- Email: [email protected]
Developing reflective capacities in midwifery students
Abstracts / Women and Birth 30(S1) (2017) 1–47
P10
P11
High rates of breastfeeding exclusivity and duration amongst Australian Breastfeeding Association volunteer counsellors and community educators: The evidence
Midwives perceived role in supporting women with perinatal depression
Susan Tawia 1,∗ , Elizabeth McGuire 1 , Cate Bailey 2 , Jennifer James 3 1 Australian Breastfeeding Association, Melbourne, Victoria, Australia 2 Deakin University, Melbourne, Victoria, Australia 3 RMIT University, Melbourne, Victoria, Australia
Introduction: Breastfeeding rates in Australia are low and current strategies to increase breastfeeding rates are inadequate. A different approach to supporting women to breastfeed is required. In 2008, a marketing survey of Australian Breastfeeding Association (ABA) members suggested that, at around 5 to 6 months, exclusive breastfeeding rates were much higher than those of the general Australian population, 46% compared to 21%. More research is required to determine what factors enabled women to breastfeed optimally, especially to breastfeed exclusively to around 6 months. ABA is uniquely placed to research why some women breastfeed their infants according to health recommendations, but others do not. Aim: The EMBER project provided an opportunity to identify whether specific maternal characteristics, experiences or events (including during pregnancy and birth) influenced breastfeeding outcomes, both breastfeeding exclusivity and duration. Methods: Breastfeeding-related data was obtained from lactation histories collected when women applied to train with ABA. The lactation histories collected both quantitative and qualitative data. From 2014–2015, trainee applicants were invited to participate in the EMBER project and 174 applicants agreed to make their lactation histories available to the team of researchers from ABA and RMIT University. Ethics approval (ASEHAPP 41-14) was obtained from RMIT University, Melbourne, Australia. Results: Women in the EMBER project had very high levels of exclusive breastfeeding to around 6 months and long durations of breastfeeding in comparison to the general Australian population. The characteristics, experiences or events, which may explain their better breastfeeding outcomes, were determined and will be presented. Conclusion and implications: EMBER women were on track with WHO recommendations to exclusively breastfeed for 6 months and to continue to breastfeed for two years or more. Identifying the maternal characteristics, experiences or events that related to better breastfeeding outcomes, and supporting the broader community to adopt them where possible, could be powerful methods to produce change. http://dx.doi.org/10.1016/j.wombi.2017.08.106
41
Dianne Hurt 1,∗ , Maralyn Foureur 1 , Cathrine Fowler 1,2 1
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia 2 Tresillian Family Care Centre, New South Wales, Australia Introduction: Around 15% of childbearing women in Australia experience perinatal depression. Midwives are in an ideal position to identify women either experiencing or at risk of perinatal depression and are in the front line of providing care for these women and their families. However, the midwife’s scope of practice is often limited to identifying and referring on women with particular needs with some midwives expressing concern at their lack of knowledge, confidence and skills related to perinatal depression. There is a lack of understanding of the ability of midwives in this aspect of practice. Aim: To investigate and make visible the confidence, skills and knowledge of midwives in identifying and supporting women with perinatal depression, using the lens of Appreciative Inquiry. Methods: A qualitative descriptive design using the four-stage appreciative inquiry model is being employed. Twelve midwives from three participating public and private hospitals in one Local Health District in NSW volunteered to participate in individual, in-depth interviews to explore their experience of working with women with perinatal depression. Appreciative Inquiry will be used as a theoretical lens to lead the thematic analysis of the interview transcripts. Hunter New England and UTS Human Research Ethics Committees provided ethical approval. Results: Data analysis has revealed three main themes: Midwives have hidden talents; supporting families; doing more than required. Conclusion and implications: Increasing midwives’ knowledge, skill and confidence will enable midwives to make a difference in the lives of women with perinatal depression; as well as alleviating the stigma of depression: thereby enhancing the wellbeing of future generations. http://dx.doi.org/10.1016/j.wombi.2017.08.107 P12 Developing reflective capacities in midwifery students Linda Sweet 1,∗ , Janice Bass 2 , Kristen Graham 1 , Mary Sidebotham 2 , Jenny Fenwick 2 1
Flinders University of South Australia, South Australia, Australia 2 Griffith University, Queensland, Australia Introduction: The capacity to reflect underpins professional judgement and ethical awareness and is an essential part of professional midwifery life. Developing reflective capacities is therefore an important, but often overlooked component of curriculum. At Flinders University, students’ capacity to reflect is demonstrated through writing at the completion of a workplace based model known as Continuity of Care Experiences (COCE). It was evident that much of the students’ writing was descriptive rather than reflective, providing poor evidence of their reflective capacity.
42
Abstracts / Women and Birth 30(S1) (2017) 1–47
Aim: This project sought to improve student’s capacity to reflect on practice through written reflections on the COCE. The project is funded through an Office of Learning and Teaching program grant. Methods: A mixed-method education design research approach was used. Students were provided with guidance and support on how to use the Holistic Reflection Model to structure their written reflections. During a 12-month period students written reflections completed before and after the introduction of the model were evaluated using a rubric. In addition, focus group discussions were conducted across all three-year levels to explore student’s perceptions of how they developed their reflective capacities. Results: Students valued the holistic reflection model as it gave guidance and structure for their reflective thinking and writing. Overtime, some students began to adapt the model and develop their own style of reflection. The introduction of the model made a significant improvement in the written reflections for the COCE across all years. Conclusion and implications: The project has demonstrated that the use of a structured model of reflection guides and enables students to demonstrate their capacity to reflect on practice through their writing. http://dx.doi.org/10.1016/j.wombi.2017.08.108 P13 Taking off the training wheels: transitioning from hospital-based practice to independent practice Hilary Karry Griffith University, Queensland, Australia Newly emerging clinicians, such as myself, may rely heavily on guidelines and policies, as we gain confidence in clinical practice. Multiple social, political and environmental factors can inhibit our ability to provide evidence-based, woman-centred care in hospital. This can be a significant source of frustration to midwives and women alike. Private practice midwives work in an entirely different context, and therefore moving from hospital to private practise requires a significant transition for midwives. As a midwife transitioning to private practice, I have identified four driving factors which have compelled me towards being a more woman-centred, evidence-based clinician: 1. 2. 3. 4.
The increased scrutiny upon independent midwives, the increased freedom, the women, and personal motivators.
These have led to me examining the evidence underpinning current recommendations, challenged my beliefs and assumptions, highlighted areas where I require additional professional development, pushed me to investigate current research, as well as demonstrated my personal biases. I have been pushed out of my comfort zone and to the limits of my knowledge on multiple occasions–and enjoyed the developments these have brought me as a woman and a midwife. This presentation will be an examination of the driving forces which have shaped my personal transition from hospital midwife to independent practitioner. I hope this will help other midwives thinking about getting into private practice. http://dx.doi.org/10.1016/j.wombi.2017.08.109
P14 Professional identity; conflict between professional ideologies Michelle Gray University of the Sunshine Coast, Queensland, Australia Aim: This study investigated Australian midwives’ responses to the commencement of a national registration process, of particular interest was the response of midwives to the introduction of a separate midwifery register and changes in conditions for annual registration renewal particularly requirements relating to Recency of Practice (RoP) and Continuing Professional Development (CPD). Methods: Ethical approval was provided for a longitudinal case study of midwives across the two initial annual registration renewal cycles following the changes. Data were collected in 2, individual interviews conducted with a purposive sample of twenty midwives drawn from four Australian states. A focus group of four midwives from a fifth state was used to corroborate the preliminary findings which were generated using a thematic analysis procedure. Findings: Findings revealed constructions of a dichotomy of identities between practice roles. These identities exemplified specific practice activities, places and roles to illustrate how competence for registration renewal could be validated. The picture of complexities around practice, roles, and midwifery professional identity influenced midwives’ decision-making around registration renewal processes. Implications: The midwives’ decisions following the changes have had potential significance for individual practitioners, the midwifery profession and maternity services in Australia more generally. The revealed perceptions of identity pose potential implications on the future workforce and direction of maternity services in Australia. http://dx.doi.org/10.1016/j.wombi.2017.08.110 P15 YES - Yoga ESpecially for Mums by Midwives: A pilot research study exploring a new antenatal pedagogy Stacey Enchelmaier ∗ , Beth Hartley, Lauren Kearney Sunshine Coast Hospital and Health Service, Women and Families Service Group, University of the Sunshine Coast, Queenland, Australia Introduction: Yoga during pregnancy is popular in Australia, with some public health services now offer pregnancy yoga during the antenatal period. No published research has explored this within a midwife-led antenatal education model and the clinical outcomes this may affect. The delineation of midwives as teachers makes this a vastly separate and highly original innovative approach from commercially accessible prenatal yoga classes. Aim: The aim of this research study was to trial a midwifeled antenatal yoga program to complement standard antenatal care, and as an alternative to mainstream childbirth education classes. Midwives are expert in teaching women about their breath, baby, body, labour, birth, positions and coping skills to assist them throughout the perinatal continuum, including pregnancy, labour and birth, and the transition to parenthood. The null hypothesis was that there would be no difference between women who attend
P10
P11
High rates of breastfeeding exclusivity and duration amongst Australian Breastfeeding Association volunteer counsellors and community educators: The evidence
Midwives perceived role in supporting women with perinatal depression
Susan Tawia 1,∗ , Elizabeth McGuire 1 , Cate Bailey 2 , Jennifer James 3 1 Australian Breastfeeding Association, Melbourne, Victoria, Australia 2 Deakin University, Melbourne, Victoria, Australia 3 RMIT University, Melbourne, Victoria, Australia
Introduction: Breastfeeding rates in Australia are low and current strategies to increase breastfeeding rates are inadequate. A different approach to supporting women to breastfeed is required. In 2008, a marketing survey of Australian Breastfeeding Association (ABA) members suggested that, at around 5 to 6 months, exclusive breastfeeding rates were much higher than those of the general Australian population, 46% compared to 21%. More research is required to determine what factors enabled women to breastfeed optimally, especially to breastfeed exclusively to around 6 months. ABA is uniquely placed to research why some women breastfeed their infants according to health recommendations, but others do not. Aim: The EMBER project provided an opportunity to identify whether specific maternal characteristics, experiences or events (including during pregnancy and birth) influenced breastfeeding outcomes, both breastfeeding exclusivity and duration. Methods: Breastfeeding-related data was obtained from lactation histories collected when women applied to train with ABA. The lactation histories collected both quantitative and qualitative data. From 2014–2015, trainee applicants were invited to participate in the EMBER project and 174 applicants agreed to make their lactation histories available to the team of researchers from ABA and RMIT University. Ethics approval (ASEHAPP 41-14) was obtained from RMIT University, Melbourne, Australia. Results: Women in the EMBER project had very high levels of exclusive breastfeeding to around 6 months and long durations of breastfeeding in comparison to the general Australian population. The characteristics, experiences or events, which may explain their better breastfeeding outcomes, were determined and will be presented. Conclusion and implications: EMBER women were on track with WHO recommendations to exclusively breastfeed for 6 months and to continue to breastfeed for two years or more. Identifying the maternal characteristics, experiences or events that related to better breastfeeding outcomes, and supporting the broader community to adopt them where possible, could be powerful methods to produce change. http://dx.doi.org/10.1016/j.wombi.2017.08.106
41
Dianne Hurt 1,∗ , Maralyn Foureur 1 , Cathrine Fowler 1,2 1
Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia 2 Tresillian Family Care Centre, New South Wales, Australia Introduction: Around 15% of childbearing women in Australia experience perinatal depression. Midwives are in an ideal position to identify women either experiencing or at risk of perinatal depression and are in the front line of providing care for these women and their families. However, the midwife’s scope of practice is often limited to identifying and referring on women with particular needs with some midwives expressing concern at their lack of knowledge, confidence and skills related to perinatal depression. There is a lack of understanding of the ability of midwives in this aspect of practice. Aim: To investigate and make visible the confidence, skills and knowledge of midwives in identifying and supporting women with perinatal depression, using the lens of Appreciative Inquiry. Methods: A qualitative descriptive design using the four-stage appreciative inquiry model is being employed. Twelve midwives from three participating public and private hospitals in one Local Health District in NSW volunteered to participate in individual, in-depth interviews to explore their experience of working with women with perinatal depression. Appreciative Inquiry will be used as a theoretical lens to lead the thematic analysis of the interview transcripts. Hunter New England and UTS Human Research Ethics Committees provided ethical approval. Results: Data analysis has revealed three main themes: Midwives have hidden talents; supporting families; doing more than required. Conclusion and implications: Increasing midwives’ knowledge, skill and confidence will enable midwives to make a difference in the lives of women with perinatal depression; as well as alleviating the stigma of depression: thereby enhancing the wellbeing of future generations. http://dx.doi.org/10.1016/j.wombi.2017.08.107 P12 Developing reflective capacities in midwifery students Linda Sweet 1,∗ , Janice Bass 2 , Kristen Graham 1 , Mary Sidebotham 2 , Jenny Fenwick 2 1
Flinders University of South Australia, South Australia, Australia 2 Griffith University, Queensland, Australia Introduction: The capacity to reflect underpins professional judgement and ethical awareness and is an essential part of professional midwifery life. Developing reflective capacities is therefore an important, but often overlooked component of curriculum. At Flinders University, students’ capacity to reflect is demonstrated through writing at the completion of a workplace based model known as Continuity of Care Experiences (COCE). It was evident that much of the students’ writing was descriptive rather than reflective, providing poor evidence of their reflective capacity.
42
Abstracts / Women and Birth 30(S1) (2017) 1–47
Aim: This project sought to improve student’s capacity to reflect on practice through written reflections on the COCE. The project is funded through an Office of Learning and Teaching program grant. Methods: A mixed-method education design research approach was used. Students were provided with guidance and support on how to use the Holistic Reflection Model to structure their written reflections. During a 12-month period students written reflections completed before and after the introduction of the model were evaluated using a rubric. In addition, focus group discussions were conducted across all three-year levels to explore student’s perceptions of how they developed their reflective capacities. Results: Students valued the holistic reflection model as it gave guidance and structure for their reflective thinking and writing. Overtime, some students began to adapt the model and develop their own style of reflection. The introduction of the model made a significant improvement in the written reflections for the COCE across all years. Conclusion and implications: The project has demonstrated that the use of a structured model of reflection guides and enables students to demonstrate their capacity to reflect on practice through their writing. http://dx.doi.org/10.1016/j.wombi.2017.08.108 P13 Taking off the training wheels: transitioning from hospital-based practice to independent practice Hilary Karry Griffith University, Queensland, Australia Newly emerging clinicians, such as myself, may rely heavily on guidelines and policies, as we gain confidence in clinical practice. Multiple social, political and environmental factors can inhibit our ability to provide evidence-based, woman-centred care in hospital. This can be a significant source of frustration to midwives and women alike. Private practice midwives work in an entirely different context, and therefore moving from hospital to private practise requires a significant transition for midwives. As a midwife transitioning to private practice, I have identified four driving factors which have compelled me towards being a more woman-centred, evidence-based clinician: 1. 2. 3. 4.
The increased scrutiny upon independent midwives, the increased freedom, the women, and personal motivators.
These have led to me examining the evidence underpinning current recommendations, challenged my beliefs and assumptions, highlighted areas where I require additional professional development, pushed me to investigate current research, as well as demonstrated my personal biases. I have been pushed out of my comfort zone and to the limits of my knowledge on multiple occasions–and enjoyed the developments these have brought me as a woman and a midwife. This presentation will be an examination of the driving forces which have shaped my personal transition from hospital midwife to independent practitioner. I hope this will help other midwives thinking about getting into private practice. http://dx.doi.org/10.1016/j.wombi.2017.08.109
P14 Professional identity; conflict between professional ideologies Michelle Gray University of the Sunshine Coast, Queensland, Australia Aim: This study investigated Australian midwives’ responses to the commencement of a national registration process, of particular interest was the response of midwives to the introduction of a separate midwifery register and changes in conditions for annual registration renewal particularly requirements relating to Recency of Practice (RoP) and Continuing Professional Development (CPD). Methods: Ethical approval was provided for a longitudinal case study of midwives across the two initial annual registration renewal cycles following the changes. Data were collected in 2, individual interviews conducted with a purposive sample of twenty midwives drawn from four Australian states. A focus group of four midwives from a fifth state was used to corroborate the preliminary findings which were generated using a thematic analysis procedure. Findings: Findings revealed constructions of a dichotomy of identities between practice roles. These identities exemplified specific practice activities, places and roles to illustrate how competence for registration renewal could be validated. The picture of complexities around practice, roles, and midwifery professional identity influenced midwives’ decision-making around registration renewal processes. Implications: The midwives’ decisions following the changes have had potential significance for individual practitioners, the midwifery profession and maternity services in Australia more generally. The revealed perceptions of identity pose potential implications on the future workforce and direction of maternity services in Australia. http://dx.doi.org/10.1016/j.wombi.2017.08.110 P15 YES - Yoga ESpecially for Mums by Midwives: A pilot research study exploring a new antenatal pedagogy Stacey Enchelmaier ∗ , Beth Hartley, Lauren Kearney Sunshine Coast Hospital and Health Service, Women and Families Service Group, University of the Sunshine Coast, Queenland, Australia Introduction: Yoga during pregnancy is popular in Australia, with some public health services now offer pregnancy yoga during the antenatal period. No published research has explored this within a midwife-led antenatal education model and the clinical outcomes this may affect. The delineation of midwives as teachers makes this a vastly separate and highly original innovative approach from commercially accessible prenatal yoga classes. Aim: The aim of this research study was to trial a midwifeled antenatal yoga program to complement standard antenatal care, and as an alternative to mainstream childbirth education classes. Midwives are expert in teaching women about their breath, baby, body, labour, birth, positions and coping skills to assist them throughout the perinatal continuum, including pregnancy, labour and birth, and the transition to parenthood. The null hypothesis was that there would be no difference between women who attend