Janice Butt

Western Australian women's perceptions of the style and quality of midwifery postnatal care in hospital and at home

AIM AND BACKGROUND An important part of maternity service provision is the care provided by midwives in the immediate postpartum period. Evidence suggests that postpartum morbidity and its impact on womens health after childbirth is an area of genuine concern. In Western Australia there is limited information on womens postpartum health needs and/or the quality of midwifery care provided in hospital and at home. This paper describes Western Australian (WA) womens perceptions of midwifery care in the early postpartum period. METHOD A cross-sectional, self report survey was used to describe the practical, emotional and informational support provided by midwives in the initial postpartum period. A questionnaire, specially designed for this population, was posted at 8 weeks postpartum to every woman with a registered live birth in WA between February and June 2006. Completed questionnaires were received from 2699 women. Data were analysed using descriptive statistics, t-tests and chi-squared. RESULTS Results indicate that overall, women were happy with most aspects of midwifery care related to practical advice and assistance in relation to baby care and their immediate physical recovery. Areas that received a less positive rating were related to providing consistent advice, availability of the midwife, emotional care and information on maternal health needs, immunisation and contraception. In general, first time mothers rated both the style and quality of care more negatively than multiparous women. There was a trend by women accessing private hospital care to rank their care less favourably. There were minimal differences noted between women in metropolitan and non-metropolitan areas. Midwifery care at home was rated very positively and significantly better than hospital care (p</=0.002). CONCLUSION Although the majority of women in this study were satisfied with the components of physical care and information and assistance with infant feeding and sleep and settling provided in the short-term, there was less satisfaction with emotional care and preparation for life at home with a new baby. This study adds to our understandings of womens experiences of the early postnatal period and provides information on which to base improvements in postnatal care and maternity services in WA and across Australia.

The association between women's perceptions of professional support and problems experienced on breastfeeding cessation : a Western Australian study

A cross-sectional survey was used to determine the association among women’s breastfeeding problems, their perceptions of support from midwives and child health nurses, and breastfeeding cessation in the first 10 weeks postbirth in a sample of Western Australian women (N = 2669). Primiparous women (75.8%) experienced significantly more problems that multiparous women (52.6%). Although 78.8% of all women agreed or strongly agreed that staff were helpful with feeding, 53.4% confirmed that different midwives offered different feeding advice; however, receiving different advice from midwives around feeding was not associated with breastfeeding cessation. Differences in breastfeeding cessation were associated with parity. Primiparous women’s cessation was associated with experiencing any breastfeeding problems, unhelpful hospital midwives, and unhelpful information from child health nurses, whereas for multiparous women, this included 2 or more breastfeeding problems, not being able to choose when to feed, and unhelpful information from child health nurses. J Hum Lact. 27(1):49-57.

The caregiving experience: How much do health professionals understand?

Legal, social and economic factors have changed the delivery of care to people who have a mental disorder. Many of these people are now treated in the community and they live with or in close proximity to their family. The aim of this paper is to provide health professionals with an insight into the experience of being a caregiver to a person with a person with a mental disorder. For these families caregiving becomes an integral part of everyday life. Positive outcomes for both the caregiver and the ill family member are more likely to occur when effective levels of collaboration exist between health professionals and caregivers. Collaboration is enhanced when caregivers and health professionals value each others contribution to the ill family members care. Often the burden, stress, and socio-economic effects on the family caring for a person with mental illness is not sufficiently appreciated and further increases this burden. A review of the literature from the caregivers perception is presented. An increased understanding of the caregiving experience will enable health professionals to develop and implement strategies that facilitate positive outcomes for the caregiver and the ill family member.

Association between mode of birth and self-reported maternal physical and psychological health problems at 10 weeks postpartum

AIM: To determine the association between mode of birth and physical and psychological health problems reported at 10 weeks postpartum. METHODS: A cross-sectional, self-report survey was completed by 2,699 Western Australian women at 10 weeks postpartum. Information on birth mode and physical and psychological health was sought. Descriptive statistics and frequency distributions were performed to describe the sample. Logistic regression was used to determine the association between mode of birth and the reported number of physical health problems (two or more and three or more) and two psychological health problems. RESULTS: The occurrence of physical health problems for all women were incontinence (11.5%), no bowel control (2.6%), backache (41%), heavy bleeding (14.1%), and excessive fatigue or tiredness (35.7%). A significant association was found between all cesarean sections (elective and emergency) and the number of physical health problems compared to spontaneous vaginal births. Women who had an emergency cesarean were most likely (OR = 3.15, CI = 2.40–4.13, p < 0.0005) to report two or more physical problems, whereas women who had an elective cesarean were more likely (OR = 2.75, CI = 2.08–3.63, p < 0.0005) to report three or more physical problems. Nearly 15% of women reported being unhappy for more than a few days. This was highest in women having an emergency cesarean (16.4%) and lowest in women giving birth spontaneously (13.5%). Some 6.4% of women stated they were constantly reliving negative thoughts of birth and/or labor. Women who had an emergency cesarean were more likely (OR = 3.10, CI = 1.96–4.89, p < 0.0005) to choose this item and they were also more likely (OR = 2.04, CI = 1.01–4.13, p < 0.047) to experience both psychological health items. CONCLUSION: Women’s reports of health problems within the first 10 weeks postpartum are concerning and warrant ongoing attention. The prevalence of health problems was higher in women who had experienced a cesarean. This information on morbidity postbirth is essential for women and their care providers in making informed decisions around available birth options.

Providing Information and Support to Postnatal Women Who Have Experienced a Cesarean Section: A Pilot Study

BACKGROUND: Australia has a low uptake of vaginal birth after cesarean despite the evidence that this is best practice. A new midwifery-led service was introduced with the overall goal to improve the quality of care offered to women and their families that have experienced a cesarean section. The postnatal arm of the service targeted women who had experienced their first cesarean section. The service included an early hospital postnatal visit from the next birth after cesarean (NBAC) midwives whereby women were given an opportunity to share their experiences. Women were subsequently given an evidence-based resource on birth after cesarean as well as the midwives’ contact details should they wish to contact them anytime during the first 6 weeks after birth. AIM: To evaluate the effectiveness the postnatal arm of the service on women’s birth mode intentions in a subsequent pregnancy and their levels of childbirth fear and self-efficacy at 12 weeks postpartum. METHOD: Comparative descriptive design (pre-/posttest). Fifty-three women receiving standard care (comparison group) and 50 women receiving the NBAC postnatal service completed a childbirth fear measure (Wijma Delivery Expectancy/Experience Questionnaire Version B), a self-efficacy scale (New General Self-Efficacy Scale [NGSE]), and were asked their preferred birth mode for a subsequent pregnancy. Data was collected at 3–5 days and 12 weeks postpartum. Descriptive statistics and chi-square analysis were used to test several formulated hypotheses. RESULTS: Although women who received a visit from the NBAC midwives were more likely to state they intended to birth vaginally in a next pregnancy, compared to women receiving standard care, the finding was not significant (p = .272). Likewise, there was no difference in childbirth fear with both groups of women having high levels of childbirth fear (comparison [86.27] and NBAC group [84.67]). Comparison of self-efficacy items between groups at 12 weeks were not significant aside from NBAC women feeling more confident with their ability to complete tasks well (p = .005). CONCLUSION: Although the findings of this small study were not statistically significant, the simple and timely nature of the intervention seems worthy of further consideration and investigation. In addition, research needs to continue to focus on how midwives can better meet women’s emotional needs in the postpartum period helping to ameliorate women’s fear and build confidence for their next pregnancy and birth experience.