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

Health engagement: a systematic review of tools modifiable for use with vulnerable pregnant women

Objective To examine available health engagement tools suitable to, or modifiable for, vulnerable pregnant populations.Design Systematic review.Eligibility criteria Original studies of tool development and validation related to health engagement, with abstract available in English, published between 2000 and 2022, sampling people receiving outpatient healthcare including pregnant women.Data sources CINAHL Complete, Medline, EMBASE and PubMed were searched in April 2022.Risk of bias Study quality was independently assessed by two reviewers using an adapted COSMIN risk of bias quality appraisal checklist. Tools were also mapped against the Synergistic Health Engagement model, which centres on women’s buy-in to maternity care.Included studies Nineteen studies were included from Canada, Germany, Italy, the Netherlands, Sweden, the UK and the USA. Four tools were used with pregnant populations, two tools with vulnerable non-pregnant populations, six tools measured patient–provider relationship, four measured patient activation, and three tools measured both relationship and activation.Results Tools that measured engagement in maternity care assessed some of the following constructs: communication or information sharing, woman-centred care, health guidance, shared decision-making, sufficient time, availability, provider attributes, discriminatory or respectful care. None of the maternity engagement tools assessed the key construct of buy-in. While non-maternity health engagement tools measured some elements of buy-in (self-care, feeling hopeful about treatment), other elements (disclosing risks to healthcare providers and acting on health advice), which are significant for vulnerable populations, were rarely measured.Conclusions and implications Health engagement is hypothesised as the mechanism by which midwifery-led care reduces the risk of perinatal morbidity for vulnerable women. To test this hypothesis, a new assessment tool is required that addresses all the relevant constructs of the Synergistic Health Engagement model, developed for and psychometrically assessed in the target group.PROSPERO registration number CRD42020214102

Development of a co‐designed, evidence‐based, multi‐pronged strategy to support normal birth

Australia's caesarean section (CS) rate has been steadily increasing for decades. In response to this, we co‐designed an evidence‐based, multi‐pronged strategy to increase the normal birth rate in Queensland and reduce the need for CS. We conducted three workshops with a multi‐stakeholder group to identify a broad range of options to reduce CS, prioritise these options, and achieve consensus on a final strategy. The strategy comprised of: universal access to midwifery continuity‐of‐care and choice of place of birth; multi‐disciplinary normal birth education; resources to facilitate informed decision‐making; respectful maternity care and positive workplace culture; and establishment of a Normal Birth Collaborative

A cost analysis of upscaling access to continuity of midwifery carer: Population-based microsimulation in Queensland, Australia

Objective To quantify the economic impact of upscaling access to continuity of midwifery carer, compared with current standard maternity care, from the perspective of the public health care system. Methods We created a static microsimulation model based on a whole-of-population linked administrative data set containing all public hospital births in one Australian state (Queensland) between July 2017 to June 2018 (n = 37,701). This model was weighted to represent projected State-level births between July 2023 and June 2031. Woman and infant health service costs (inpatient, outpatient and emergency department) during pregnancy and birth were summed. The base model represented current standard maternity care and a counterfactual model represented two hypothetical scenarios where 50 % or 65 % of women giving birth would access continuity of midwifery carer. Costs were reported in 2021/22 AUD. Results The estimated cost savings to Queensland public hospital funders per pregnancy were $336 in 2023/24 and$546 with 50 % access. With 65 % access, the cost savings were estimated to be $534 per pregnancy in 2023/24 and$839 in 2030/31. A total State-level annual cost saving of $12 million in 2023/24 and$19 million in 2030/31 was estimated with 50 % access. With 65 % access, total State-level annual cost savings were estimated to be $19 million in 2023/24 and$30 million in 2030/31. Conclusion Enabling most childbearing women in Australia to access continuity of midwifery carer would realise significant cost savings for the public health care system by reducing the rate of operative birth

Sexual selection, automata and ethics in George Eliot's The Mill on the Floss and Olive Schreiner's Undine and From Man to Man

This paper brings together two related areas of debate in the latter half of the nineteenth century. The first concerns how the courtship plot of the nineteenth-century novel responded to, and helped to shape, scientific ideas of sexual competition and selection. In The Mill on the Floss (1860), George Eliot strikingly prefigures Darwin's later work on sexual selection, drawing from her own extensive knowledge of the wider debates within which evolutionary theory developed. Maggie Tulliver's characterisation allows Eliot to explore the ethical complexities raised by an increasingly powerful scientific naturalism, where biology is seen to be embedded within morality in newly specific ways. The second strand of the paper examines the extension of scientific method to human mind and motivation which constituted the new psychology. It argues that there are crucial continuities of long-established ethical and religious ideas within this increasingly naturalistic view of human mind and motivation. The contention that such ideas persist and are transformed, rather than simply jettisoned, is illustrated through the example of Thomas Henry Huxley's 1874 essay on automata. Turning finally to focus on Olive Schreiner's Undine (1929) and From Man to Man (1926), the paper explores the importance of these persistent ethical and religious ideas in two novels which remained unpublished during her lifetime. It argues that they produce both difficulty and opportunity for imagining love plots within the context of increasingly assertive biological and naturalistic accounts of human beings

Navigating pregnancy and early motherhood in prison: a thematic analysis of mothers’ experiences

BACKGROUND: Maternal imprisonment negatively impacts mothers and their children and is likely to have lifelong and intergenerational sequelae. In many jurisdictions nationally and internationally, young children (usually those less than 5 years) can reside with their mothers in prison. However, there is considerable debate regarding the impact of prison environments on incarcerated mothers and their children who are born, and/or raised in prison. Research to date on the pregnancy and mothering experiences of imprisoned mothers and their preferences for care arrangements for their babies and young children is limited. METHODS: This study was part of the Transforming Corrections to Transform Lives project, in which workshops were conducted with imprisoned mothers to understand their needs while in custody and post-release, and the kind of supports and system changes that are required to meet those needs. Incarcerated mothers (n = 75) participated in seven workshops conducted across four Queensland prisons. Themes were generated through reflexive thematic analysis. RESULTS: Three themes characterised mothers’ experiences of being pregnant and undertaking a mothering role of a young child while in prison. First, for most mothers, imprisonment adds vulnerability and isolation during pregnancy and childbirth. Second, although mothers felt that residing together with their children in prison motivated them to change for a better future, they were concerned about the potential negative impact of the prison environment on the child’s development. Lastly, most mothers voiced losing autonomy and agency to practice motherhood independently within custodial settings. Mothers expressed a need for the correctional system to be adapted, so it is better equipped to address the unique and additional needs of mothers with young children. CONCLUSION: Mothers’ experiences indicated that the correctional system and policies, which were predominantly designed for men, do not adequately address the varied and complex needs of pregnant women, mothers, and their young children. Imprisonment of pregnant women and mothers with young children should be the last resort, and they should be provided with holistic, individually tailored support, most preferably in community settings, to address their multiple intersecting needs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40352-022-00196-4