Moving Beyond First Year: An Exploration of Staff and Student Experience

Transition pedagogy has had a major impact on the first year experience for higher education students in Australia. Similarly, there has been a significant focus on transitioning students from their final year of study to employment. Considerably fewer studies have sought to understand the “middle child”; the years in between the first and final year of study. Staff at a metropolitan Australian university noticed an increase in students struggling with university life after the first year of their program, with students purposefully withdrawing from courses or their program entirely. This article reports on focus groups held with staff and feedback via a student survey. Findings suggest the challenges faced by students in second year are multi-faceted, and curriculum and delivery should be intentionally designed to support students through a series of transitions throughout the university journey

A public e-survey to explore community understanding of the role of the midwife in Australia

Introduction:There is compelling evidence that when a woman sees the same midwife there are better outcomes. Yet in Australia, access to midwifery continuity of care remains limited. There are a number of reasons for this but one barrier appears to be a lack of public understanding regarding the role of the midwife. This study undertook an e-survey to explore Australian public perceptions of the role of the midwife.Methods:A public opinion sample e-survey, using an exploratory design, a Likert scale and open-ended questions, was distributed through social media over six weeks. The survey was open to Australian residents and was completed by 1657 participants. Of these, 96.9% identified as female and 82.1% of participants had children.Results:Nearly half of the participants believed that a woman must see a doctor during pregnancy and after birth, compared to 21.9% during birth. Many participants described midwives as caring and supportive but there was a lack of understanding about their level of skill and expertise. A dominant theme was the alignment of medical care with safety and the perception that medical practitioners reduce risk. These misperceptions may impact on women making an informed choice regarding midwifery model of care in Australia.Conclusions:There is an underlying public narrative whereby the public primarily associate midwives with birth and perceive them as assistants rather than lead care providers. The study findings informed a public awareness campaign in South Australia conducted to educate the public’s understanding of the role of the midwife

Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia: Women’s experiences and birth outcomes

IntroductionThe ongoing closure of regional maternity services in Australia has significant consequences for women and communities. In South Australia, a regional midwifery model of care servicing five birthing sites was piloted with the aim of bringing sustainable birthing services to the area. An independent evaluation was undertaken. This paper reports on women’s experiences and birth outcomes.AimTo evaluate the effectiveness, acceptability, continuity of care and birth outcomes of women utilising the new midwifery model of care.MethodAn anonymous questionnaire incorporating validated surveys and key questions from the Quality Maternal and Newborn Care (QMNC) Framework was used to assess care across the antenatal, intrapartum and postnatal period. Selected key labour and birth outcome indicators as reported by the sites to government perinatal data collections were included.FindingsThe response rate was 52.6% (205/390). Women were overwhelmingly positive about the care they received during pregnancy, birth and the postnatal period. About half of women had caseload midwives as their main antenatal care provider; the other half experienced shared care with local general practitioners and caseload midwives. Most women (81.4%) had a known midwife at their birth. Women averaged 4 post-natal home visits with their midwife and 77.5% were breastfeeding at 6–8 weeks. Ninety-five percent of women would seek this model again and recommend it to a friend. Maternity indicators demonstrated a lower induction rate compared to state averages, a high primiparous normal birth rate (73.8%) and good clinical outcomes.ConclusionThis innovative model of care was embraced by women in regional SA and labour and birth outcomes were good as compared with state-wide indicators

Examining the Influence of Self-compassion Education and Training Upon Parents and Families When Caring for their Children: A Systematic Review

Background: It is well-recognized that early parenting significantly influences the health and well-being of children. However, many parents struggle with the daily demands of being a parent and feel overwhelmed and exhausted psychologically and physically. Encouraging self-care practices is essential for parents, and self-compassion may be a potential strategy to utilize. Objectives: The review aims to assess the influence and impact of providing self-compassion education for parents and families when caring for their children. Methods: This systematic review utilized Joanna Briggs Institute (JBI) methodology. A three-stage search approach was undertaken that included seven electronic databases, registries and websites. These databases are Medline, Embase, PsycINFO, Emcare, Cochrane library, Scopus, and ProQuest. The included studies were appraised using the standardized critical appraisal instruments for evidence of effectiveness developed by JBI. Results: Ten studies met the inclusion criteria. Overall, the studies confirmed improved psychological well-being, and higher levels of self-compassion, kindness towards oneself and others, and mindfulness were reported. In addition, there were improvements in psychological well-being, decreased parental distress and perceived distress, lower levels of anxiety, and avoidance of negative experiences. Conclusion: The findings provide evidence to guide further research on developing, designing, facilitating, and evaluating self-compassion education programs and workshops for parents and families. PROSPERO registration This systematic review title is registered at the International Prospective Register of Systematic Reviews: CRD42021225021

‘There is no other option’: Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia

IntroductionIn the past 30 years, 60% of South Australia’s rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all-risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken.ObjectiveThe study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers.DesignThe evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services.FindingsThe first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the ‘MMoC was working well.’ The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that ‘there is no other option - it has to work’.DiscussionAll participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals.ConclusionThis innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is ‘no other option–it has to work’

Measuring organizational readiness for implementing change (ORIC) in a new midwifery model of care in rural South Australia

BackgroundThe sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change.MethodsA descriptive study assessing readiness for change was measured using the Organizational Readiness for Implementing Change scale (ORIC). The 12 item Likert scale measures a participant’s commitment to change and change efficacy. All clinicians working within the model of care (midwives, nurses and doctors) were invited to complete an e-survey.ResultsOverall, 55% (56/102) of clinicians participating in the model responded. The mean ORIC score was 41.5 (range 12–60) suggesting collectively, midwives, nurses and doctors began the new model of care with a sense of readiness for change. Participants were most likely to agree on the change efficacy statements, “People who work here feel confident that the organization can get people invested in implementing this change and the change commitment statements “People who work here are determined to implement this change”, “People who work here want to implement this change”, and “People who work here are committed to implementing this change.ConclusionResults of the ORIC survey indicate that clinicians transitioning to the new model of care were willing to embrace change and commit to the new model. The process of organizational change in health care settings is challenging and a continuous process. If readiness for change is high, organizational members invest more in the change effort and exhibit greater persistence to overcome barriers and setbacks. This is the first reported use of the instrument amongst midwives and nurses in Australia and should be considered for use in other national and international clinical implementation studies

Women’s Barriers to Weight Loss, Perception of Future Diabetes Risk and Opinions of Diet Strategies Following Gestational Diabetes: An Online Survey

Weight loss after gestational diabetes (GDM) reduces the risk of type 2 diabetes (T2DM); however, weight loss remains challenging in this population. In order to explore perceptions of T2DM risk, barriers to weight loss, and views of diet strategies in women with previous GDM, a cross-sectional online survey of n = 429 women in Australia aged ≥18 years with previous GDM was conducted. Opinions of intermittent energy restriction (IER) were of interest. Seventy-five percent of responders (n = 322) had overweight or obesity, and 34% (n = 144) believed they had a high risk of developing T2DM. Within the Theoretical Domains Framework, barriers to weight loss were prominently related to Environmental Context and Resources, Beliefs about Capabilities, and Behavioural Regulation. Exercising was the most tried method of weight loss over other diet strategies (71%, n = 234) and weight loss support by a dietician was appealing as individual appointments (65%, n = 242) or an online program (54%, n = 200). Most women (73%, n = 284) had heard of IER (the “5:2 diet”), but only 12% (n = 34) had tried it. Open comments (n = 100) revealed mixed views of IER. Women in Australia with previous GDM were found to lack a self-perceived high risk of developing T2DM and expressed barriers to weight loss related to their family environment, beliefs about their capabilities and behavioural regulation. IER is appealing for some women with previous GDM; however, views vary

Using co-design to explore how midwives can support the emerging mother-infant relationship during the early postnatal period: Protocol for a mixed-method study

Background: The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship.Objective: The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period.Methods: This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys.Results: Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023.Conclusions: The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period

The role of midwives in supporting the development of the mother-infant relationship: a scoping review

Background: The mother-infant relationship is complex and dynamic, informing the psychological development of the infant through bonding and attachment. Positive early interactions influence the quality of this relationship. Midwives are well placed to support the developing relationship between the mother and baby, yet there has been limited research exploring the role of the midwife in this context. Aim: To explore interventions that have been provided by the midwife which support the development of the maternal-fetal or mother-infant relationship amongst a low-risk population from pregnancy, and up to six weeks postnatal. The review also sought to understand the types of interventions developed, format and delivery, outcomes measured and if cultural considerations had been incorporated. Methods: A scoping review of the research literature was undertaken using the Joanna Briggs Institute framework. Five online databases were searched for relevant articles published in English from 2000 to 2021. Findings: Sixteen articles met the inclusion criteria. Three themes emerged: (1) viewing the fetus as separate from the mother, (2) focused activities on the maternal-infant relationship and (3) targeted educational interventions. Discussion: Providing focused activities and targeted education during the pre and postnatal periods support the development of the mother-infant relationship. Significantly, there was insufficient research that considered the influence of culture in supporting the mother-infant relationship. Conclusion: Further research is required to develop interventions that include a diverse sample to ensure culturally appropriate activities can be integrated into care during pregnancy and/or the postnatal period provided by midwives

Yourtime: The development and pilot of a perinatal mental wellbeing digital tool using a co-design approach

IntroductionMaternal anxiety and depression are major public health issues with prevalence as high as one in five women. There is a need to focus on preventative strategies to enable women to self-monitor their mental health status during pregnancy and postnatally.AimTo co-design and test a perinatal mental health digital tool to enable women to self-monitor their mental wellbeing during pregnancy and early parenting and promote positive self-care strategies.Methods and ethicsA sequential mixed methods study utilising two stages 1) co-design workshops; 2) fit for purpose pilot with women through a purpose designed survey to evaluate acceptability, useability, functionality, and satisfaction.FindingsMothers, midwives, design researchers and students, participated in co-designing a digital tool and prototype application, YourTime. Fourteen participants engaged in the pilot, with all women agreeing that the tool would be beneficial in alerting them to changes in mental wellbeing. Seventy-seven percent agreed that this prototype had the potential to positively affect wellbeing during the perinatal period.DiscussionThe need to develop a perinatal mental health digital tool that enables women to self-monitor their wellbeing was identified. Women reported the YourTime app offered an acceptable and effective means to self-assess and monitor their wellbeing.ConclusionThe YourTime app responds to the growing agenda for digital approaches to address perinatal mental health challenges. The pilot study demonstrated that the app offered potential to alert women to changes in mental wellbeing, but functionality need further development