- Email: [email protected]
Making a mutual difference
S52
ACM2015 Poster Presentations / Women and Birth 28S (2015) S39–S56
[P21] Does hypertension in pregnancy impact the woman’s mental health? Lynne Roberts 1,*, Caroline S.E. Homer 2, Gregory K. Davis 1 1
Women’s and Children’s Health St George Hospital, Sydney, Australia University of Technology Sydney, Sydney, Australia *Corresponding author. 2
Introduction: Pregnancy and childbirth may lead to increased rates of depression, anxiety and posttraumatic stress disorder (PTSD) in women and the likelihood may be greater for those who have perinatal complications. There is some evidence that hypertension in pregnancy (HIP) might be linked to depression, anxiety and PTSD symptoms. However, it is uncertain whether the cause of the mental health problem is the hypertensive disorder, the sequelae of this complication (eg. preterm birth, baby requiring specialised care) or whether these issues pre-dated the pregnancy. We are undertaking a prospective study to explore this issue. Aim: To identify women who may have increased risk of depression, anxiety and PTSD following the birth of their baby. Methods: Eligible, consenting women who had either hypertension (gestational or preeclampsia) or normal blood pressure in pregnancy, complete the Edinburgh Postnatal Depression scale (EPDS),the General Anxiety Disorder scale and the Post-traumatic Stress Diagnostic Scale at 6months postpartum. Results: 136 women have completed the questionnaires, 31 had HIP. The women with HIP scored slightly higher than the normotensive group in all domains. EPDS score >12 in 10% versus 6%, moderate anxiety reported by 7% versus 4%, and PTSD symptoms reported by 55% versus 38%. In both groups, 3% met PTSD criteria, however all were unrelated to the pregnancy or birth experience. Conclusion: The study is in early stages but potentially suggests more mental health problems in the HIP group. If this effect continues, the antenatal and postnatal care a woman receives for HIP should also focus on mental health issues not only physical health. http://dx.doi.org/10.1016/j.wombi.2015.07.164 [P51] Making a mutual difference Laura Robertson * King Edward Memorial Hospital, Perth, Australia *Corresponding author. The Visiting Midwifery Service (VMS) of King Edward Memorial Hospital (KEMH) in Perth serves around 6000 birthing women per year. We see women from all walks of life, entering their lives and homes for a few days offering midwifery continuity of care after their births in our highly medicalised setting. There is a satisfying richness in providing the care in the home, which allows the time to cover all the bases. We debrief their births, sit on their beds, help them to learn how to communicate with their babies, meet their families, laugh and cry with them, and see living culture. We witness maturation and growth, and take some of it away with us. The breadth of complexity we cover in a single day with families in our care is unpredictable and extensive. These women and their families experience the time-honoured challenges of mothering, and provide stories of an ever-changing society. We visiting
midwives are a small team, with our own real lives. We share the joys, sorrows, fears and hopes of women in our care. We have a deep wealth of skills, resources, and compassion that make a difference to those we serve. The connection we have with women enriches us daily as we walk along with them. This not tick-box midwifery from a tertiary setting. Come and hear the stories from a day in the lives of the visiting midwives and learn about the richness that makes a difference to both women and professionals. Our care matters, to the lives of us all. http://dx.doi.org/10.1016/j.wombi.2015.07.165 [P22] POstnatal Processes and PathwaYs (POPPY): A study investigating postnatal pathways and care for women and their babies in NSW Virginia Schmied 1,*, Elaine Burns 1, Hannah Dahlen 1, Joanne Curry 1, Deborah Matha 2, Catherine Price 3, Anne McKenzie 4 1
University of Western Sydney, Sydney, Australia NSW Kids and Families, Sydney, Australia 3 Liverpool Hospital Maternity Services, Sydney, Australia 4 South Western Sydney Local Health District, Community Health, Sydney, Australia *Corresponding author. 2
Introduction: For over a decade, research has reported the limitations of postnatal services in addressing the needs of women and families. Length of postnatal stay has continued to decrease and some, but not all, women receive home-based midwifery support for one to two weeks after birth. Most women see multiple care providers. Women have reported low level of satisfaction with postnatal care, yet there have been few attempts to understand the components of care women find helpful and to improve this service. Aim: To report on the findings of the Postnatal Processes and Pathways (POPPY) study which aims to map the postnatal care pathways for women and their newborns at low risk for health complications during in-hospital and community-based maternity care. Methods: We are using Essomenic, a novel ‘patient journey’ (‘woman and newborn’ journey) modelling tool, to map all aspects of the postnatal journey including interactions between women and midwives/services, communication between staff and with other services; care documentation and administrative processes in hospital and the community. Data collection includes: (1) workshops with 30 midwives, midwifery consultants, managers, and child and family health nurses; (2) activity diaries completed by 20 women from birth to two weeks postpartum and one-to-one telephone interviews with these women and (3) 50 h of observation of care in the postnatal unit and at home. Results: Workshop data has been modeled using the Essomenic tool identifying service duplication and gaps, particularly relating to breastfeeding support. In March to April this year we will add to the Essomenic visual model women’s diary and interview data and data from observations of care and estimate costs of current pathways. This model of the current postnatal journey will be presented. Implications: Opportunities for service innovation and redesign will be discussed. http://dx.doi.org/10.1016/j.wombi.2015.07.166
ACM2015 Poster Presentations / Women and Birth 28S (2015) S39–S56
[P21] Does hypertension in pregnancy impact the woman’s mental health? Lynne Roberts 1,*, Caroline S.E. Homer 2, Gregory K. Davis 1 1
Women’s and Children’s Health St George Hospital, Sydney, Australia University of Technology Sydney, Sydney, Australia *Corresponding author. 2
Introduction: Pregnancy and childbirth may lead to increased rates of depression, anxiety and posttraumatic stress disorder (PTSD) in women and the likelihood may be greater for those who have perinatal complications. There is some evidence that hypertension in pregnancy (HIP) might be linked to depression, anxiety and PTSD symptoms. However, it is uncertain whether the cause of the mental health problem is the hypertensive disorder, the sequelae of this complication (eg. preterm birth, baby requiring specialised care) or whether these issues pre-dated the pregnancy. We are undertaking a prospective study to explore this issue. Aim: To identify women who may have increased risk of depression, anxiety and PTSD following the birth of their baby. Methods: Eligible, consenting women who had either hypertension (gestational or preeclampsia) or normal blood pressure in pregnancy, complete the Edinburgh Postnatal Depression scale (EPDS),the General Anxiety Disorder scale and the Post-traumatic Stress Diagnostic Scale at 6months postpartum. Results: 136 women have completed the questionnaires, 31 had HIP. The women with HIP scored slightly higher than the normotensive group in all domains. EPDS score >12 in 10% versus 6%, moderate anxiety reported by 7% versus 4%, and PTSD symptoms reported by 55% versus 38%. In both groups, 3% met PTSD criteria, however all were unrelated to the pregnancy or birth experience. Conclusion: The study is in early stages but potentially suggests more mental health problems in the HIP group. If this effect continues, the antenatal and postnatal care a woman receives for HIP should also focus on mental health issues not only physical health. http://dx.doi.org/10.1016/j.wombi.2015.07.164 [P51] Making a mutual difference Laura Robertson * King Edward Memorial Hospital, Perth, Australia *Corresponding author. The Visiting Midwifery Service (VMS) of King Edward Memorial Hospital (KEMH) in Perth serves around 6000 birthing women per year. We see women from all walks of life, entering their lives and homes for a few days offering midwifery continuity of care after their births in our highly medicalised setting. There is a satisfying richness in providing the care in the home, which allows the time to cover all the bases. We debrief their births, sit on their beds, help them to learn how to communicate with their babies, meet their families, laugh and cry with them, and see living culture. We witness maturation and growth, and take some of it away with us. The breadth of complexity we cover in a single day with families in our care is unpredictable and extensive. These women and their families experience the time-honoured challenges of mothering, and provide stories of an ever-changing society. We visiting
midwives are a small team, with our own real lives. We share the joys, sorrows, fears and hopes of women in our care. We have a deep wealth of skills, resources, and compassion that make a difference to those we serve. The connection we have with women enriches us daily as we walk along with them. This not tick-box midwifery from a tertiary setting. Come and hear the stories from a day in the lives of the visiting midwives and learn about the richness that makes a difference to both women and professionals. Our care matters, to the lives of us all. http://dx.doi.org/10.1016/j.wombi.2015.07.165 [P22] POstnatal Processes and PathwaYs (POPPY): A study investigating postnatal pathways and care for women and their babies in NSW Virginia Schmied 1,*, Elaine Burns 1, Hannah Dahlen 1, Joanne Curry 1, Deborah Matha 2, Catherine Price 3, Anne McKenzie 4 1
University of Western Sydney, Sydney, Australia NSW Kids and Families, Sydney, Australia 3 Liverpool Hospital Maternity Services, Sydney, Australia 4 South Western Sydney Local Health District, Community Health, Sydney, Australia *Corresponding author. 2
Introduction: For over a decade, research has reported the limitations of postnatal services in addressing the needs of women and families. Length of postnatal stay has continued to decrease and some, but not all, women receive home-based midwifery support for one to two weeks after birth. Most women see multiple care providers. Women have reported low level of satisfaction with postnatal care, yet there have been few attempts to understand the components of care women find helpful and to improve this service. Aim: To report on the findings of the Postnatal Processes and Pathways (POPPY) study which aims to map the postnatal care pathways for women and their newborns at low risk for health complications during in-hospital and community-based maternity care. Methods: We are using Essomenic, a novel ‘patient journey’ (‘woman and newborn’ journey) modelling tool, to map all aspects of the postnatal journey including interactions between women and midwives/services, communication between staff and with other services; care documentation and administrative processes in hospital and the community. Data collection includes: (1) workshops with 30 midwives, midwifery consultants, managers, and child and family health nurses; (2) activity diaries completed by 20 women from birth to two weeks postpartum and one-to-one telephone interviews with these women and (3) 50 h of observation of care in the postnatal unit and at home. Results: Workshop data has been modeled using the Essomenic tool identifying service duplication and gaps, particularly relating to breastfeeding support. In March to April this year we will add to the Essomenic visual model women’s diary and interview data and data from observations of care and estimate costs of current pathways. This model of the current postnatal journey will be presented. Implications: Opportunities for service innovation and redesign will be discussed. http://dx.doi.org/10.1016/j.wombi.2015.07.166