Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians

© 2016 Australian College of Midwives Problem One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. Background Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC). Aim To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women. Methods A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted. Findings The central themes were: ‘developing trust’, ‘navigating the system’ and ‘optimising support’. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted. Conclusion Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication

Artificial Synthesis of Conjugated Microporous Polymers via Sonogashira-Hagihara Coupling

Amorphous network materials are becoming increasingly important with applications, for example, as supercapacitors, battery anodes, and proton conduction membranes. The design of these materials is hampered by the amorphous nature of the structure and sensitivity to synthetic conditions. Here, we show that through artificial synthesis, fully mimicking the catalytic formation cycle, and full synthetic conditions, we can generate structural models that can fully describe the physical properties of these amorphous network materials. This opens up pathways for the rational design where complex structural influences, such as the solvent and catalyst choice, can be taken into account

Chemical vapour deposition synthetic diamond: materials, technology and applications

Substantial developments have been achieved in the synthesis of chemical vapour deposition (CVD) diamond in recent years, providing engineers and designers with access to a large range of new diamond materials. CVD diamond has a number of outstanding material properties that can enable exceptional performance in applications as diverse as medical diagnostics, water treatment, radiation detection, high power electronics, consumer audio, magnetometry and novel lasers. Often the material is synthesized in planar form, however non-planar geometries are also possible and enable a number of key applications. This article reviews the material properties and characteristics of single crystal and polycrystalline CVD diamond, and how these can be utilized, focusing particularly on optics, electronics and electrochemistry. It also summarizes how CVD diamond can be tailored for specific applications, based on the ability to synthesize a consistent and engineered high performance product.Comment: 51 pages, 16 figure

Midwives' emotional wellbeing: Impact of conducting a Structured Antenatal Psychosocial Assessment (SAPSA)

Research problem: To investigate the impact of conducting structured antenatal psychosocial assessments (SAPSA) on midwives' emotional wellbeing. The SAPSA includes screening and assessment tools for domestic violence, childhood trauma, drug and alcohol use, depression, and vulnerability factors. Participants and methods: Registered midwives who had conducted the SAPSA with women during the first hospital booking visit at two hospitals in NSW. Data was collected by means of focus group interviews. Results: Four sub-themes were identified that directly impacted upon the midwives' emotional wellbeing: cumulative complex disclosures, frustration and stress, lack of support for midwives and unhealthy coping strategies. Discussion and conclusions: There was a cumulative emotional effect with some midwives utilising unhealthy strategies to cope with feelings of frustration, inadequacy and vicarious trauma. Establishment of structured referral pathways for women and supportive systems for midwives is essential prior to implementing the SAPSA. Crown Copyright © 2009

Pregnant women and health professional's perceptions of complementary alternative medicine, and participation in a randomised controlled trial of acupressure for labour onset

© 2016 Elsevier Ltd. Feasibility randomised controlled trials of complementary medicine are important to evaluate acceptability and practicality. This study examined participants' and health professionals' perceptions of CAM and participation in a feasibility RCT of acupressure for labour onset. Methods: A qualitative study incorporated within an RCT. Data were collected from postnatal women via questionnaires and health professionals via focus groups. Results: Four themes emerged from the women's views: "Using CAM to start labour", "Feeling empowered through action", "Desiring randomisation to acupressure group", and "Welcoming the opportunity to assist in research". Five themes emerged from the health professionals' views: "Personal awareness and attitudes towards CAM" "Supporting and empowering women" "Complements the wellness model of pregnancy and childbirth" "Need for evidenced based practice" and "Randomisation 'doing it on the sly'". Conclusions: Themes from the groups were similar. The study protocol will be refined with a placebo group to improve equipoise with a powered RCT planned

A feasibility randomised controlled trial of acupressure to assist spontaneous labour for primigravid women experiencing a post-date pregnancy

© 2016 Elsevier Ltd. Objective: this Australian feasibility study aimed to determine; the willingness of women experiencing a post-date pregnancy to participate in a randomised controlled trial (RCT) of acupressure and compliance with the study protocol. The study also aimed to determine the effect size of the primary outcome in order to calculate a sample size for a future appropriately powered RCT. Design: a two-arm randomised controlled trial. Staff providing clinical care were blinded to group allocation unless the participant disclosed study participation. Setting: maternity services at two outer metropolitan public hospitals in New South Wales, Australia. Participants: sixty seven healthy primigravid women experiencing a singleton cephalic pregnancy at 40 weeks±2 days gestation were assessed as eligible to participate and were provided with study information. Intervention: both groups received standard clinical care, with the intervention group also receiving verbal and written instructions on the self-administration of three acupoints (Spleen 6, Large Intestine 4, and Gall Bladder 21) to be used until spontaneous or induced labour began. Measurements: assessment of feasibility included determining recruitment rate and acceptability of an RCT for a CAM modality, and acupressure treatment compliance, via participant surveys. The primary clinical outcome was spontaneous onset of labour. Findings: from the 67 women eligible during the timeframe for the study, 44 women (65.6%) agreed to participate and were randomised. There was no statistically significant difference in rate of spontaneous onset of labour (50% acupressure vs 41% control). Twenty nine participant surveys were returned (65.9%). In the intervention group there was a high compliance with the acupressure protocol (83%) and the use of the three acupoints (94%). Conclusions and implications for practice: this feasibility study revealed that pregnant women are interested in the use of CAM, and acupressure in particular, for the initiation of labour. Most women found it acceptable to be randomised to receive the intervention. While the 9% difference in the primary outcome was not statistically significant it is the best estimate of the treatment effect for calculating a sample size of 994 for a future RCT with 80% power, alpha 0.05. Trial registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ANZCTR:12613000145707

Midwives knowledge and education/training in complementary and alternative medicine (CAM): A national survey

Despite the proliferation of research exploring complementary and alternative medicine (CAM) use in maternity care and midwifery practice, there is a gap on midwives’ level of CAM knowledge and education/training. This national survey investigated Australian midwives’ knowledge and education/training in CAM. A total of 571 midwives completed the survey (16%). Over half (54.3%) had some level of CAM education/ training (self-learning to diploma) and with multiple CAM modalities. The top four modalities that midwives had received education/training were acupressure (66.5%), aromatherapy (60.3%), massage (45.5%), and reflexology (37.7%). There was a significant correlation between midwives attending a CAM workshop with competency-assessment (p < 0.000) and confidence to discuss CAM options with pregnant women compared with participants who have not. There are no other health-related therapies used by women consumers with such frequency where clinicians are not expected to have baseline knowledge and understanding. Midwifery education programs need to include evidence-based information on CAM modalities