Strengthening midwifery in response to global climate change to protect maternal and newborn health

In this editorial, we argue that midwives should focus on climate change, a link which has been underexplored

Women’s expectations and experiences of maternity care in NSW - what women highlight as most important

Background Although surveys have identified that women are generally highly satisfied with maternity care provision, those aspects of care that women highlight as most important for achieving satisfaction and a satisfactory maternity care experience have not been reported. The aim of this study was to investigate how women understand and experience their maternity care and to report which aspects of care women highlight as most important. Methods This large qualitative study explored women’s expectations and experiences of maternity care provision. In-depth semi-structured interviews were conducted with 53 women experiencing maternity care in a range of tertiary, regional, rural, remote hospitals and midwife-led practices in the state of New South Wales, Australia during 2011 to 2012. Included in the interview schedule was the question ‘What 3 aspects would you see as most important for delivery of maternity care?’ Descriptive analyses of entire transcripts and responses to the question on most important aspects of care were undertaken. Results Descriptive analyses of women’s responses identified 5 important aspects of care: woman-focused care, staff qualities, systems and facilities, family-focused care and continuity of care/information. First-time mothers were more likely to identify woman-focused care, staff qualities and continuity of care/information as important 3 aspects than multiparous mothers. Urban and regional mothers highlighted staff qualities as having greater importance for satisfaction with their care while rural and particularly remote women nominated systems and facilities as important. Conclusions Our study showed that women from a range of settings are more concerned with staff and relational issues than facilities. Differences in perceptions among primiparous versus multiparous women, at different stages of pregnancy and among women from rural and remote compared to urban settings highlight the need to include women with a diversity of experience when trying to understand the aspects of maternity care most important to women

Ventilatory frequency as a measure of the response of tammar wallabies (Macropus eugenii) to the odour of potential predators

This study uses changes in ventilatory frequency to quantify the physiological response of an Australian terrestrial herbivore, the tammar wallaby (Macropus eugenii), to olfactory cues suggesting the presence of potential predators. Ventilatory frequency proved to be a quantifiable measure to assess the response of this macropod marsupial to olfactory cues. Ventilatory frequency increased from mean resting levels of 45 ± 5.1 breaths min–1 to 137 ± 11.2 breaths min–1 during the first minute of exposure to all odours. These physiological responses diminished over time, with ventilatory frequency in the first minute after introduction of the scents greater than that during the subsequent four, suggesting that the initial reaction was due to disturbance and was investigative in nature. However, the ratio of ventilatory frequency in the remaining 4 min after introduction of the odours compared with before was greater for fox (3.58 ± 0.918) and cat (2.44 ± 0.272) odours than for snake (2.27 ± 0.370), distilled water (1.81 ± 0.463) and quoll (1.71 ± 0.245) odours, suggesting that fox and cat odour provoked a greater response. However, the wallabies’ response to the odour of these introduced predators and to horse odour (2.40 ± 0.492) did not differ. Our study indicates that a long period of co-history with particular predators is not a prerequisite for detection of potentially threatening species. We do not find any support for the hypothesis that an inability to interpret olfactory cues to detect and respond to potential predation by introduced predators is responsible for the decline of these macropod marsupials

The influences on women who choose publicly-funded home birth in Australia

Objective: to explore the influences on women who chose a publicly-funded home birth in one Australian state. Design: a constructivist grounded theory methodology was used. Setting: a publicly-funded home birth service located within a tertiary referral hospital in the southern suburbs of Sydney, Australia. Participants: data were collected though semi-structured interviews of 17 women who chose to have a publicly-funded home birth. Findings: six main categories emerged from the data. These were feeling independent, strong and confident, doing it my way, protection from hospital related activities, having a safety net, selective listening and telling, and engaging support. The core category was having faith in normal. This linked all the categories and was an overriding attitude towards themselves as women and the process of childbirth. The basic social process was validating the decision to have a home birth. Conclusion: women reported similar influences to other studies when choosing home birth. However, the women in this study were reassured by the publicly-funded system's 'safety net' and apparent seamless links with the hospital system. The flexibility of the service to permit women to change their minds to give birth in hospital, and essentially choose their birthplace at any time during pregnancy or labour was also appreciated. Implications for practice: women that choose a publicly-funded home birth service describe strong influences that led them to home birth within this model of care. Service managers and health professionals need to acknowledge the importance of place of birth choice for women

Multiparous women's confidence to have a publicly-funded homebirth : a qualitative study

Background: Hospital birth is commonly thought to be a safer option than homebirth, despite many studies showing similar rates of safety for low risk mothers and babies when cared for by qualified midwives with systems of back-up in place. Recently in Australia, demand has led to the introduction of a small number of publicly-funded homebirth programs. Women's confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored. Aim: The aim of the study was to explore the reasons why multiparous women feel confident to have a homebirth within a publicly-funded model of care in Australia. Methods: Ten multiparous English-speaking women who chose to have a homebirth with the St George Hospital Homebirth Program were interviewed in the postnatal period using semi-structured, open-ended questions. Interviews were transcribed, then a thematic analysis was undertaken. Results: Women, having already experienced a normal birth, demonstrated a strong confidence in their ability to give birth at home and described a confidence in their bodies, their midwives, and the health system. Women weighed up the risks of homebirth through information they gathered and integration with their previous experience of birth, their family support and self-confidence. Discussion: Women choosing publicly-funded homebirth display strong confidence in both themselves to give birth at home, and their belief in the health system's ability to cope with any complications that may arise. Implications for practice: Many women may benefit from access to publicly-funded homebirth models of care. This should be further investigated

[In Press] A metasynthesis of nurses and midwives' experiences of clinical supervision

Problem: Given the current rate of burnout and attrition among nurses and midwives globally, there is a need to understand the effectiveness of supportive strategies to help retain this workforce. Background: Clinical supervision can help to ensure that nurses and midwives are supported and have the capacity to cope with their job demands. Yet there are no metasyntheses that provide a collective understanding of their experiences with clinical supervision. Aim: To synthesise the experiences of nurses and midwives who have accessed clinical supervision. Methods: A metasynthesis was conducted by systematically searching academic databases for relevant publications; assessing their quality using an established checklist; extracting and analysing qualitative content; and synthesising key findings about the experiences of nurses and midwives regarding clinical supervision. Findings: Themes and subthemes were identified from 12 papers, including: optimal logistics; support; safety and confidentiality; improving practice through reflection; and trust in the group. Discussion: For clinicians to feel comfortable discussing their practice and workplace with the facilitator and colleagues, nurses and midwives needed to feel safe during clinical supervision and trust the process and their peers. Despite common difficulties of finding time for the sessions, clinical supervision can enhance collaboration and communication in the workplace. Conclusion: Clinical supervision that adheres to group rules can provide professional support within a safe, confidential space. Having trust in peers and facilitators at the sessions can help staff develop confidence, provide personal development and professional sustenance

CASP questions.

<p>CASP questions.</p

Keywords and MeSH terms used in search strategy.

<p>Keywords and MeSH terms used in search strategy.</p