Sara Bayes

Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women.

AIM To investigate pre- and postpartum levels of childbirth fear in a cohort of childbearing women and explore the relationship to birth outcomes. BACKGROUND While results are mixed, there is evidence that fear of childbirth is associated with mode of birth. Limited theoretical work around childbirth fear has been undertaken with Australian women. DESIGN A prospective correlation design. Method. Women (n = 401) completed the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A at 36 weeks gestation, with 243 (61%) women also completing version B at six weeks postpartum. Scores were summarised with means and standard deviations. Content analysis of the free statements identified nine issues of concern. RESULTS Twenty-six per cent of pregnant women reported low levels of childbirth fear, 48% were moderately fearful and 26% were highly fearful. Fear decreased after birth for those women in the high antenatal fear group, however surgical intervention at birth (n = 238, anova, F(1,230) = 12.39, p = 0.001) and suspected fetal compromise (F(1,230) = 4.33, p = 0.039) increased levels of postpartum fear. Univariately, high antenatal fear was associated with emergency caesarean delivery (n = 324, Wald 5.05, p = 0.025) however after adjustment for nulliparity and fetal compromise the association disappeared. Australian-born women were more likely to report higher levels of fear and experience higher rates of caesarean section than participants of non-Australian origin. CONCLUSIONS Results support those from earlier studies in showing that nulliparous women experience more fear than parous women before birth and that there is no difference in levels of postpartum fear between these two groups. Fear levels were higher in Australian women when compared to a Swedish sample. RELEVANCE TO CLINICAL PRACTICE The results of this study add to our preliminary understanding of the phenomena of childbirth fear within an Australian context and are particularly useful in profiling women for whom secondary fear of childbirth is more likely to occur.

A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be

AIM To explore and describe mens experiences of pregnancy and childbirth expectations. BACKGROUND There remains limited work exploring expectant fathers perspectives. DESIGN Qualitative descriptive design. Twelve Australian expectant fathers participated in between 1 and 2 interviews during pregnancy and 1 after childbirth (32 in total). Six fathers also chose to submit a number of diary entries via e-mail. Thematic analysis was used to analyse the data set. FINDINGS Five themes emerged from the data. The themes pregnancy news: heralds profound change adjusting to pregnancy, and birth looming described how men processed the news of pregnancy, worked to accept their changed circumstances and negotiated the final week of the pregnancy. A fourth theme, labelled Feeling sidelined, outlined mens experiences of antenatal care and their feeling of isolation as a result of largely feeling ignored by health care professionals. The fifth theme represents mens childbirth expectations. CONCLUSION Adjusting to the news of a pregnancy was a potentially unsettling time for an expectant father that was often associated with increased apprehension and anxiety. Regardless of whether they were a first or once again father most men engaged in a level of emotional work to come to terms with and accept the pregnancy. Understanding mens antenatal experiences and anxieties is an important step in the development of preventative paternal perinatal mental health measures. The significance of this work is situated within the reality that mens wellbeing is associated with maternal psychological well-being, positive peri-natal experiences and child development.

Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention

BackgroundThe top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context.Methods/designA case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6–22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined.DiscussionThe health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.

Participant experiences of mindfulness-based childbirth education: a qualitative study

BackgroundChildbirth is an important transitional life event, but one in which many women are dissatisfied stemming in part from a sense that labour is something that happens to them rather than with them. Promoting maternal satisfaction with childbirth means equipping women with communication and decision making skills that will enhance their ability to feel involved in their labour. Additionally, traditional antenatal education does not necessarily prepare expectant mothers and their birth support partner adequately for birth. Mindfulness-based interventions appear to hold promise in addressing these issues. Mindfulness-based Child Birth Education (MBCE) was a pilot intervention combining skills-based antenatal education and Mindfulness Based Stress Reduction. Participant experiences of MBCE, both of expectant mothers and their birth support partners are the focus of this article.MethodsA generic qualitative approach was utilised for this study. Pregnant women between 18 and 28 weeks gestation, over 18 years of age, nulliparous with singleton pregnancies and not taking medication for a diagnosed mental illness or taking illicit drugs were eligible to undertake the MBCE program which was run in a metropolitan city in Australia. Focus groups with 12 mothers and seven birth support partners were undertaken approximately four months after the completion of MBCE. Audio recordings of the groups were transcribed verbatim and analysed thematically using the method of constant comparison by all four authors independently and consensus on analysis and interpretation arrived at through team meetings.ResultsA sense of both ‘empowerment’ and ‘community’ were the essences of the experiences of MBCE both for mothers and their birth support partner and permeated the themes of ‘awakening my existing potential’ and ‘being in a community of like-minded parents’. Participants suggested that mindfulness techniques learned during MBCE facilitated their sense of control during birth, and the content and pedagogical approach of MBCE enabled them to be involved in decision making during the birth. The pedagogical approach also fostered a sense of community among participants which extended into the postnatal period.ConclusionsMBCE has the potential to empower women to become active participants in the birthing process, thus addressing common concerns regarding lack of control and satisfaction with labour and facilitate peer support into the postnatal period. Further education of health professionals may be needed to ensure that they respond positively to those women and birth support partners who remain active in decision making during birth.

Women's Perceptions of Contributory Factors for Successful Vaginal Birth After Cesarean

BACKGROUND: In July 2008, a new midwife-led “Next Birth After Cesarean” (NBAC) service was launched at King Edward Memorial Hospital (KEMH) in Perth, Western Australia. Midwives from the NBAC service provide antenatal care, evidence-based information about birth choices, tailored birth preparation classes, and assistance with developing birth plans to pregnant women who have had a previous cesarean birth. OBJECTIVE: To determine the contributory factors that women who were cared for by the NBAC service and experienced a vaginal birth after cesarean (VBAC) perceived to be associated with achieving their desired mode of birth. METHODS: A qualitative descriptive approach was used for this study in which semistructured interviews were conducted with 13 participant women who have achieved a VBAC and were analyzed using a modified “constant comparison” technique. FINDINGS: Two key themes reflecting personal and professional factors comprising eight subthemes emerged from analysis of interview data. CONCLUSIONS: These findings offer a unique perspective on the phenomenon of achieving a VBAC and provide maternity care practitioners and policy makers around the world with valuable insights into how the care environment might be enhanced for women who would prefer a vaginal birth after their previous cesarean section.

Women's Perceptions of Contributory Factors for Not Achieving a Vaginal Birth After Cesarean (VBAC)

BACKGROUND: With cesarean rates around the world escalating, concern is growing around why women wanting a vaginal birth after cesarean (VBAC) are not achieving their goal. AIM: To gain an understanding of women’s perceptions of factors they felt contributed to not achieving a VBAC. SETTING AND PARTICIPANTS: Fifteen women were interviewed following a nonelective repeat cesarean section (NERCS). They had attended a Western Australian midwifery-led service, next birth after cesarean (NBAC), and labored but were not successful in achieving a VBAC because of reasons around delayed progress. Interview transcripts were analyzed using Colaizzi’s method of thematic analysis. FINDINGS: Five themes emerged: “Tentative commitment with lingering doubts,” “My body failed me,” “Compromised by a longer than tolerable labor,” “Unable to effectively self-advocate in a climate of power struggling and poor support,” and “The inflexibility of hospital processes.” The final theme included two subthemes: “Restrictive policies” on labor and use of the cardiotocography, “The CTG.” CONCLUSIONS: When labor did not progress as envisaged and hospital processes adversely affected how women were supported, women’s doubts around being able to achieve a VBAC were reinforced with a NERCS. Maternity services need to ensure clinical practice reflects best evidence while assuring staff are supportive of women’s choice.

Becoming Redundant: Australian Women's experiences of pregnancy after being unexpectedly scheduled for a medically necessary term elective cesarean section

PURPOSE: There is now a comprehensive body of evidence reporting the effects of emergency cesarean section on women’s emotional well-being. How women respond to becoming in need of a medically necessary elective cesarean section, however, has not previously been reported. This article describes and explains how a cohort of Australian women experienced the remainder of the antenatal period following the discovery during pregnancy of a medical reason to book a term elective cesarean section. DESIGN: Grounded theory methodology was used for this study. FINDINGS: Seven categories emerged from data analysis to represent the women’s responses to becoming in need of a medically necessary term elective cesarean section. Four categories describe women’s actions and interactions as they dealt with their lost expectations and their perceived “displacement” from their baby’s birth. The other three categories represent the factors that mediated, or caused, women’s responses. MAIN CONCLUSIONS: This study provides new knowledge about how women experience and respond to an unwanted and unforeseen change in their childbearing journey. The sense of disappointment and loss that is likely to arise for women who must “change track” must be anticipated, recognized, acknowledged, and when possible, forestalled by maternity care professionals.

The real ‘ cost ’ of study in Australia and the ramifications for China, Australia, and the Chinese nursing students: What do these three players want? A narrative review

ABSTRACT Australia attracts international nursing students from China to maintain its economic advantage and to alleviate the projected nursing shortage; conversely, China needs its best and brightest citizens who have trained abroad in nursing to return to cope with current challenges within its healthcare system and nursing education. This paper explores whether China can lure its foreign-trained nurses home to achieve its goals; whether China or Australia will win the nursing talent war; and do Chinese nursing students want to remain abroad or return home. The insight gained can support the development of successful human capital investment for all parties involved.

Factors associated with midwives’ job satisfaction and intention to stay in the profession: An integrative review

AIMS AND OBJECTIVES To conduct an integrative review of the factors associated with why midwives stay in midwifery. BACKGROUND Midwifery retention and attrition are globally acknowledged as an issue. However, little is known as to why midwives stay in midwifery as the focus has previously focussed on why they leave. DESIGN A structured six-step integrative review approach was used, and this involved the development of a search strategy, study selection and critical appraisal, data abstraction and synthesis, interpretation of findings and recommendations for future practice. METHODS The review was conducted using the databases MEDLINE, CINAHL and PsychInfo. Included studies were in the English language with an unlimited publication date. RESULTS Six studies were included in this review: one qualitative, two quantitative and three using mixed methods. Seven themes emerged from synthesisation of the data reported for the six included studies that together help answer the question of why midwives stay in midwifery. CONCLUSION This integrative review has highlighted some important factors that assist in answering the question why midwives stay in midwifery. However, it has also highlighted the need for quality data that reflects the range of contexts in which midwifery is practised. RELEVANCE TO CLINICAL PRACTICE There is an abundance of literature focussing on why midwives leave the profession; however, the gap exists in the reasons why midwives stay. If we can uncover this important detail, then changes within the profession can begin to be implemented, addressing the shortage of midwives issue that has been seen globally for a large number of years.

Readiness for practice change: Evaluation of a tool for the Australian midwifery context

BACKGROUND Midwifery is a research-informed profession with a mandated requirement to utilise latest best evidence. It is now recognised, however, that the introduction of new evidence into practice is complicated and uncertain. Growing awareness of this fact has led to the establishment of a new discipline, Implementation Science (IS), which is focused on developing ways to expedite the timely movement of evidence into practice. To date though, the wider midwifery profession has yet to make use of IS change-facilitation tools and methods. AIM The aim of this study was to determine the fitness for use in midwifery of one established IS tool: the UK NHS Spread & Adoption tool, which is designed to enable clinicians to assess their organisational context for change readiness. METHODS A qualitative descriptive methodology was used for this study, which was set in two Australian states. Focus groups were used to collect data. The sample comprised ten Australian change-leader midwifery teams who had led evidence-based practice change initiatives in the previous 12 months. FINDINGS Three themes emerged from the data which together convey that although poor internet access was problematic for some, and some of the language was found to be inappropriate, the tool was ultimately viewed as very useful for helping the implementation of practice change in midwifery settings. CONCLUSIONS This study provides valuable information about the broad suitability of the tested tool for Australian midwifery settings. Further research is required to evaluate a revised version.