Julie Hennegan

Holding the baby: Early mother–infant contact after childbirth and outcomes

AIMnto describe the timing, type and duration of initial infant contact and associated demographic and clinical factors in addition to investigating the impact of early contact on breastfeeding and maternal health and well being after birth.nnnMETHODndata from a recent population survey of women birthing in Queensland, Australia were used to describe the nature of the first hold and associated demographic characteristics. Initial comparisons, with subsequent adjustment for type of birthing facility and mode of childbirth, were used to assess associations between timing, type and duration of initial contact and outcomes. Further analyses were conducted to investigate a dose-response relationship between duration of first contact and outcomes.nnnFINDINGSnwomen who had an unassisted vaginal birth held their infant sooner, and for longer than women who had an assisted vaginal birth or caesarean and were more satisfied with their early contact. Multivariate models showed a number of demographic and clinical interventions contributing to timing, duration and type of first contact with type of birthing facility (public/private), area of residence, and assisted birth as prominent factors. For women who had a vaginal birth; early, skin-to-skin, and longer duration of initial contact were associated with high rates of breastfeeding initiation and breastfeeding at discharge, but not breastfeeding at 13 weeks. Some aspects of early contact were associated with improved maternal well being. However, these associations were not found for women who had a caesarean birth. With longer durations of first contact, a dose-response effect was found for breastfeeding.nnnCONCLUSIONnresults of the study provide a description of current practice in Queensland, Australia and factors impacting on early contact. For vaginal births, findings add to the evidence in support of early skin-to-skin contact for an extended period. It is suggested that all research in this area should consider the effects of early contact separately for women having vaginal and caesarean births.nnnIMPLICATIONS FOR PRACTICEncare providers should consider extending the period of early contact in routine care following vaginal birth and explore the way in which women having a caesarean birth might be better supported in benefitting from early contact with their infant.

Great expectations. Eating expectancies as mediators of reinforcement sensitivity and eating

Eating expectancies are proposed as cognitive pathways linking reinforcement (reward and punishment) sensitivities and the tendency to over-eat in response to appetitive and emotional cues. In Study One (N=243 university women) explicit eating expectancies were tested as potential mediators of reinforcement sensitivities and eating styles. Broadly, expectancies that eating alleviates negative affect/boredom mediated both reward and punishment sensitivity and emotional eating. The expectancy that eating is pleasurable and rewarding mediated reward sensitivity and external eating. In Study Two (N=109), using an implicit eating expectancy task, reward sensitivity and external eating was mediated via positive expectancy statements, notably, that eating is pleasurable and rewarding. Reward sensitivity and emotional eating was mediated specifically by expectancies that eating manages boredom. Punishment sensitivity was not associated with any implicit expectancies. Findings support the role of expectancies as cognitive mediators in the relationship between reinforcement sensitivities and emotionally-driven versus externally-driven eating styles. However, the largely appetitive implicit expectancies task only supported an association with reward sensitivity.

Young women′s recent experience of labour and birth care in Queensland

BACKGROUNDnyoung parenthood continues to be an issue of concern in terms of clinical and psychosocial outcomes for mothers and their babies, with higher rates of medical complications such as preterm labour and hypertensive disease and a higher risk of depression. The aim of this study was to investigate how young age impacts on womens experience of intrapartum care.nnnMETHODSnsecondary analysis of data collected in a population based survey of women who had recently given birth in Queensland, comparing clinical and interpersonal aspects of the intrapartum maternity care experience for 237 eligible women aged 15-20 years and 6534 aged more than 20 years. Descriptive and multivariate analyses were undertaken.nnnRESULTSnin the univariate analysis a number of variables were significantly associated with clinical aspects of labour and birth and perceptions of care: young women were more likely to birth in a public facility, to travel for birth and to live in less economically advantaged areas, to have a normal vaginal birth and to have one carer through labour. They were also less likely to report being treated with respect and kindness and talked to in a way they could understand. In logistic regression models, after adjustment for parity, other socio-demographic factors and mode of birth, younger mothers were still more likely to birth in a public facility, to travel for birth, to be more critical about interpersonal and aspects of care and the hospital or birth centre environment.nnnCONCLUSIONnthis study shows how experience of care during labour and birth is different for young women. Young women reported poorer quality interpersonal care which may well reflect an inferior care experience and stereotyping by health professionals, indicating a need for more effective staff engagement with young women at this time.

Another country, another language and a new baby: A quantitative study of the postnatal experiences of migrant women in Australia.

BACKGROUNDnGovernments and service providers have consistently acknowledged the importance of support for women and families in the transition to parenthood. Lower levels of satisfaction and concern about postnatal depression have highlighted womens needs at this time. Migrant women may also face relocation, distant family and support networks, language barriers and potentially discriminatory or culturally insensitive care.nnnOBJECTIVEnThe present study evaluates the unique contribution of migrant status, comparing the experience of this group to that of native-born English-speaking women.nnnMETHODnSecondary analysis of data from a population-based survey of maternity care in Queensland. Experiences of 233 women born outside Australia who spoke another language at home were compared to 2722 Australian-born English-speaking women with adjustment for demographic differences.nnnRESULTSnAfter adjustment, differences between the groups included physical, psychological aspects and perceptions of care. Women born outside Australia were less likely to report pain after birth was manageable, or rate overall postnatal physical health positively. They more frequently reported having painful stitches, distressing flashbacks and feeling depressed in the postnatal period. Few differences in ratings of care providers were found, however, women born outside Australia were less likely to feel involved in decisions and to understand their options for care. However, they were more likely to report being visited by a care provider at home after birth.nnnCONCLUSIONSnThe findings represent an important addition to existing qualitative reports of the experiences of migrant women, reflecting poorer postnatal health, issues associated with migration and parenthood and highlighting areas for care improvement.

Remote access and care: A comparison of Queensland women's maternity care experience according to area of residence

BACKGROUNDnThis study fills a gap in the literature with a quantitative comparison of the maternity care experiences of women in different geographic locations in Queensland, Australia.nnnMETHODnData from a large-scale survey were used to compare womens care experiences according to Australian Standard Geographical Classification (major city, inner regional, outer regional, remote and very remote).nnnRESULTSnCompared to the other groups, women from remote or very remote areas were more likely to be younger, live in an area with poorer economic resources, identify as Aboriginal and/or Torres Strait Islander and give birth in a public facility. They were more likely to travel to another city, town or community for birth. In adjusted analyses women from remote areas were less likely to have interventions such as electronic fetal monitoring, but were more likely to give birth in an upright position and be able to move around during labour. Women from remote areas did not differ significantly from women from major cities in their satisfaction with interpersonal care. Antenatal and postpartum care was lacking for rural women. In adjusted analyses they were much less likely to have booked for maternity care by 18 weeks gestation, to be telephoned or visited by a care provider in the first 10 days after birth. Despite these differences, women from remote areas were more likely to be breastfeeding at 13 weeks and confident in caring for their baby at home.nnnCONCLUSIONSnFindings support qualitative assertions that remote and rural women are disadvantaged in their access to antenatal and postnatal care by the need to travel for birth, however, other factors such as age were more likely to be significant barriers to high quality interpersonal care. Improvements to maternity services are needed in order to address inequalities in maternity care particularly in the postnatal period.

Young Women's Experiences as Consumers of Maternity Care in Queensland

BACKGROUNDnYoung motherhood is commonly associated with vulnerabilities, stereotyping of young womens behavior, and poor outcomes for them and their children. The objective was to understand how maternity care is experienced by this group in the transition to parenthood.nnnMETHODSnData from a large-scale 2010 survey of womens experience of maternity care were analyzed using qualitative methods with open text responses.nnnRESULTSnOverall, 7,193 women responded to the survey: 237 were aged 20 years or less. Most (83%) of these young women provided open text responses. The main themes were: being a consumer, the quality of care, needing support, and pride in parenthood whereas subthemes included being young and how staff made me feel, testimonials for staff, not being left, and it is all worthwhile.nnnCONCLUSIONnMany young women responding described a positive experience. For many first-time mothers this feeling marked a change in their identity. Nevertheless, staff perceptions and attitudes affected how they saw themselves and what they took away from their experience of maternity care. A key message for other women is offered, supporting and reinforcing their role as active and involved consumers who, in engaging with services, have to stand up for themselves and make their needs and wishes known.

Exposure to food cues moderates the indirect effect of reward sensitivity and external eating via implicit eating expectancies

Previous research has suggested that the expectancy eating is rewarding is one pathway driving the relationship between trait reward sensitivity and externally-driven eating. The aim of the current study was to extend previous research by examining the conditions under which the indirect effect of reward sensitivity and external eating via this eating expectancy occurs. Using a conditional indirect effects approach we tested the moderating effect of exposure to food cues (e.g., images) relative to non-food cues on the association between reward sensitivity and external eating, via eating expectancies. Participants (Nxa0=xa0119, Mxa0=xa018.67 years of age, SDxa0=xa02.40) were university women who completed a computerised food expectancies task (E-TASK) in which they were randomly assigned to either an appetitive food cue condition or non-food cue condition and then responded to a series of eating expectancy statements or self-description personality statements. Participants also completed self-report trait measures of reward sensitivity in addition to measures of eating expectancies (i.e., endorsement of the belief that eating is a rewarding experience). Results revealed higher reward sensitivity was associated with faster reaction times to the eating expectancies statement. This was moderated by cue-condition such that the association between reward sensitivity and faster reaction time was only found in the food cue condition. Faster endorsement of this belief (i.e., reaction time) was also associated with greater external eating. These results provide additional support for the proposal that individuals high in reward sensitivity form implicit associations with positive beliefs about eating when exposed to food cues.