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What can be done to increase the duration of breastfeeding?
Posters is the best way forwards? Is there one approach, one policy that will fit every country? The aim of this study is to compare and evaluate the health policy positions across Cambodia, Thailand, Malaysia and Sri Lanka as they relate to maternal mortality and the provision of midwifery services. Thailand, Malaysia and Sri Lanka have drastically reduced their maternal mortality ratio in recent times. Whilst it might be simplistic to assume that what has worked in one country may be helpful in another, it may be of benefit to consider the emerging themes and similarities that arise between these countries. In this study I have focused on textual papers that highlight the strategies that have decreased maternal mortality rates in these four countries. Maternal mortality is defined as death resulting either directly during pregnancy or childbirth or indirectly as a result of complications of either pregnancy or childbirth. It is a leading cause of death and disability among women in low income countries. It is estimated that worldwide each year more than 500,000 women die during pregnancy or childbirth, and at least 10 million women suffer injuries, infection and disabilities. Evidence suggests that increasing the number of births overseen by skilled birth attendants is the single most effective means of decreasing the maternal mortality rate. There are many policy papers and reports from countries such as Cambodia, Thailand, Malaysia and Sri Lanka, around these issues of safer motherhood. My hope with this review is to address the current policy issues that impact on maternal mortality, and highlight the most effective strategies — what has actually worked. There are implications for us as midwives, as we tackle this unacceptable burden for many women and their families around the world. doi:10.1016/j.wombi.2011.07.131 Exploring the structure and organisation of home-based postnatal care in Victoria Helen McLachlan a,∗ , Della Forster a,b , Rachael Ford b,c , Heather McKay c , Tanya Farrell b a
La Trobe University, Victoria, Australia The Royal Women’s Hospital, Victoria, Australia c Mother and Child Health Research, Victoria, Australia b
Background: In Australia, the length of hospital stay after childbirth has declined dramatically since the 1980s, and women are being discharged earlier than ever before. For women in the public sector, the Victorian Government funds one or two postnatal midwifery home visits; however, there has been little investigation into home-based postnatal care, and consequently there is little evidence to guide the planning or future development of postnatal domiciliary care, particularly within the context of Australia’s public hospital system. In addition, there is minimal exploration of maternity managers’ views and experiences of home-based care, and little systematic investigation into the content of homebased care. Collectively such research is crucial because home-based postnatal care is an important component of postnatal care provision now and into the future. Aim: To explore the organisation and structure of homebased postnatal care within the Victorian public hospital system. This study is one component of a broader review
S41 of home-based postnatal care which also includes the experiences of midwives and women. Method: This cross sectional study will use an online survey (comprising predominantly closed-ended questions) sent to the managers of maternity units in all Victorian public hospitals that provide postnatal care (anticipated number ? 69). Findings: The survey which will be distributed in December 2010, will investigate home-based postnatal care provision including: delivery of service, staffing, staff training and education, documentation, and practices. Results will be presented at the conference. Implications/relevance: The findings will help contribute to the evidence-gap regarding home-based postnatal care, and help inform hospital managers and policy makers about home-based care. The results will assist in the planning and development of more effective postnatal services in the future. doi:10.1016/j.wombi.2011.07.132 What can be done to increase the duration of breastfeeding? Shahla Meedya St George Hospital, Sydney, NSW, Australia Problem: Australia has a high rate of breastfeeding initiation (80—90%) but it drops off rapidly after discharge from hospital. Approximately 50% of women continue any breastfeeding up to six months which compares unfavourably with WHO recommendation of exclusive breastfeeding for the first six months of life. Purpose: This presentation will outline a midwifeprovided ante and post natal educational intervention for pregnant woman and their partners aimed at increasing duration of breastfeeding which is the subject of a large comparative trial. Method: Medline, CINAHL, Maternity and Infant Care, and Cochrane Databases were searched. The review of the research literature focused on potentially modifiable factors where there was good evidence of their positive association with prolonged breastfeeding. Findings: There are three key modifiable factors that are positively associated with breastfeeding duration: (a) the woman’s breastfeeding intention, (b) her perception of her breastfeeding self-efficacy and (c) her social support. Some interventional studies address these key modifiable factors individually but until now none have addressed all three factors simultaneously. Key limitations of existing interventional studies include: (a) using an educational intervention that is based on psychological theories which ignore the embodied nature of pregnancy and breastfeedings; (b) limiting the educational intervention to one session only; (c) lack of quality control of the intervention; (d) excluding partners from the groups; and (e) failing to focus the intervention on all three key factors at the same time. Conclusion: A promising way to increase breastfeeding duration is currently being researched via prospective trial. Midwifery theories aimed at optimising women’s psychophysiology have been added to the standard ‘self-efficacy’
S42 theory. The current educational program simultaneously works at enhancing women’s breastfeeding intention; embodied awareness, inner power, self-efficacy and social support. The midwife-provided educational intervention also addresses the identified key limitations.
Posters Exploring the ‘follow-through experience’: a survey of Victorian midwifery students and academics Michelle Newton a,∗ , Helen McLachlan a,b , Jane Morrow b,c , Gina Kruger d , Helen Nightingale a a
doi:10.1016/j.wombi.2011.07.133 Can we improve women’s satisfaction with postnatal care? Implementing and evaluating individualised postnatal care and caseload midwifery using a before and after design Jane Morrow a,∗ , Della Forster b,c , Helen McLachlan b , Mary-Ann Davey d , Arthur Hseuh b , Therese Cotter e , Kim Layton e a
Australian Catholic University, Victoria, Australia La Trobe University, Victoria, Australia c The Royal Women’s Hospital, Victoria, Australia d Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Victoria, Australia e Barwon Health, Victoria, Australia b
Background: Women have consistently rated postnatal care less favourably that antenatal and intrapartum care. In 2008, an Australian regional hospital introduced two major changes to maternity care provision. These included (1) the introduction of individualised, evidence-based postnatal care early in 2008 (including removing routine observations on ‘normal’ women; promoting self care; and minimising disturbances before 0900 h); and (2) a caseload model of care (MGP) six months later to provide women with a known carer throughout pregnancy, birth and postnatally. Method: Cross-sectional postal surveys were administered six months postpartum to women birthing prior to the changes, then to a second group of women following the changes to postnatal care, and to a third group following the introduction of caseload midwifery. Results: Response fractions were 49% (251/511) at baseline (TP1), 43% (230/536) four months after the postnatal changes (TP2); and 42% (289/680) ten months after the introduction of MGP (TP3). Following the changes, there were no differences in specific or global measures of various aspects of postnatal care, and few differences by parity. However, women reported improved opportunities for sleep and rest (45% compared with 58%; p = 0.002) and also feeling better prepared for parenting (59% compared to 67%; p = 0.05). Women were significantly more likely to say their length of postnatal stay was ‘‘about right’’ at all time points if it had been a joint decision with the care providers (p = 0.01). There were no differences in women’s rating of domiciliary care across the surveys, and no difference by model of care or parity. Conclusions: Improvements in women’s satisfaction with postnatal care were not found in this study despite the implementation of major changes to postnatal care provision. The complexity and challenges in improving women’s experiences of postnatal care remain. doi:10.1016/j.wombi.2011.07.134
School of Nursing & Midwifery, La Trobe University, Bundoora, Australia b Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia c Australian Catholic University, Melbourne, Victoria, Australia d Victoria University, St Albans, Victoria, Australia Background: Follow-through experiences (FTEs) (which enable midwifery students to experience continuity with individual women through pregnancy, labour and birth and the postnatal period) are a component of midwifery education programs in Australia. Although there is good evidence of the benefit of continuity of care for women, some concerns have been raised about the impact of FTEs on student attrition, paid employment and university attendance. The recently approved Australian Nursing & Midwifery Council Standards and Criteria for the Accreditation of Nursing & Midwifery Courses Leading to Registration, Enrolment, Endorsement and Authorisation for midwives stipulates that all midwifery students have 20 continuity of care experiences with an average of 20 h per woman. The aim of this study is to explore the impact of FTEs from the perspective of Victorian midwifery students and academics. Method: Using a web-based tool, Victorian midwifery students and academics from all universities that offer midwifery in Victoria (including Bachelor of Midwifery, Bachelor of Nursing/Bachelor of Midwifery double degree and Postgraduate Diploma of Midwifery) will be surveyed regarding various aspects of FTEs. Findings: Surveys will be administered in early 2011 and results will be presented at the conference. The findings will provide a significantly stronger evidence base to help inform the national midwifery curricula and the education standards for student midwives in Australia. doi:10.1016/j.wombi.2011.07.135 Antenatal education—–moving the goal posts! Joanne O’Callaghan, Julie Graham Partner of babeSense, NSW, Australia Background: With the set-up of a holistic multidisciplinary private practice a visionary obstetrician allowed for the conglomeration of specialist fetal medicine services and the dawning of a personalised and innovative antenatal education program. The education provided by midwives builds on support networks for those attending. Purpose: To provide an innovative service with endless possibilities of breaking the constraints of traditional education boundaries, and demonstrates that dreams and, reaching for the stars can become a reality for midwives. Aim: To showcase an alternative antenatal education program that provides a personal touch.
La Trobe University, Victoria, Australia The Royal Women’s Hospital, Victoria, Australia c Mother and Child Health Research, Victoria, Australia b
Background: In Australia, the length of hospital stay after childbirth has declined dramatically since the 1980s, and women are being discharged earlier than ever before. For women in the public sector, the Victorian Government funds one or two postnatal midwifery home visits; however, there has been little investigation into home-based postnatal care, and consequently there is little evidence to guide the planning or future development of postnatal domiciliary care, particularly within the context of Australia’s public hospital system. In addition, there is minimal exploration of maternity managers’ views and experiences of home-based care, and little systematic investigation into the content of homebased care. Collectively such research is crucial because home-based postnatal care is an important component of postnatal care provision now and into the future. Aim: To explore the organisation and structure of homebased postnatal care within the Victorian public hospital system. This study is one component of a broader review
S41 of home-based postnatal care which also includes the experiences of midwives and women. Method: This cross sectional study will use an online survey (comprising predominantly closed-ended questions) sent to the managers of maternity units in all Victorian public hospitals that provide postnatal care (anticipated number ? 69). Findings: The survey which will be distributed in December 2010, will investigate home-based postnatal care provision including: delivery of service, staffing, staff training and education, documentation, and practices. Results will be presented at the conference. Implications/relevance: The findings will help contribute to the evidence-gap regarding home-based postnatal care, and help inform hospital managers and policy makers about home-based care. The results will assist in the planning and development of more effective postnatal services in the future. doi:10.1016/j.wombi.2011.07.132 What can be done to increase the duration of breastfeeding? Shahla Meedya St George Hospital, Sydney, NSW, Australia Problem: Australia has a high rate of breastfeeding initiation (80—90%) but it drops off rapidly after discharge from hospital. Approximately 50% of women continue any breastfeeding up to six months which compares unfavourably with WHO recommendation of exclusive breastfeeding for the first six months of life. Purpose: This presentation will outline a midwifeprovided ante and post natal educational intervention for pregnant woman and their partners aimed at increasing duration of breastfeeding which is the subject of a large comparative trial. Method: Medline, CINAHL, Maternity and Infant Care, and Cochrane Databases were searched. The review of the research literature focused on potentially modifiable factors where there was good evidence of their positive association with prolonged breastfeeding. Findings: There are three key modifiable factors that are positively associated with breastfeeding duration: (a) the woman’s breastfeeding intention, (b) her perception of her breastfeeding self-efficacy and (c) her social support. Some interventional studies address these key modifiable factors individually but until now none have addressed all three factors simultaneously. Key limitations of existing interventional studies include: (a) using an educational intervention that is based on psychological theories which ignore the embodied nature of pregnancy and breastfeedings; (b) limiting the educational intervention to one session only; (c) lack of quality control of the intervention; (d) excluding partners from the groups; and (e) failing to focus the intervention on all three key factors at the same time. Conclusion: A promising way to increase breastfeeding duration is currently being researched via prospective trial. Midwifery theories aimed at optimising women’s psychophysiology have been added to the standard ‘self-efficacy’
S42 theory. The current educational program simultaneously works at enhancing women’s breastfeeding intention; embodied awareness, inner power, self-efficacy and social support. The midwife-provided educational intervention also addresses the identified key limitations.
Posters Exploring the ‘follow-through experience’: a survey of Victorian midwifery students and academics Michelle Newton a,∗ , Helen McLachlan a,b , Jane Morrow b,c , Gina Kruger d , Helen Nightingale a a
doi:10.1016/j.wombi.2011.07.133 Can we improve women’s satisfaction with postnatal care? Implementing and evaluating individualised postnatal care and caseload midwifery using a before and after design Jane Morrow a,∗ , Della Forster b,c , Helen McLachlan b , Mary-Ann Davey d , Arthur Hseuh b , Therese Cotter e , Kim Layton e a
Australian Catholic University, Victoria, Australia La Trobe University, Victoria, Australia c The Royal Women’s Hospital, Victoria, Australia d Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Victoria, Australia e Barwon Health, Victoria, Australia b
Background: Women have consistently rated postnatal care less favourably that antenatal and intrapartum care. In 2008, an Australian regional hospital introduced two major changes to maternity care provision. These included (1) the introduction of individualised, evidence-based postnatal care early in 2008 (including removing routine observations on ‘normal’ women; promoting self care; and minimising disturbances before 0900 h); and (2) a caseload model of care (MGP) six months later to provide women with a known carer throughout pregnancy, birth and postnatally. Method: Cross-sectional postal surveys were administered six months postpartum to women birthing prior to the changes, then to a second group of women following the changes to postnatal care, and to a third group following the introduction of caseload midwifery. Results: Response fractions were 49% (251/511) at baseline (TP1), 43% (230/536) four months after the postnatal changes (TP2); and 42% (289/680) ten months after the introduction of MGP (TP3). Following the changes, there were no differences in specific or global measures of various aspects of postnatal care, and few differences by parity. However, women reported improved opportunities for sleep and rest (45% compared with 58%; p = 0.002) and also feeling better prepared for parenting (59% compared to 67%; p = 0.05). Women were significantly more likely to say their length of postnatal stay was ‘‘about right’’ at all time points if it had been a joint decision with the care providers (p = 0.01). There were no differences in women’s rating of domiciliary care across the surveys, and no difference by model of care or parity. Conclusions: Improvements in women’s satisfaction with postnatal care were not found in this study despite the implementation of major changes to postnatal care provision. The complexity and challenges in improving women’s experiences of postnatal care remain. doi:10.1016/j.wombi.2011.07.134
School of Nursing & Midwifery, La Trobe University, Bundoora, Australia b Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia c Australian Catholic University, Melbourne, Victoria, Australia d Victoria University, St Albans, Victoria, Australia Background: Follow-through experiences (FTEs) (which enable midwifery students to experience continuity with individual women through pregnancy, labour and birth and the postnatal period) are a component of midwifery education programs in Australia. Although there is good evidence of the benefit of continuity of care for women, some concerns have been raised about the impact of FTEs on student attrition, paid employment and university attendance. The recently approved Australian Nursing & Midwifery Council Standards and Criteria for the Accreditation of Nursing & Midwifery Courses Leading to Registration, Enrolment, Endorsement and Authorisation for midwives stipulates that all midwifery students have 20 continuity of care experiences with an average of 20 h per woman. The aim of this study is to explore the impact of FTEs from the perspective of Victorian midwifery students and academics. Method: Using a web-based tool, Victorian midwifery students and academics from all universities that offer midwifery in Victoria (including Bachelor of Midwifery, Bachelor of Nursing/Bachelor of Midwifery double degree and Postgraduate Diploma of Midwifery) will be surveyed regarding various aspects of FTEs. Findings: Surveys will be administered in early 2011 and results will be presented at the conference. The findings will provide a significantly stronger evidence base to help inform the national midwifery curricula and the education standards for student midwives in Australia. doi:10.1016/j.wombi.2011.07.135 Antenatal education—–moving the goal posts! Joanne O’Callaghan, Julie Graham Partner of babeSense, NSW, Australia Background: With the set-up of a holistic multidisciplinary private practice a visionary obstetrician allowed for the conglomeration of specialist fetal medicine services and the dawning of a personalised and innovative antenatal education program. The education provided by midwives builds on support networks for those attending. Purpose: To provide an innovative service with endless possibilities of breaking the constraints of traditional education boundaries, and demonstrates that dreams and, reaching for the stars can become a reality for midwives. Aim: To showcase an alternative antenatal education program that provides a personal touch.