Sue Kildea - Academia.edu (original) (raw)

Papers by Sue Kildea

Journal of Child Health Care, 2013

Bronchiolitis is a major cause of children's admission to hospital. The study aim was to describe... more Bronchiolitis is a major cause of children's admission to hospital. The study aim was to describe the experiences of parents who had, or nurses who cared for, a child admitted to hospital for severe bronchiolitis requiring oxygen therapy. A descriptive phenomenological approach was used to interview 12 mothers and 12 nurses. The findings were clustered into three domains: fear, parentchild interaction and technical caring. The mothers found the experience to be extremely frightening, based on their fear that their child could die. This was compounded by their lack of knowledge and understanding about what was happening and their inability to fulfil their mothering role. Although nurses recognised that parents were anxious, they did not seem to appreciate fully the depth of fear and emotion that mothers were experiencing and tended to describe procedural aspects of their role. The mothers' relationship with their child was focused upon physical contact and the desire to comfort their child. Their ability to do so was significantly impacted upon by the method of oxygen delivery to their child. For nurses, although they recognised the psychosocial dimension, their emphasis was on health and safety aspects of oxygen therapy, both for the child and themselves.

Faculty of Health Institute of Health and Biomedical Innovation School of Public Health Social Work, Jan 12, 2013

In response to an identified need, a specialist antenatal clinic for women from refugee backgroun... more In response to an identified need, a specialist antenatal clinic for women from refugee backgrounds was introduced in 2008, with an evaluation planned and completed in 2010. Can maternity care experiences for women from refugee backgrounds, attending a specialist antenatal clinic in a tertiary Australian public hospital, be improved? The evaluation employed mixed methods, generating qualitative and quantitative data from two hospital databases, a chart audit, surveys and interviews with service users, providers and stakeholders. Contributions were received from 202 participants. The clinic was highly regarded by all participants. Continuity of care throughout the antenatal period was particularly valued by newly arrived women as it afforded them security and support to negotiate an unfamiliar Western maternity system. Positive experiences decreased however; as women transitioned from the clinic to labour and postnatal wards where they reported that their traditional birthing and recuperative practices were often interrupted by the imposition of Western biomedical notions of appropriate care. The centrally located clinic was problematic, frequently requiring complex travel arrangements. Appointment schedules often impacted negatively on traditional spousal and family obligations. Providing comprehensive and culturally responsive maternity care for women from refugee backgrounds is achievable, however it is also resource intensive. The production of translated information which is high quality in terms of production and content, whilst also taking account of languages which are only rarely encountered, is problematic. Cultural competency programmes for staff, ideally online, require regular updating in light of new knowledge and changing political sensitivities.

Women and Birth, 2015

Caesarean delivery rates have increased in Australia over the last decade creating new challenges... more Caesarean delivery rates have increased in Australia over the last decade creating new challenges for breastfeeding mothers and caregivers. The advantages of breastfeeding are well recognised, however breastfeeding problems are common. Review of the literature revealed limited qualitative research relating to the experience of women having difficulties breastfeeding after caesarean section under regional anaesthesia. This study aimed to fill that gap in the literature. Participants were women referred to the hospital Breastfeeding Support Centre with difficulty initiating and establishing breastfeeding. The methodology employed was interpretive phenomenology and purposeful sampling. Data was analysed using van Manen's hermeneutical circular process. Themes identified included Unnatural birth, Natural instincts compromised, Helping mothers to mother and Sabotage and defeat. These themes elicited ten subthemes which were interpreted and reflected upon to reveal key findings. These findings included the emotional and physical effects of the delivery and anaesthetic, the lack of true skin to skin contact, separation of mother and baby, inconsistent information, inadequate support, unnecessary formula supplementation and feelings of failure. Key recommendations included increasing skin to skin contact after caesarean section to support the natural instincts of mother and baby, increasing education on possible effects of surgical delivery on breastfeeding and increasing postnatal breastfeeding support for this group of women. Broader issues of inadequate staffing and a changing postnatal dynamic reflecting increased post-surgical care need further exploration.

The Australian journal of holistic nursing

Birth, 2015

Background: Across Australia there are substantial disparities in uptake of antenatal testing for... more Background: Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. Methods: In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation sampling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. Results: Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%); almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. Discussion: The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs. (BIRTH 2015)

Midwifery, 2015

to explore back pain in labour from the perspectives of women and midwives. a qualitative study, ... more to explore back pain in labour from the perspectives of women and midwives. a qualitative study, which generated data through individual semi-structured interviews with postnatal women and focus groups with midwives. Data were analysed thematically. two metropolitan maternity units in Queensland, Australia. nine postnatal women and 11 midwives, all of whom had participated in a randomized controlled trial investigating the use of sterile water injections for back pain in labour. two major themes were identified, including back pain in labour: accounts, rationalisations and coping strategies, and fetal position: destabilising the Occipito Posterior-back pain discourse. back pain may be severe in labour, may impact negatively upon women׳s labour and birth experiences, and interfere with their ability to cope as planned. The assumed relationship between fetal position and back pain in labour is a dominant discourse, albeit one which is lacking in empirical credibility. Nonetheless, the information provided to women by maternity professionals tended to reiterate customary practices and beliefs rather than factual knowledge. Increasingly, women refer to other sources, which may challenge the information provided by health professionals. Back pain in labour is an under-researched area and the lack of solid evidence underpinning the advice provided to women has implications for labour management, and possibly for maternal and fetal outcomes. Care providers might usefully consider back pain as multifactorial, not always associated with OP position, and continue to seek evidence-based management strategies which address women׳s needs.

Journal of Neonatal Nursing, 2015

ABSTRACT Research has highlighted transitioning to the new design may be challenging for staff. T... more ABSTRACT Research has highlighted transitioning to the new design may be challenging for staff. To facilitate the transition to a new NICU we have searched literature to find strategies other units have implemented during their transition.

BMC Pregnancy & Childbirth, 2015

Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increa... more Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care.

International Journal of Nursing Studies, 2015

Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to th... more Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to the neonatal intensive care unit, low birth weight infants, and artificial feeding. To determine if caseload midwifery or young women's clinic are associated with improved perinatal outcomes when compared to standard care. A retrospective cohort study. A tertiary Australian hospital where routine maternity care is delivered alongside two community-based maternity care models specifically for young women aged 21 years or less: caseload midwifery (known midwife) and young women's clinic (rostered midwife). All pregnant women aged 21 years or less, with a singleton pregnancy, who attended a minimum of two antenatal visits, and who birthed a baby (without congenital abnormality) at the study hospital during May 2008 to December 2012. Caseload midwifery and young women's clinic were each compared to standard maternity care, but not with each other, for four primary outcomes: preterm birth (<37 weeks gestation), low birth weight infants (<2500g), neonatal intensive care unit admission, and breastfeeding initiation. Two analyses were performed on the primary outcomes to examine potential associations between maternity care type and perinatal outcomes: intention-to-treat (model of care at booking) and treatment-received (model of care on admission for labour/birth). 1908 births were analysed by intention-to-treat and treatment-received analyses. Young women allocated to caseload care at booking, compared to standard care, were less likely to have a preterm birth (adjusted odds ratio 0.59 (0.38-0.90, p=0.014)) or a neonatal intensive care unit admission adjusted odds ratio 0.42 (0.22-0.82, p=0.010). Rates of low birth weight infants and breastfeeding initiation were similar between caseload and standard care participants. Participants allocated to young women's clinic at booking, compared to standard care, were less likely to have a low birth weight infant adjusted odds ratio 0.49 (0.24-1.00, p=0.049), however when analysed by treatment-received, this finding was not significant. There was no difference in the other primary outcomes. Young women who were allocated to caseload midwifery at booking, and/or were receiving caseload midwifery at the time of admission for birth, were less likely to experience preterm birth and neonatal intensive care unit admission.

Women and birth : journal of the Australian College of Midwives, Jan 3, 2015

Evidence suggests the closure of maternity units is associated with an increase in babies born be... more Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA). To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives. A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time. During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, p<0.001 and Queensland, r=0.917, n=20 years, p<0.001 and this was negatively co...

Midwifery, Jan 28, 2015

caseload midwifery and CenteringPregnancy™ (a form of group antenatal care) are two models of mat... more caseload midwifery and CenteringPregnancy™ (a form of group antenatal care) are two models of maternity care that are separately associated with better clinical outcomes, maternal satisfaction scores and positive experiences compared to standard care. One study reported exclusively on younger women׳s experiences of caseload midwifery; none described younger women׳s experiences of group antenatal care. We retrieved no studies on the experiences of women who received a combination of caseload midwifery and group antenatal care. examine younger women׳s experiences of caseload midwifery in a setting that incorporates group antenatal care. a critical, focused ethnographic approach. the study was conducted in an Australian hospital and its associated community venue from 2011 to 2013. purposive sampling of younger (19-22 years) pregnant and postnatal women (n=10) and the caseload midwives (n=4) who provided group antenatal care within one midwifery group practice. separate focus group int...

Rural and remote health

The closure of rural maternity units in Australia means an increasing number of women are transfe... more The closure of rural maternity units in Australia means an increasing number of women are transferred into major centres to await birth. Accurately excluding the onset of labour could delay relocation. The fetal fibronectin (fFN) test is used to predict preterm birth; however, the accuracy of this test for determining impending term birth is unclear. 75 women were recruited to this study from<strong> </strong>two remote maternity units. Eligibility criteria were: aged #8805;18 years, singleton pregnancy, 37+0-40+3 weeks (37 weeks to 40 weeks and 3 days gestation) and no indication for induction of labour or caesarean section in next 7 days. The Quikcheck fFN® test was performed at 37 weeks and then repeated at 7 day intervals. Time-to-birth from test date was modelled using linear regression. Logistic regression models estimated odds of birth within 7 days. Separate models considered first and last test results and those at 38 weeks; adjusted for use of lubricant and...

Rural and remote health

The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants ar... more The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants are significantly poorer than they are for other Australians; they worsen with increasing remoteness where the provision of services becomes more challenging. Australia has committed to 'Overcoming Indigenous Disadvantage' and 'Closing the Gap' in health outcomes. Fifty-five per cent of Aboriginal and Torres Strait Islander birthing women live in outer regional and remote areas and suffer some of the worst health outcomes in the country. Not all of these women are receiving care from a skilled provider, antenatally, in birth or postnatally while the role of midwives in reducing maternal and newborn mortality and morbidity is under-utilised. The practice of relocating women for birth does not address their cultural needs or self-identified risks and is contributing to these outcomes. An evidence based approach for the provision of maternity services in these areas is require...

The Medical journal of Australia, Jan 2, 2007

Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the ... more Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under-reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000-2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994-2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia.

Journal of Child Health Care, 2013

Bronchiolitis is a major cause of children's admission to hospital. The study aim was to describe... more Bronchiolitis is a major cause of children's admission to hospital. The study aim was to describe the experiences of parents who had, or nurses who cared for, a child admitted to hospital for severe bronchiolitis requiring oxygen therapy. A descriptive phenomenological approach was used to interview 12 mothers and 12 nurses. The findings were clustered into three domains: fear, parentchild interaction and technical caring. The mothers found the experience to be extremely frightening, based on their fear that their child could die. This was compounded by their lack of knowledge and understanding about what was happening and their inability to fulfil their mothering role. Although nurses recognised that parents were anxious, they did not seem to appreciate fully the depth of fear and emotion that mothers were experiencing and tended to describe procedural aspects of their role. The mothers' relationship with their child was focused upon physical contact and the desire to comfort their child. Their ability to do so was significantly impacted upon by the method of oxygen delivery to their child. For nurses, although they recognised the psychosocial dimension, their emphasis was on health and safety aspects of oxygen therapy, both for the child and themselves.

Faculty of Health Institute of Health and Biomedical Innovation School of Public Health Social Work, Jan 12, 2013

In response to an identified need, a specialist antenatal clinic for women from refugee backgroun... more In response to an identified need, a specialist antenatal clinic for women from refugee backgrounds was introduced in 2008, with an evaluation planned and completed in 2010. Can maternity care experiences for women from refugee backgrounds, attending a specialist antenatal clinic in a tertiary Australian public hospital, be improved? The evaluation employed mixed methods, generating qualitative and quantitative data from two hospital databases, a chart audit, surveys and interviews with service users, providers and stakeholders. Contributions were received from 202 participants. The clinic was highly regarded by all participants. Continuity of care throughout the antenatal period was particularly valued by newly arrived women as it afforded them security and support to negotiate an unfamiliar Western maternity system. Positive experiences decreased however; as women transitioned from the clinic to labour and postnatal wards where they reported that their traditional birthing and recuperative practices were often interrupted by the imposition of Western biomedical notions of appropriate care. The centrally located clinic was problematic, frequently requiring complex travel arrangements. Appointment schedules often impacted negatively on traditional spousal and family obligations. Providing comprehensive and culturally responsive maternity care for women from refugee backgrounds is achievable, however it is also resource intensive. The production of translated information which is high quality in terms of production and content, whilst also taking account of languages which are only rarely encountered, is problematic. Cultural competency programmes for staff, ideally online, require regular updating in light of new knowledge and changing political sensitivities.

Women and Birth, 2015

Caesarean delivery rates have increased in Australia over the last decade creating new challenges... more Caesarean delivery rates have increased in Australia over the last decade creating new challenges for breastfeeding mothers and caregivers. The advantages of breastfeeding are well recognised, however breastfeeding problems are common. Review of the literature revealed limited qualitative research relating to the experience of women having difficulties breastfeeding after caesarean section under regional anaesthesia. This study aimed to fill that gap in the literature. Participants were women referred to the hospital Breastfeeding Support Centre with difficulty initiating and establishing breastfeeding. The methodology employed was interpretive phenomenology and purposeful sampling. Data was analysed using van Manen&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hermeneutical circular process. Themes identified included Unnatural birth, Natural instincts compromised, Helping mothers to mother and Sabotage and defeat. These themes elicited ten subthemes which were interpreted and reflected upon to reveal key findings. These findings included the emotional and physical effects of the delivery and anaesthetic, the lack of true skin to skin contact, separation of mother and baby, inconsistent information, inadequate support, unnecessary formula supplementation and feelings of failure. Key recommendations included increasing skin to skin contact after caesarean section to support the natural instincts of mother and baby, increasing education on possible effects of surgical delivery on breastfeeding and increasing postnatal breastfeeding support for this group of women. Broader issues of inadequate staffing and a changing postnatal dynamic reflecting increased post-surgical care need further exploration.

The Australian journal of holistic nursing

Birth, 2015

Background: Across Australia there are substantial disparities in uptake of antenatal testing for... more Background: Across Australia there are substantial disparities in uptake of antenatal testing for fetal anomalies, with very low uptake observed among Aboriginal women. The reasons behind these disparities are unclear, although poorer access to testing has been reported in some communities. We interviewed health care practitioners to explore the perceived barriers to providing fetal anomaly screening to Aboriginal women. Methods: In 2009 and 2010, in-depth interviews were undertaken with 59 practitioners in five urban and remote sites across the Northern Territory (NT) of Australia. Data were analyzed thematically. Maximum variation sampling, independent review of findings by multiple analysts, and participant feedback were undertaken to strengthen the validity of findings. Results: Participants included midwives (47%), Aboriginal health practitioners (AHP) (32%), general practitioners (12%), and obstetricians (9%); almost all (95%) were female. Participants consistently reported difficulties counseling women. Explaining the concept of "risk" (of abnormalities and the screening test result) was identified as particularly challenging, because of a perceived lack of an equivalent concept in Aboriginal languages. While AHPs could assist with overcoming language barriers, they are underutilized. Participants also identified impediments to organizing testing including difficulties establishing gestational age, late presentation for care, and a lack of standardized information and training. Discussion: The availability of fetal anomaly testing is challenged by communication difficulties, including a focus on culturally specific biomedical concepts, and organizational barriers to arranging testing. Developing educational activities that address the technical aspects of screening and communication skills will assist in improving access. These activities must include AHPs. (BIRTH 2015)

Midwifery, 2015

to explore back pain in labour from the perspectives of women and midwives. a qualitative study, ... more to explore back pain in labour from the perspectives of women and midwives. a qualitative study, which generated data through individual semi-structured interviews with postnatal women and focus groups with midwives. Data were analysed thematically. two metropolitan maternity units in Queensland, Australia. nine postnatal women and 11 midwives, all of whom had participated in a randomized controlled trial investigating the use of sterile water injections for back pain in labour. two major themes were identified, including back pain in labour: accounts, rationalisations and coping strategies, and fetal position: destabilising the Occipito Posterior-back pain discourse. back pain may be severe in labour, may impact negatively upon women׳s labour and birth experiences, and interfere with their ability to cope as planned. The assumed relationship between fetal position and back pain in labour is a dominant discourse, albeit one which is lacking in empirical credibility. Nonetheless, the information provided to women by maternity professionals tended to reiterate customary practices and beliefs rather than factual knowledge. Increasingly, women refer to other sources, which may challenge the information provided by health professionals. Back pain in labour is an under-researched area and the lack of solid evidence underpinning the advice provided to women has implications for labour management, and possibly for maternal and fetal outcomes. Care providers might usefully consider back pain as multifactorial, not always associated with OP position, and continue to seek evidence-based management strategies which address women׳s needs.

Journal of Neonatal Nursing, 2015

ABSTRACT Research has highlighted transitioning to the new design may be challenging for staff. T... more ABSTRACT Research has highlighted transitioning to the new design may be challenging for staff. To facilitate the transition to a new NICU we have searched literature to find strategies other units have implemented during their transition.

BMC Pregnancy & Childbirth, 2015

Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increa... more Retrospective studies suggest that maternal exposure to a severe stressor during pregnancy increases the fetus' risk for a variety of disorders in adulthood. Animal studies testing the fetal programming hypothesis find that maternal glucocorticoids pass through the placenta and alter fetal brain development, particularly the hypothalamic-pituitary-adrenal axis. However, there are no prospective studies of pregnant women exposed to a sudden-onset independent stressor that elucidate the biopsychosocial mechanisms responsible for the wide variety of consequences of prenatal stress seen in human offspring. The aim of the QF2011 Queensland Flood Study is to fill this gap, and to test the buffering effects of Midwifery Group Practice, a form of continuity of maternity care.

International Journal of Nursing Studies, 2015

Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to th... more Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to the neonatal intensive care unit, low birth weight infants, and artificial feeding. To determine if caseload midwifery or young women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinic are associated with improved perinatal outcomes when compared to standard care. A retrospective cohort study. A tertiary Australian hospital where routine maternity care is delivered alongside two community-based maternity care models specifically for young women aged 21 years or less: caseload midwifery (known midwife) and young women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinic (rostered midwife). All pregnant women aged 21 years or less, with a singleton pregnancy, who attended a minimum of two antenatal visits, and who birthed a baby (without congenital abnormality) at the study hospital during May 2008 to December 2012. Caseload midwifery and young women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinic were each compared to standard maternity care, but not with each other, for four primary outcomes: preterm birth (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;37 weeks gestation), low birth weight infants (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;2500g), neonatal intensive care unit admission, and breastfeeding initiation. Two analyses were performed on the primary outcomes to examine potential associations between maternity care type and perinatal outcomes: intention-to-treat (model of care at booking) and treatment-received (model of care on admission for labour/birth). 1908 births were analysed by intention-to-treat and treatment-received analyses. Young women allocated to caseload care at booking, compared to standard care, were less likely to have a preterm birth (adjusted odds ratio 0.59 (0.38-0.90, p=0.014)) or a neonatal intensive care unit admission adjusted odds ratio 0.42 (0.22-0.82, p=0.010). Rates of low birth weight infants and breastfeeding initiation were similar between caseload and standard care participants. Participants allocated to young women&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s clinic at booking, compared to standard care, were less likely to have a low birth weight infant adjusted odds ratio 0.49 (0.24-1.00, p=0.049), however when analysed by treatment-received, this finding was not significant. There was no difference in the other primary outcomes. Young women who were allocated to caseload midwifery at booking, and/or were receiving caseload midwifery at the time of admission for birth, were less likely to experience preterm birth and neonatal intensive care unit admission.

Women and birth : journal of the Australian College of Midwives, Jan 3, 2015

Evidence suggests the closure of maternity units is associated with an increase in babies born be... more Evidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA). To explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives. A retrospective study utilised routinely collected perinatal data (1992-2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time. During 1992-2011, the absolute numbers (N=22,814) of women having a BBA each year in Australia increased by 47% (N=836-1233); and 206% (n=140-429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N=623-368=18 per year) and a 28% reduction in Queensland (n=129-93). BBA rates increased significantly across Australia, r=0.837, n=20 years, p<0.001 and Queensland, r=0.917, n=20 years, p<0.001 and this was negatively co...

Midwifery, Jan 28, 2015

caseload midwifery and CenteringPregnancy™ (a form of group antenatal care) are two models of mat... more caseload midwifery and CenteringPregnancy™ (a form of group antenatal care) are two models of maternity care that are separately associated with better clinical outcomes, maternal satisfaction scores and positive experiences compared to standard care. One study reported exclusively on younger women׳s experiences of caseload midwifery; none described younger women׳s experiences of group antenatal care. We retrieved no studies on the experiences of women who received a combination of caseload midwifery and group antenatal care. examine younger women׳s experiences of caseload midwifery in a setting that incorporates group antenatal care. a critical, focused ethnographic approach. the study was conducted in an Australian hospital and its associated community venue from 2011 to 2013. purposive sampling of younger (19-22 years) pregnant and postnatal women (n=10) and the caseload midwives (n=4) who provided group antenatal care within one midwifery group practice. separate focus group int...

Rural and remote health

The closure of rural maternity units in Australia means an increasing number of women are transfe... more The closure of rural maternity units in Australia means an increasing number of women are transferred into major centres to await birth. Accurately excluding the onset of labour could delay relocation. The fetal fibronectin (fFN) test is used to predict preterm birth; however, the accuracy of this test for determining impending term birth is unclear. 75 women were recruited to this study from<strong> </strong>two remote maternity units. Eligibility criteria were: aged #8805;18 years, singleton pregnancy, 37+0-40+3 weeks (37 weeks to 40 weeks and 3 days gestation) and no indication for induction of labour or caesarean section in next 7 days. The Quikcheck fFN® test was performed at 37 weeks and then repeated at 7 day intervals. Time-to-birth from test date was modelled using linear regression. Logistic regression models estimated odds of birth within 7 days. Separate models considered first and last test results and those at 38 weeks; adjusted for use of lubricant and...

Rural and remote health

The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants ar... more The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants are significantly poorer than they are for other Australians; they worsen with increasing remoteness where the provision of services becomes more challenging. Australia has committed to 'Overcoming Indigenous Disadvantage' and 'Closing the Gap' in health outcomes. Fifty-five per cent of Aboriginal and Torres Strait Islander birthing women live in outer regional and remote areas and suffer some of the worst health outcomes in the country. Not all of these women are receiving care from a skilled provider, antenatally, in birth or postnatally while the role of midwives in reducing maternal and newborn mortality and morbidity is under-utilised. The practice of relocating women for birth does not address their cultural needs or self-identified risks and is contributing to these outcomes. An evidence based approach for the provision of maternity services in these areas is require...

The Medical journal of Australia, Jan 2, 2007

Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the ... more Maternal mortality associated with psychiatric illness in the perinatal period (pregnancy to the end of the first year postpartum) has until recently been under-reported in Australia due to limitations in the scope of the data collection and methods of detection. The recent United Kingdom report Why mothers die 2000-2002 identified psychiatric illness as the leading cause of maternal death in the UK. Findings from the last three reports on maternal deaths in Australia (covering the period 1994-2002) suggest that maternal psychiatric illness is one of the leading causes of maternal death, with the majority of suicides occurring by violent means. Such findings strengthen the case for routine perinatal psychosocial screening programs, with clear referral guidelines and assertive perinatal treatment of significant maternal psychiatric morbidity. Data linkage studies are needed to measure the full extent of maternal mortality associated with psychiatric illness in Australia.