Implementing evidence in order to promote freedom of movement for women in labour

Background/Aims: There is clear and important evidence that upright positions in the first stage of labour reduces the duration of labour, the risk of caesarean birth and the need for epidural. Despite this evidence, conventional hospital labour management continues to restrict mobility and confine women to birthing beds. The aim of this study was to find evidence based, new and innovative ways of promoting the use of upright and mobile positions for women who labour in conventional hospital settings. Methods: A literature review was conducted. The areas of focus included the reasons why, where, when and how promoting freedom of movement for women during labour could be achieved. Gaps and trends in research knowledge were considered. Strategies to overcome the theory-practice gap were developed for consultation and implementation. Results: Results indicate that optimising freedom of movement for women in labour requires a twopronged approach. Firstly, research evidence must inform birth policies and guidelines. Secondly, policies and guidelines must inform labour ward design and midwifery intrapartum care. Each stage is equally important, as freedom of movement for women in labour can be restricted because of intrapartum policy and/or environment and/or care. Conclusion: As midwives, we are obliged to inform women of the benefits to themselves and their babies of being upright and mobile during labour. In order to optimise freedom of movement for women during labour, we must actively promote and implement mobility-friendly birth policies and practices in our conventional labour ward settings

Exploring the experiences of Indigenous women who participated in a 'follow-through' journey within a Bachelor of Midwifery program

[Extract] Summary: • The women interviewed in our study reported the many benefits of having an Indigenous midwifery student provide them with Continuity of Care • Increasing the number of Aboriginal & Torres Strait Islander midwives is essential to improving health outcomes for Aboriginal & Torres Strait Islander familie

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Meeting the needs of rural and regional families: educating midwives

Recent claims that Australian midwifery is at a crossroads (Newhnam, 2010), and related debate centred upon women-centred versus medical models of care, requires urgent attention to ensure the future of midwifery practice. Less apparent in the public sphere is a current move by some Universities away from postgraduate midwifery programs in favour of direct entry undergraduate programs, alongside the Australian College of Midwives' apparent criticism of the alternative undergraduate model of joint Bachelor of Nursing/Bachelor of Midwifery undergraduate degrees. We contend that the time has come for public debate regarding these two contentious issues. As nurses, midwives and academics practising in regional Australia, we take issue with the notion that an undergraduate Bachelor of Midwifery degree alone will meet the health workforce needs, and thus the needs of women and families, of regional, rural and remote Australia into the future. We argue that the Bachelor of Midwifery degree should be one of several ways in which midwives are educationally prepared to practice across a country as diverse as ours

Telemedicine in neonatology : lessons from North Queensland

Using videoconferencing technology, educational programs in neonatology were provided for staff at rural hospitals. The technology was also used to reunite babies with their families and its usefulness in long-distance diagnosis was assessed. Eighty-two educational sessions were delivered over a 9 month period and, despite problems with technology, operation and presentation, were considered worthwhile by the audiences. Family reunions were very successful. Neonatal diagnosis was impossible at the narrow bandwidth used (128 kilobits/s). Valuable lessons were learned regarding optimum use of this medium

Exploring the experiences of Indigenous women and Indigenous students who participated in a 'follow through' journey within a Bachelor of Midwifery Program

International reports highlight that improvements to health outcomes for Indigenous populations is linked to greater participation by Indigenous people in the provision of health service delivery. Australian government policies underline the need to increase the number of practising Indigenous midwives as a strategy for delivering culturally appropriate healthcare that will help improve health outcomes for Aboriginal and Torres Strait Islander families. One of the key components of the 'Close the Gap' initiative includes enabling Aboriginal and Torres Strait Islander people to enter the healthcare workforce. Indigenous midwives and nurses' lived experiences, along with their knowledge of health service delivery, provides them with unique insight of the health system. It is recognised that it is essential to increase the numbers of Aboriginal and Torres Strait Islander people with tertiary level qualifications in order to provide culturally appropriate healthcare that will ultimately lead to increased uptake and subsequent health improvements. In this presentation, we share the stories told to us as part of a small, qualitative study that explored the experiences of a sample of Indigenous Australian women and Indigenous student midwives who participated in a 'follow through' journey as part of a Bachelor of Midwifery program in northern Australia. The findings of our study highlight the urgent need for improved strategies and policies that recruit and retain Indigenous midwifery students as their contribution is key to improving health outcomes for Indigenous childbearing women and their families

Exploring the experiences of Indigenous women who participated in a 'follow-through' journey within a Bachelor of Midwifery program\ud

[Extract] Summary:\ud \ud • The women interviewed in our study reported the many benefits of having an Indigenous midwifery student provide them with Continuity of Care\ud \ud • Increasing the number of Aboriginal & Torres Strait Islander midwives is essential to improving health outcomes for Aboriginal & Torres Strait Islander familie