continuity. Midwifery leaders were aware of the integration of continuity experiences in midwifery education programs in the United Kingdom (Anderson and Lewis, 2000) and in New Zealand (Pairman, 2000) and the opportunities that these provided to

Sense of coherence and childbearing choices: A cross sectional survey

BACKGROUND as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a womans SOC and the childbirth choices she makes in pregnancy. METHODS the study aims to investigate the relationship between SOC and womens pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. FINDINGS 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with womens pregnancy choices. CONCLUSION this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and womens birthing outcomes.

Examining the Validity and Reliability of Antonovsky's Sense of Coherence Scale in a Population of Pregnant Australian Women.

Antonovsky’s Orientation to Life questionnaires were developed to measure sense of coherence (SOC). Although the SOC 13 instrument is widely used to measure health in general populations, it has not been assessed in pregnant women. If the SOC 13 is to be used to assess women’s childbearing health, it requires further examination. The purpose of the research is to assess the psychometric properties of Antonovsky’s SOC 13 questionnaire in pregnant women. When administered to 718 pregnant Australian women, the construct validity of the SOC 13 was difficult to establish. The SOC 9 was created by removing 4 items and provided best data fit. The SOC 13 and SOC 9 were found to have sound criterion validity, internal reliability, and equivalence between versions. It is hoped that the present study will stimulate additional research on SOC scales to examine their ability to assess women’s childbearing health.

A researcher's journey: Exploring a sensitive topic with vulnerable women

BACKGROUND The conduct of research regardless of the subject or methods employed brings responsibilities and challenges. These are greater when dealing with sensitive topics and vulnerable groups and therefore researchers must navigate a range of complex issues and make choices in relation to practical, ethical and philosophical concerns. While literature dealing with research methodologies and research design may assist to some degree, it cannot provide a clear pathway or template as each research project must respond to a unique set of circumstances. We can however, also learn from sharing our stories and critical reflections on our research processes. OBJECTIVE The purpose of this article is to highlight the practical and methodological issues arising from researching a sensitive topic with vulnerable women experiencing an Assumption of Care. DISCUSSION Research involving topics that are deeply personal and private combined with a vulnerable population can be complex and challenging for the researcher. Although some issues were anticipated from the literature, others encountered in this study were unexpected. Special considerations and prerequisites were necessary to build mutual trust and share power with women who had experienced an Assumption of Care at birth. Narrative Inquiry was a good methodological fit for this study as it privileged the voices of women and insisted that their experiences be considered within the context of their lives. CONCLUSION Although Narrative Inquiry is a suitable choice for researching sensitive topics with vulnerable women specific considerations are still required to ensure the benefits of this research for both participants and researchers. Family and Community Service (FACS) have now replaced the formerly known Department of Community Services (DoCS) and in consideration of the timing of this study this article uses the terminology as DoCS.

Sense of coherence and women׳s birthing outcomes: A longitudinal survey.

BACKGROUND in Western countries, caesarean section rates are increasing at an alarming rate. This trend has implications for women׳s health and calls into question the use of pathogenesis to frame maternity services. The theory of salutogenesis offers an alternative as it focuses on health rather than illness. Sense of coherence (SOC), the cornerstone of salutogenesis, is a predictive indicator of health. This study aimed to explore associations between pregnant women׳s SOC, their birthing outcomes and factors associated with SOC changes. METHODS a longitudinal survey was conducted where women completed a questionnaire in the antenatal and postnatal period. Questionnaire one provided information on SOC scores, Edinburgh Postnatal Depression Scale (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. Questionnaire two provided information on SOC scores, EPDS scores and birthing outcomes. FINDINGS 1074 women completed questionnaire one and 753 women completed questionnaire two. Compared to women with low antenatal SOC, women with high antenatal SOC were less likely to experience caesarean section (OR 0.437 95% CI 0.209-0.915) and more likely to experience assisted vaginal birth (AVB) (OR 3.108 95% CI 1.557-6.203). Higher birth satisfaction, higher antenatal EPDS scores and lower antenatal SOC were associated with an increase in SOC. Epidural, AVB and decreased birth satisfaction were associated with a decrease in SOC. CONCLUSION high sense of coherence in pregnant women is associated with half the likelihood of caesarean section compared to women with low sense of coherence. Women׳s sense of coherence is raised and lowered by degree of satisfaction with their births and lowered by some labour interventions.

The Canberra Dedicated Education Unit

This chapter describes the uptake of the Dedicated Education Unit in Canberra, Australia, based on the Flinders University model. The authors provide brief background information about Canberra and the University of Canberra undergraduate nursing curriculum before describing the curriculum redesign required for uptake of the Dedicated Education Unit, key Dedicated Education Unit roles and responsibilities, key assumptions about students in the Dedicated Education Unit context, supports for student learning, engaging clinicians in the learning culture, activities used to promote learning, assessment strategies and different clinical settings for specific Dedicated Education Units. They then shift the focus to evaluation of current Canberra Dedicated Education Units and reflect on the challenges facing Dedicated Education Units, such as the need for ongoing revision of, and engagement with, this clinical education model, and administration. The chapter ends with considerations about the further development of Dedicated Education Units and research possibilities within them.

Women's motivation, perception and experience of complementary and alternative medicine in pregnancy: A meta-synthesis

BACKGROUND complementary and Alternative Medicine use during pregnancy is popular in many countries, including Australia. There is currently little evidence to support this practice, which raises the question of womens motivation for use of these therapies and the experiences they encounter. OBJECTIVE this study aims to explore the perceptions, motivations and experiences of pregnant women with regard to their use of Complementary and Alternative Medicine during pregnancy. METHODS a systemic review and meta-synthesis of the available research was conducted. Five databases were explored - CINAHL Plus, Medline, PubMed, AMED and Web of Science using the search terms complementary and alternative medicine; pregnancy; and pregnant. Articles included in this meta-synthesis were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses tool. FINDINGS ten initial themes were drawn from the six studies. These ten themes were summarised by three cluster themes. The results suggest that women are using Complementary and Alternative Medicine in their pregnancy as a means of supporting their sense of self-determination, to pursue a natural and safe childbirth, and because they experience a close affiliation with the philosophical underpinnings of Complementary and Alternative Medicine as an alternative to the biomedical model. CONCLUSION these findings are important to practitioners, policy makers, governing bodies and researchers, providing insight into the motivations for Complementary and Alternative Medicine use by women in pregnancy.