Lyn Ebert

What do midwives need to understand/know about smoking in pregnancy?

AIM This paper seeks to help midwives more fully understand smoking in pregnancy, particularly from a midwifery partnership perspective. METHOD Using the midwifery philosophy of partnership as a framework for reviewing literature on smoking in pregnancy, we explored the literature on nicotine metabolism and addiction in general, and the changes that occur in pregnancy. Quit smoking interventions commonly used were examined to see if knowledge about addiction and the physiological adaptations of pregnancy are incorporated into anti-smoking efforts aimed at pregnant women. RESULTS Quitting is harder for the pregnant woman because the physiological adaptations of pregnancy increase the clearance of nicotine thus lowering nicotine levels and increasing the desire to smoke. Women who continue to smoke generally have fewer external sources of pleasure and satisfaction in their lives, which, when combined with the physiological and emotional challenges of pregnancy, means that they are less likely to quit smoking and remain abstinent. These factors do not appear to be taken into account for pregnant smokers. The concept of partnership between women and midwives during anti-smoking interactions is lacking. CONCLUSION Midwives are in a position to support women and their families in all health related issues, including smoking cessation. We recommend that midwives ask permission before making enquires about sensitive issues such as smoking. When discussing smoking with pregnant women, midwives work within the philosophy of midwifery, with the emphasis on building trust and maintaining relationships. Great sensitivity is required and as much as possible the conversation should be a dialogue, not a monologue.

Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care

BACKGROUND Although midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters. OBJECTIVE The objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged womans ability to actively engage in decision-making processes relevant to her care. RESEARCH DESIGN The qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters. FINDINGS Socially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of womens decisions to accept responsibility for their babys wellbeing by delegating health care decision-making to the health care professional. CONCLUSION This research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the womans participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.

Learning to be a midwife in the clinical environment; tasks, clinical practicum hours or midwifery relationships

Discussions continue within the midwifery profession around the number of and type of clinical experiences required to ensure competent midwifery graduates. Introduction of the three year Bachelor of Midwifery in Australia, almost two decades ago, was intended to reduce the pressure students were under to complete their academic requirements whilst ensuring students developed midwifery practice that encapsulates the philosophical values of midwifery. Currently, midwifery students are mandated to achieve a minimum number of clinical skills and Continuity of Care Experience (CCE) relationships in order to register upon completion of their degree. To achieve these experiences, universities require students to complete a number of clinical practicum hours. Furthermore students are required to demonstrate competent clinical performance of a number of clinical skills. However, there is no evidence to date that a set number of experiences or hours ensures professional competence in the clinical environment. The aim of this paper is to promote discussion regarding the mandated requirements for allocated clinical practicum hours, specified numbers of clinical-based skills and CCE relationships in the context of learning to be a midwife in Australia.

The Continuity of Care Experience in Australian midwifery education-What have we achieved?

PROBLEM/BACKGROUND The Continuity of Care Experience is a mandated workplace based component of midwifery education in Australia. Since its inclusion in midwifery clinical education, the pedagogical approaches used across Australia have varied. AIM The purpose of this integrative review is to determine the outcomes of the Continuity of Care Experience as an educational model. METHODS A search for relevant research literature was undertaken in 2015 using a range of databases and by examining relevant bibliographies. Articles published in English, which provided information about the outcomes of Continuity of Care Experiences for midwifery education were included. A total of 20 studies were selected. FINDINGS The included studies were primarily exploratory and descriptive. Studies reported the value that both students and women place on the relationship they developed. This relationship resulted in opportunities that enhanced student learning by providing a context in which clinical practice learning was optimized. Challenges identified included managing time and workload pressures for students in relation to the CCE, inconsistencies in academic use of the experience, and variations in how the healthcare system influences the continuity experience. CONCLUSION No research was found that reports on the educational model in terms of defining learning objectives and assessment of outcomes. This represents an important omission in mandating this clinical practice model in midwifery curricula without sufficient guidance to unify and maximize learning for students. Research is required to explore the educational intent and assessment methods of the Continuity of Care Experience as an educational model.

Development of a mobile application of Breast Cancer e-Support program for women with breast cancer undergoing chemotherapy

BACKGROUND Women with breast cancer undergoing chemotherapy experience a variety of physical and psychosocial symptoms, which have negative effect on womens quality of life and psychological well-being. Although M-health technologies provides innovative and easily accessible option to provide psychosocial support, mobile phone based interventions remain limited for these women in China. OBJECTIVE To develop a new mobile application to offer information as well as social and emotional support to women with breast cancer undergoing chemotherapy to promote their self-efficacy and social support, thus improving symptom management strategies. METHODS Basing on previous theoretical framework which incorporated Banduras self-efficacy theory and the social exchange theory, a new mobile application, called Breast Cancer e-Support Program (BCS) was designed, with the content and functionality being validated by the expert panel and women with breast cancer. RESULTS BCS App program has four modules: 1) Learning forum; 2) Discussion forum; 3) Ask-the-Expert forum; and 4) Personal Stories forum. BCS program can be applied on both android mobile phones and iPhones to reach more women. CONCLUSIONS This is the first of its kind developed in China for women with breast cancer undergoing chemotherapy. A randomized controlled trial is undertaking to test the effectiveness of BCS program.

Regardless of where they give birth, women living in non-metropolitan areas are less likely to have an epidural than their metropolitan counterparts

QUESTION Can differences in Australian birth intervention rates be explained by womens residence at the time of childbearing?. METHODS Data were collected prospectively via surveys in 1996, 2000, 2003, 2006 and 2009 from women, born between 1973 and 1978, of the Australian Longitudinal Study on Womens Health. Analysis included data from 5886 women who had given birth to their first child between 1994 and 2009. Outcome measures were self-report of birth interventions: pharmacological pain relief (epidural and spinal block analgesia, inhalational analgesia and intramuscular injections), surgical births (an elective or emergency caesarean section) and instrumental births (forceps and ventouse). FINDINGS Primiparous women residing in non-metropolitan areas of Australia experienced fewer birth interventions than women residing in metropolitan areas: 43% versus 56% received epidural analgesia; 8% versus 11% had elective caesarean sections; and 16% versus 18% had emergency caesarean sections. Differences in maternal age and private health insurance status at first birth accounted for differences in surgical birth rates but did not fully explain differences in epidural analgesia. CONCLUSION Non-metropolitan women had fewer birth interventions, particularly epidural analgesia, than metropolitan women. Differences in maternal age and private health insurance do not fully explain the differences in epidural analgesia rates, suggesting care provided to labouring women may differ by area of residence. The difference in epidural analgesia rates may be due to lack of choice in maternity services, however it could also be due to differing expectations leading to differences in birth interventions for primiparous women living in metropolitan and non-metropolitan areas.

Integrative Review on the Effectiveness of Internet-Based Interactive Programs for Women With Breast Cancer Undergoing Treatment

Problem Identification: Internet‐based interactive programs have been developed to address health needs for women with breast cancer undergoing treatment, but evidence has been inadequate to establish the effectiveness of these programs. This article aims to synthesize studies published in English or Chinese regarding the effectiveness of these programs on the outcomes of symptom distress, social support, self‐efficacy, quality of life, and psychological well‐being for women with breast cancer undergoing treatment. Literature Search: CINAHL Complete, MEDLINE®, Mosby’s Nursing Index, PsycINFO®, Scopus, Web of Science, Joanna Briggs Institute, Cochrane Library, Embase, and China National Knowledge Infrastructure. Databases were searched from the start of the database to April 2015. Data Evaluation: 174 articles were retrieved, yielding 23 eligible articles. A manual search led to an additional five eligible articles. After 10 were excluded, 3 qualitative and 15 quantitative studies were evaluated. Data were analyzed to identify similarities and differences across articles. Synthesis: Internet‐based interactive programs moderated by healthcare professionals have demonstrated positive effects on women’s self‐efficacy, symptom distress, and psychological well‐being, but inconclusive effects have been found on social support and quality of life. Conclusions: Moderated Internet‐based interactive programs are a promising intervention for women with breast cancer undergoing treatment. Implications for Research: Studies with more robust research designs and theoretical frameworks and conducted in different countries and cultures are warranted to elucidate the effectiveness of these programs.

An evaluation of perinatal mental health interventions: An integrative literature review

BACKGROUND National statistics related specifically to the mental health of women in the perinatal period is poorly acknowledged in Australia. Maternal deaths related to mental health in the perinatal period can be attributed to a lack of appropriate treatment and/or support. A barrier to womens help-seeking behaviors is the lack of discrete, perinatal specific interventions where women can self-assess and access support. AIM This review examines original research evaluating perinatal mental health interventions used by women to improve mental health. METHOD An integrative literature review was undertaken. A comprehensive search strategy using 5 electronic databases resulted in the retrieval of 1898 articles. Use of an inclusion and exclusion criteria and Critical Appraisal Skills Program tools resulted in 4 original research papers. Thematic analysis identified universal themes. FINDINGS Cognitive Behavioral Therapy, Behavioral Activation and Mindfulness-based interventions, specifically adapted to meet the needs of women in the perinatal period, demonstrate an overall improvement in mental health. Women involved in the interventions experienced both improvements in symptoms of anxiety and depression as well as secondary benefits from participating in the research. CONCLUSION To improve perinatal mental health outcomes, innovative modes of providing effective perinatal mental health interventions that address the unique needs of women in the perinatal period are needed. Future development of perinatal mental health interventions require adaptions of Cognitive Behavioral Therapy, Behavioral Activation and/or Mindfulness-based methods to address mental health outcomes for women in the perinatal period.

A historical account of the governance of midwifery education in Australia and the evolution of the Continuity of Care Experience

BACKGROUND Midwifery programs leading to registration as a midwife in Australia have undergone significant change over the last 20 years. During this time accreditation and governance around midwifery education has been reviewed and refined, moving from state to national jurisdiction. A major change has been the mandated inclusion of Continuity of Care Experiences as a clinical practice-based learning component. AIM The purpose of this discussion is to present the history of the governance and accreditation of Australian midwifery programs. With a particular focus on the evolution of the Continuity of Care Experience as a now mandated clinical practice based experience. METHODS Historical and contemporary documents, research and grey literature, are drawn together to provide a historical account of midwifery programs in Australia. This will form the background to the inclusion of the Continuity of Care Experience and discuss research requirements to enhance the model to ensure it is educationally sound. DISCUSSION The structure and processes for the Continuity of Care Experience vary between universities and there is currently no standard format across Australia. As such, how it is interpreted and conducted varies amongst students, childbearing women, academics and midwives. The Continuity of Care Experience has always been strongly advocated for; however there is scant evidence available in terms of its educational theory underpinnings. CONCLUSION Research concerned with the intended learning objectives and outcomes for the Continuity of Care Experience will support the learning model and ensure it continues into the future as an educationally sound learning experience for midwifery students.