Michelle Kealy

What have sampling and data collection got to do with good qualitative research

Objective: To highlight the importance of sampling and data collection processes in qualitative interview studies, and to discuss the contribution of these processes to determining the strength of the evidence generated and thereby to decisions for public health practice and policy.

The essential role of social theory in qualitative public health research

Objective: To define the role of social theory and examine how research studies using qualitative methods can use social theory to generalise their results beyond the setting of the study or to other social groups.

Maternal age, ethnicity and gestational diabetes mellitus

BACKGROUND in Australia, and globally, rates for gestational diabetes mellitus (GDM) have risen dramatically in recent decades. This is of concern as GDM is associated with adverse pregnancy outcomes and additional health-care costs. Factors linked to increasing incidence include older maternal age and non-Caucasian ethnicity. However, as yet, there is no clear consensus on the magnitude of effect associated with these factors in combination. This study therefore investigated the effect of maternal age and country/region of birth on GDM incidence. METHODS all women who gave birth in Victoria, Australia in 2005 and 2006 (n=133,359) were included in this population-based cross-sectional study. Stratified cross-tabulations were conducted to examine the incidence of GDM by maternal age group and country/region of birth. Primiparous women were further analysed separately from parous women. The proportion of women with GDM was reported, along with the χ(2) for linear trend. FINDINGS whilst women born outside Australia constituted just 24.6% of women giving birth during the study period, they accounted for 41.4% of GDM cases. The highest GDM incidence was seen among Asian women at 11.5%, compared with Australian born women at 3.7%. There was strong evidence that women born in all regions except North America were increasingly likely to develop GDM in pregnancies at older ages (p<0.001).On examining age related GDM trends by maternal region of birth, higher rates were seen across all regions studied but were most marked among women born in Asia and the Middle East. CONCLUSIONS older maternal age and non-Australian birth increased a womans risk of developing GDM and this increase was most evident among Asian women. As GDM is associated with adverse maternal and infant outcomes, it is important to explore ways of preventing GDM, and to put in place strategies to effectively manage GDM during pregnancy and to reduce the later risk of developing type 2 diabetes. Pregnancy presents midwives with a unique opportunity to provide education and to encourage dietary and behavioural modifications as women have repeated contact with the health system during this time.

Older Maternal Age and Intervention in Labor: A Population-Based Study Comparing Older and Younger First-Time Mothers in Victoria, Australia

BACKGROUND In Australia, birth rates for women aged 35 years or more are significant and increasing and a considerable percentage are first births. This study investigated the effect of maternal age on interventions in labor and birth for primiparous women aged 35 to 44 years compared with primiparous women aged 25 to 29 years. METHODS All primiparous women who gave birth in Victoria, Australia, in 2005 and 2006 (n = 57,426) were included in this population-based cross-sectional study. Women were stratified by admission status (private/public). Main outcome measures were induction of labor, augmentation of labor, use of epidural analgesia, and method of birth. Multivariate logistic regression was used to explore the relationship between maternal age and cesarean adjusted for confounders. RESULTS Older women were more likely to give birth by cesarean section whether admitted as public or private patients. For private patients, total cesarean rates were 31.8 percent (25-29 yr), 46.0 percent (35-39 yr), and 60.0 percent (40-44 yr; p < 0.001) compared with 27.5, 41.6, and 53.4 percent for public patients (p < 0.001). Older women who experienced labor were more likely to have an instrumental vaginal birth or an emergency cesarean section than younger women. Both were more common in women admitted as private patients. Age-related trends were also seen for induction of labor and use of epidural analgesia. Rates were higher for private patients. Rates of induction were (37.8, 40.2, and 42.5%) for private patients compared with (32.1, 36.7, and 40.1%) for public patients and rates for epidural were (45.3, 49.9, and 48.1%) among private patients compared with (33.3, 38.8, and 39.3%) among public patients. CONCLUSIONS Interventions in labor and birth increased with maternal age, and this effect was seen particularly for cesarean section among women admitted privately. These findings were not fully explained by the complications we considered.

Advanced maternal age and obstetric morbidity for women giving birth in Victoria, Australia: A population‐based study

As the proportions of older women giving birth increase, there is a growing body of evidence on the increased risks of poorer maternal and perinatal outcomes for this group. However, the associations are not completely understood. This study aimed to establish the prevalence of selected maternal morbidities and examine whether advanced maternal age is associated with a higher risk of morbidity for women giving birth in Victoria.

Recovery after caesarean birth: a qualitative study of women's accounts in Victoria, Australia

BackgroundThe caesarean section rate is increasing globally, especially in high income countries. The reasons for this continue to create wide debate. There is good epidemiological evidence on the maternal morbidity associated with caesarean section. Few studies have used womens personal accounts of their experiences of recovery after caesarean. The aim of this paper is to describe womens accounts of recovery after caesarean birth, from shortly after hospital discharge to between five months and seven years after surgery.MethodWomen who had at least one caesarean birth in a tertiary hospital in Victoria, Australia, participated in an interview study. Women were selected to ensure diversity in experiences (type of caesarean, recency), caesarean and vaginal birth, and maternal request caesarean section. Interviews were audiotaped and transcribed verbatim. A theoretical framework was developed (three Zones of clinical practice) and thematic analysis informed the findings.ResultsThirty-two women were interviewed who between them had 68 births; seven women had experienced both caesarean and vaginal births. Three zones of clinical practice were identified in womens descriptions of the reasons for their first caesareans. Twelve women described how, at the time of their first caesarean section, the operation was performed for potentially life-saving reasons (Central Zone), 11 described situations of clinical uncertainty (Grey Zone), and nine stated they actively sought surgical intervention (Peripheral Zone).Thirty of the 32 women described difficulties following the postoperative advice they received prior to hospital discharge and their physical recovery after caesarean was hindered by a range of health issues, including pain and reduced mobility, abdominal wound problems, infection, vaginal bleeding and urinary incontinence. These problems were experienced across the three zones of clinical practice, regardless of the reasons women gave for their caesarean.ConclusionThe women in this study reported a range of unanticipated and unwanted negative physical health outcomes following caesarean birth. This qualitative study adds to the existing epidemiological evidence of significant maternal morbidity after caesarean section and underlines the need for caesarean section to be reserved for circumstances where the benefit is known to outweigh the harms.

Women’s use of complementary medicine to enhance fertility: The views of fertility specialists in Victoria, Australia

The increasing use of complementary medicine (CM) by Australians cannot be ignored: in 2006, 69% used some form of CM, including over-the-counter purchases of nonprescribed medicines and supplements and 44% visited a CM practitioner; CM is commonly used concurrently with conventional medicine without the knowledge of medical practitioners; and is supported financially by private health insurance rebates. Women are the primary users: 75% reported CM use in 2006, and their use during pregnancy, including self-medication is well documented. While there is evidence to support the use of acupuncture in infertility treatment, little remains known about women’s use of CM to enhance fertility. In 2008, with ethical approval from La Trobe University (FHEC08 ⁄ 21), fertility specialists listed with the Victorian Infertility Treatment Authority (n = 55) were sent an invitation to participate in an anonymous survey along with a covering letter, a copy of the survey and a reply paid envelope. The survey sought their opinions on the safety, usefulness and effectiveness of CM for fertility enhancement. Five invitations were returned to sender and nine specialists completed the survey, a response fraction of 18% (9 ⁄ 50). The respondents, four females and five males, were aged between 37 and 69 years and all had undertaken medical education in Australia. All respondents practised in metropolitan Melbourne and had been in clinical practice for 12 to 46 years. Only one respondent reported personal use of CM. Respondents reported that a considerable proportion of women who consult them also use CM (range 25–80%); few routinely asked women about their CM use (two always and four sometimes); and six reported that they