Virginia Schmied

Defining Social Support in Context: A Necessary Step in Improving Research, Intervention, and Practice

A substantial body of work on the concept of social support has resulted in many definitions, but none have been accepted as definitive. The lack of consensus about the definition of social support has resulted in a lack of consistency and comparability among studies. More important, the validity of any study attempting to measure or influence social support is undermined by the use of generic definitions, which lack contextual sensitivity. In this article concept analysis is used to evaluate definitions of social support to ascertain their utility for research. The authors argue that a contextualized approach to the definition of social support is necessary to improve clarity in research, and results in interventions or practices that are useful. They also assert that the development of a contextualized definition of social support requires qualitative methods to explore the meaning of social support with groups of people for whom intervention research is ultimately intended.

Blurring the boundaries: breastfeeding and maternal subjectivity

Contemporary medical and public health discourses represent breastfeeding as vital to infant development and the mother-infant bond. Little research from a medical or sociological perspective has sought to investigate the qualitative breastfeeding experiences of women. This article draws on a range of feminist perspectives on the body and subjectivity, together with empirical data from a series of interviews with 25 Australian first-time mothers, to theorise the experience of breastfeeding. These women’s accounts revealed that, although nearly all of them subscribed vehemently to the dominant discourse of ‘breast is best’, the experience of breastfeeding differed markedly among them. Some of the women experienced breastfeeding as a connected, harmonious and intimate relationship between themselves and their baby. For others, however, the breastfeeding relationship between mother and infant was difficult to reconcile with notions of identity that value autonomy, independence and control. We use insights from feminist philosophy on subjectivity and embodiment to explain why the latter response predominated among our interviewees.

Child and family outcomes of a long-term nurse home visitation programme: a randomised controlled trial

Objective To investigate the impact of a long-term nurse home visiting programme, embedded within a universal child health system, on the health, development and well-being of the child, mother and family. Design Randomised controlled trial. Setting/participants 208 (111 intervention, 97 comparison) eligible at-risk mothers living in a socioeconomically disadvantaged area in Sydney, booking into the local public hospital for confinement. Intervention A sustained and structured nurse home visiting antenatal and postnatal parenting education and support programme. Control Usual universal care. Main outcome measures The quality of the home environment for child development (12–24 months), parent–child interaction and child mental, psychomotor and behavioural development at 18 months. Results Mothers receiving the intervention were more emotionally and verbally responsive (HOME observation) during the first 2 years of their childs life than comparison group mothers (mean difference 0.5; 95% CI 0.1 to 0.9). Duration of breastfeeding was longer for intervention mothers than comparison mothers (mean difference 7.9 weeks; 95% CI 2.9 to 12.9). There was no significant difference in parent–child interaction between the intervention and comparison groups. There were no significant overall group differences in child mental, psychomotor or behavioural development. Mothers assessed antenatally as having psychosocial distress benefitted from the intervention across a number of areas. Conclusion This sustained nurse home visiting programme showed trends to enhanced outcomes in many, but not all, areas. Specifically, it resulted in clinically enhanced outcomes in breastfeeding duration and, for some subgroups of mothers, womens experience of motherhood and childrens mental development. Trial registration number ACTRN12608000473369.

The nature and impact of collaboration and integrated service delivery for pregnant women, children and families

AIM This paper explores the impact of models of integrated services for pregnant women, children and families and the nature of collaboration between midwives, child and family health nurses and general practitioners. BACKGROUND Increasingly, maternity and child health services are establishing integrated service models to meet the needs of pregnant women, children and families particularly those vulnerable to poor outcomes. Little is known about the nature of collaboration between professionals or the impact of service integration across universal health services. DESIGN Discursive paper. METHODS A literature search was conducted using a range of databases and combinations of relevant keywords to identify papers reporting the process, and/or outcomes of collaboration and integrated models of care. RESULTS There is limited literature describing models of collaboration or reporting outcomes. Several whole-of-government and community-based integrated service models have been trialled with varying success. Effective communication mechanisms and professional relationships and boundaries are key concerns. Liaison positions, multidisciplinary teams and service co-location have been adopted to communicate information, facilitate transition of care from one service or professional to another and to build working relationships. CONCLUSIONS Currently, collaboration between universal health services predominantly reflects initiatives to move services from the level of coexistence to models of cooperation and coordination. RELEVANCE TO CLINICAL PRACTICE Integrated service models are changing the way professionals are working. Collaboration requires knowledge of the roles and responsibilities of colleagues and skill in communicating effectively with a diverse range of professionals to establish care pathways with referral and feedback mechanisms that generate collegial respect and trust.

A Description of the Relationship between Breastfeeding Experiences, Breastfeeding Satisfaction, and Weaning in the First 3 Months after Birth

This longitudinal study describes the relationships among breastfeeding experiences, maternal breastfeeding satisfaction (measured by the Maternal Breastfeeding Evaluation Scale [MBFES]), and weaning in the first 3 months postpartum. Postal surveys were used to collect data antenatally and at 2 weeks, 6 weeks, and 3 months postpartum from 365 women recruited from 3 public hospitals in Australia. Breastfeeding problems were associated with a reduction in MBFES subscale scores (P < .05) but not with weaning. Infant breastfeeding satisfaction subscale score was negatively associated with perceived inadequate milk supply (P < .05) and positively associated with engorgement (P < .05). Significant predictors of weaning at all points were total MBFES score in the lowest tertile (adjusted odds ratios [ORs]: 2 weeks, 21.9; > 2-6 weeks, 14.6; > 6 weeks to 3 months, 6.4) and leaking milk (adjusted ORs: ≤ 2 weeks, 0.23;>2-6 weeks, 0.19;>6 weeks to 3 months, 0.15). Perceived inadequate milk was a significant predictor only for weaning > 2 to 6 weeks (adjusted OR=4.2). J Hum Lact. 19(2):145-156.

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.

Immediate or early skin-to-skin contact after a Caesarean section: a review of the literature

The World Health Organization and the United Nations International Childrens Emergency Fund recommends that mothers and newborns have skin-to-skin contact immediately after a vaginal birth, and as soon as the mother is alert and responsive after a Caesarean section. Skin-to-skin contact can be defined as placing a naked infant onto the bare chest of the mother. Caesarean birth is known to reduce initiation of breastfeeding, increase the length of time before the first breastfeed, reduce the incidence of exclusive breastfeeding, significantly delay the onset of lactation and increase the likelihood of supplementation. The aim of this review is to evaluate evidence on the facilitation of immediate (within minutes) or early (within 1 h) skin-to-skin contact following Caesarean section for healthy mothers and their healthy term newborns, and identify facilitators, barriers and associated maternal and newborn outcomes. A range of electronic databases were searched for papers reporting research findings published in English between January 2003 and October 2013. Seven papers met the criteria. This review has provided some evidence that with appropriate collaboration skin-to-skin contact during Caesarean surgery can be implemented. Further evidence was provided, albeit limited, that immediate or early skin-to-skin contact after a Caesarean section may increase breastfeeding initiation, decrease time to the first breastfeed, reduce formula supplementation in hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns and reduce newborn stress.

Maternal mental health in Australia and New Zealand: A review of longitudinal studies

AIM The aim of this paper is to describe the factors that impact on the mental health of Australian and New Zealand (NZ) women in the perinatal period (pregnancy and the year following birth), and to determine the impact of perinatal mental health on womens subsequent health by summarising findings from prospective longitudinal studies conducted in Australia and NZ. METHODS A systematic search was conducted using the databases, Scopus, Medline, PsychInfo and Health Source to identify prospective longitudinal studies focused on womens social and emotional health in the perinatal period. Forty-eight papers from eight longitudinal studies were included. RESULTS The proportion of women reporting depressive symptoms in the first year after birth was between 10 and 20% and this has remained stable over 25 years. The two strongest predictors for depression and anxiety were previous history of depression and poor partner relationship. Importantly, womens mood appears to be better in the first year after birth, when compared to pregnancy and five years later. Becoming a mother at a young age is by itself not a risk factor unless coupled with social disadvantage. Women report a high number of stressors in pregnancy and following birth and the rate of intimate partner violence reported is worryingly high. CONCLUSION Midwives have an important role in the identification, support and referral of women experiencing mental health problems. As many women do not seek help from mental health services, the potential for a known midwife to impact on womens mental health warrants further examination.

A systematic review of structured compared with non-structured breastfeeding programmes to support the initiation and duration of exclusive and any breastfeeding in acute and primary health care settings

Policies and guidelines have recommended that structured programmes to support breastfeeding should be introduced. The objective of this review was to consider the evidence of outcomes of structured compared with non-structured breastfeeding programmes in acute maternity care settings to support initiation and duration of exclusive breastfeeding. Quantitative and qualitative studies were considered. Primary outcomes of interest were initiation of breastfeeding and duration of exclusive breastfeeding. Studies that only considered community-based interventions were excluded. An extensive search of literature published in 1992-2010 was undertaken using identified key words and index terms. Methodological quality was assessed using checklists developed by the Joanna Briggs Institute. Two independent reviewers conducted critical appraisal and data extraction; 26 articles were included. Because of clinical and methodological heterogeneity of study designs, it was not possible to combine studies or individual outcomes in meta-analyses. Most studies found a statistically significant improvement in breastfeeding initiation following introduction of a structured breastfeeding programme, although effect sizes varied. The impact on the duration of exclusive breastfeeding and duration of any breastfeeding to 6 months was also evident, although not all studies found statistically significant differences. Despite poor overall study quality, structured programmes compared with standard care positively influence the initiation and duration of exclusive breastfeeding and any breastfeeding. In health care settings with low breastfeeding initiation and duration rates, structured programmes may have a greater benefit. Few studies controlled for any potential confounding factors, and the impact of bias has to be considered.

What are the facilitators, inhibitors, and implications of birth positioning? A review of the literature.

BACKGROUND From the historical literature it is apparent that birthing in an upright position was once common practice while today it appears that the majority of women within Western cultures give birth in a semi-recumbent position. AIM To undertake a review of the literature reporting the impact of birth positions on maternal and perinatal wellbeing, and the factors that facilitate or inhibit women adopting various birth positions throughout the first and second stages of labour. METHODS A search strategy was designed to identify the relevant literature, and the following databases were searched: CINAHL, CIAP, the Cochrane Database of Systematic Reviews, Medline, Biomed Central, OVID and Google Scholar. The search was limited to the last 15 years as current literature was sought. Over 40 papers were identified as relevant and included in this literature review. RESULTS The literature reports both the physical and psychological benefits for women when they are able to adopt physiological positions in labour, and birth in an upright position of their choice. Women who utilise upright positions during labour, have a shorter duration of the first and second stage of labour, experience less intervention, and report less severe pain and increased satisfaction with their childbirth experience than women in a semi recumbent or supine/lithotomy position. Increased blood loss during third stage is the only disadvantage identified but this may be due to increased perineal oedema associated with upright positions. There is a lack of research into factors and/or practices within the current health system that facilitate or inhibit women to adopt various positions during labour and birth. Upright birth positioning appears to occur more often within certain models of care, and birth settings, compared to others. The preferences for positions, and the philosophies of health professionals, are also reported to impact upon the position that women adopt during birth. CONCLUSION Understanding the facilitators and inhibitors of physiological birth positioning, the impact of birth settings and how midwives and women perceive physiological birth positions, and how beliefs are translated into practice needs to be researched.