Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997–2009)

© 2017 The Authors Objective in 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997–2009. Design a retrospective, descriptive analysis of data routinely collected over the 12.5 year period was undertaken including changes over time and outcomes by demographic features. Setting and participants all women booked with the Albany Midwifery Practice were included. Findings of the 2568 women included over the 12.5 year period, more than half (57%) were from Black, Asian and Minority Ethnic (BAME) communities; one third were single and 11.4% reported being single and unsupported. Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife. There were high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding). Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage. The overall rate of caesarean section was 16%. The preterm birth rate was low (5%). Ninety-five per cent of babies had an Apgar score of 8 or greater at 5 minutes and 6% were admitted to a neonatal unit for more than two days. There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities. There were no intrapartum intrauterine deaths. Key conclusions this analysis has shown that the Albany Midwifery Practice demonstrated positive outcomes for women and babies in socially disadvantaged and BAME groups, including those with complex pregnancies and perceived risk factors. Implications for practice consideration should be given to making similar models of care available to all women

Advancing Practice: Facilitating group antenatal care: a new way of working

This article outlines the principles and evidence behind group antenatal care and explores how developing group facilitation skills can enhance midwifery practice. The authors discuss the impact of different training models developed by the REACH Pregnancy Programme to support the implementation of ‘Pregnancy Circles’ as part of a randomised controlled trial of group antenatal care within an NHS context

The 'follow-through' experience in three-year Bachelor of Midwifery programs in Australia: A survey of students

Introduction: The follow-through experience in Australian midwifery education is a strategy that requires midwifery students to 'follow' a number of women through pregnancy, labour and birth and into the parenting period. Background: The experience was introduced by the Australian College of Midwives as part of national standards for the three-year Bachelor of Midwifery programs. Anecdotally, the introduction caused considerable debate. A criticism was that these experiences were incorporated with little evidence of their value. Methods: An online survey was undertaken to explore the follow-through experience from the perspectives of current and former students. There were 101 respondents, 93 current students with eight recent graduates. Results: Participants were positive about developing relationships with women. They also identified aspects of the follow-through experience that were challenging. Support to assist with the experience was often lacking and the documentation required varied. Despite these difficulties, 75% felt it should be mandatory as it facilitated positive learning experiences. Discussion: The follow-through experience ensured that students were exposed to midwifery continuity of care. The development of relationships with women was an important aspect of learning. Conclusion: Despite these challenges, there were significant learning opportunities. Future work and research needs to ensure than an integrated approach is taken to enhance learning. © 2012 Elsevier Ltd

Women's experiences of group antenatal care in Australia-the CenteringPregnancy Pilot Study

Objective: to describe the experiences of women who were participants in the Australian CenteringPregnancy Pilot Study. CenteringPregnancy is an innovative model of care where antenatal care is provided in a group environment. The aim of the pilot study was to determine whether it would be feasible to implement this model of care in Australia. Design: a descriptive study was conducted. Data included clinical information from hospital records, and antenatal and postnatal questionnaires. Setting: two metropolitan hospitals in Sydney, Australia. Participants: 35 women were recruited to the study and 33 ultimately received all their antenatal care (eight sessions) through five[CH1] CenteringPregnancy groups. Findings: difficulties with recruitment within a short study timeline resulted in only 35 (20%) of 171 women who were offered group antenatal care choosing to participate. Most women chose this form of antenatal care in order to build friendships and support networks. Attendance rates were high and women appreciated the opportunity and time to build supportive relationships through sharing knowledge, ideas and experiences with other women and with midwives facilitating the groups. The opportunity for partners to attend was identified as important. Clinical outcomes for women were in keeping with those for women receiving standard care; however, the numbers were small. Conclusion: the high satisfaction of the women suggests that CenteringPregnancy is an appropriate model of care for many women in Australian settings, particularly if recruitment strategies are addressed and women's partners can participate. Implications for practice: CenteringPregnancy group antenatal care assists women with the development of social support networks and is an acceptable way in which to provide antenatal care in an Australian setting. Recruitment strategies should include ensuring that practitioners are confident in explaining the advantages of group antenatal care to women in early pregnancy. Further research needs to be conducted to implement this model of care more widely. © 2009 Elsevier Ltd

Students' perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia

Background: providing opportunities for students to participate in midwifery continuity of care experiences is a challenge in many midwifery education programmes. The 'follow-through experience' was a deliberate strategy introduced into midwifery education programmes in Australia to ensure that students experienced midwifery continuity of care. The follow through experience provides an opportunity for midwifery students to follow a pre-determined number of women through pregnancy, labour and birth and into the early parenting period. Aim: the aim of this study was to explore the follow-through experience in the 3 year Bachelor of Midwifery (direct entry) in Australia to better understand its impact on midwifery students and to identify the learning that is associated with this experience. Methods: a qualitative methodology was used. Data were collected from former and current Bachelor of Midwifery students through a survey and telephone interviews. Students from all 3-year pre-registration Bachelor of Midwifery programmes in Australia were invited to participate. A thematic analysis was undertaken. Constructivist learning theories were used to identify whether learning occurred in the context of the follow-through experience. Findings: students do learn from their engagement in midwifery continuity of care experiences. Learning was characterised by the primacy of the relationship with the women. Students also identified the challenges they faced which included recruitment of women and finding the time to fully engage with the follow-through experience. Difficulties were identified around the different requirements of the follow-through experience, the lack of support at times for students and the incongruence with the existing maternity system. These issues impacted on students' ability to engage in and maximise their learning. Conclusions: the follow-through experience is an innovative midwifery education strategy that facilitates learning for midwifery students. Challenges need to be addressed at a systematic level and new strategies developed to support the learning opportunities presented by the follow-through experience. © 2012 Elsevier Ltd

Testing the birth unit design spatial evaluation tool (BUDSET) in Australia: A pilot study

Objective: To pilot test the Birth Unit Design Spatial Evaluation Tool (BUDSET) in an Australian maternity care setting to determine whether such an instrument can measure the optimality of different birth settings. Background: Optimally designed spaces to give birth are likely to influence a woman's ability to experience physiologically normal labor and birth. This is important in the current industrialized environment, where increased caesarean section rates are causing concerns. The measurement of an optimal birth space is currently impossible, because there are limited tools available. Methods: A quantitative study was undertaken to pilot test the discriminant ability of the BUDSET in eight maternity units in New South Wales, Australia. Five auditors trained in the use of the BUDSET assessed the birth units using the BUDSET, which is based on 18 design principles and is divided into four domains (Fear Cascade, Facility, Aesthetics, and Support) with three to eight assessable items in each. Data were independently collected in eight birth units. Values for each of the domains were aggregated to provide an overall Optimality Score for each birth unit. Results: A range of Optimality Scores was derived for each of the birth units (from 51 to 77 out of a possible 100 points). The BUDSET identified units with low-scoring domains. Essentially these were older units and conventional labor ward settings. Conclusion: The BUDSET provides a way to assess the optimality of birth units and determine which domain areas may need improvement. There is potential for improvements to existing birth spaces, and considerable improvement can be made with simple low-cost modifications. Further research is needed to validate the tool. © 2011, Vendome Group, LLC. All rights reserved

Using video in childbirth research: Ethical approval challenges

© The Author(s) 2015. Background: Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers. Aim: This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits. Research design: The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal communication and the experiences of childbearing women, midwives and supporters. Participants and research context: Six women, 11 midwives and 11 childbirth supporters were filmed during the women’s labours in hospital birth units and interviewed 6 weeks later. Ethical considerations: The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation. Findings: The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process. Discussion: The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies. Conclusion: Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-based results

Methodological insights from a study using video-ethnography to conduct interdisciplinary research in the study of birth unit design

© eContent Management Pty Ltd. Little is known about how the physical design of a birthing unit can influence the experiences of labour and birth for women, their supporters and midwives. We proposed that an interdisciplinary approach (disciplines of midwifery, architecture, design, communication and public health) was likely to be the most effective way to better understand the complexities and interactions of design, behaviour, communication and experiences. In this methodological paper we aim to provide a roadmap that other researchers may find helpful when considering the use of video as a data collection technique, especially in the study of the powerful and intimate setting of childbirth. The paper also outlines our process for engaging both researchers and participants in reviewing video footage with the aim to contribute multiple perspectives to the analysis process

Group versus conventional antenatal care for women

© 2015 The Cochrane Collaboration. Background: Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. Objectives: 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies. 2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. Selection criteria: All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. Main results: We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943). Satisfaction was rated as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes. No data were available on the effects of group antenatal care on care provider satisfaction. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth). Authors' conclusions: Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight

Creating space for facilitated music performance: gesture controlled sound for users with complex disabilities

Musical interactions have the potential to increase emotional well-being, self-confidence and self-motivation. However, the ability to actively participate in creative activities involving music performance has so far been difficult for users with complex disabilities. This paper discusses placing a technology probe, using gesture based musical controls, in an existing music technology project for users with complex disabilities (conditions which affect both cognitive and motor abilities of an individual). The focus is on understanding the needs of this user group in a participatory design approach for creative music technologies that allow for tailored accessibility. Outcomes from this research show that many multi-level social interactions surrounding the technology, users, audience, and any third party facilitators exist in the context of ‘facilitated performance’. Results suggest that including facilitators in the design of Digital Musical Instruments (DMIs) could allow for improved accessibility for users with complex disabilities