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Perineal research in New Zealand midwifery practice
ACM2015 Oral Presentations / Women and Birth 28S (2015) S7–S32
examining this new phenomenon of the interaction between women and birth through this technological interface that gives direct access to the birthing room experience. http://dx.doi.org/10.1016/j.wombi.2015.07.044 [O12] ‘Expecting and connecting’: Evaluation of a collaborative antenatal service Lauren Kearney 1, Alison Craswell 2,*, Rachel Reed 3 1
University of the Sunshine Coast, Queensland, Australia University of Wollongong, Wollongong, Australia 3 Independent Midwife and Lecturer, Australia *Corresponding author. 2
Introduction: A midwifery-led, group antenatal care service, ‘Expecting and Connecting’, was established in 2013 at the Sunshine Coast on the campus of the local University, in collaboration with the local health service. Based on the Centering Pregnancy model, the service incorporates antenatal health care, education and peer-to-peer support delivered via group facilitation. A key aspect of the service is the integration of midwifery students and midwifery academics as part of the team providing care, specifically in the context of the continuity of care clinical experience requirements of their midwifery education. Methods: A two-phase mixed methods study design was undertaken to evaluate the program. Qualitative data were collected from students, midwives and mothers engaged with the service regarding their experience and perceptions of ‘Expecting and Connecting’. The second phase (ongoing casecontrol study) examines clinical outcomes between ‘Expecting and Connecting’ and standard hospital care, specifically caesarean section, preterm and low birth weight, pain relief used in labour, mode of birth and breastfeeding exclusivity and duration. Results: Preliminary qualitative findings are overwhelmingly positive with all participants agreeing on the value of the service and a desire for it to continue and expand. Emergent themes around expansion of role, women centred care and student learning align with other literature in this area. Quantitative analysis of a matched cohort set (case-control study) will also be presented examining health outcomes. Conclusions: The implications of these findings for policy makers are that community based group antenatal care is both desired and achievable. It also provides important insight into the student learning experience within this context, specifically in the domain of the continuity of care requirements for their midwifery degree. http://dx.doi.org/10.1016/j.wombi.2015.07.045
[O13] Perineal research in New Zealand midwifery practice Robin Cronin Victoria University of Wellington, Wellington, New Zealand Introduction: Management of perineal trauma after a normal birth in New Zealand is ordinarily a midwifery responsibility, although there is no formal requirement for midwives to update their perineal knowledge, and little is known about midwives’ perineal care.
S11
Aim: To report on part of a survey that was designed to identify midwives management of second degree perineal trauma, influences on their practice, and the level to which their practice reflects best evidence. Methods: A descriptive approach using an online survey was used to access the population of 2910 New Zealand midwives providing current perineal management in 2013; 744 (25%) met the inclusion criteria. Quantitative data were collected and associations examined using chi-square and Fisher’s exact test. Results: The presentation will identify midwives’ management of the last second degree tear treated. New Zealand midwifery practice compared favourably to overseas research and perineal morbidity was uncommon, however, there is potential for improvement with respect to rectal examination, suturing technique throughout all layers of repair, choice of analgesia, and documentation of repair. Training in perineal repair within the last two years, reported by 54% of midwives, was associated with an increased likelihood of evidence-based suturing techniques (p = 0.002), rectal examination during assessment of trauma (p = 0.019), improved perineal documentation (consent for treatment, p = 0.005; discussion of care, p = 0.005; diagram of tear, p = 0.007) and visualisation of healing (p = 0.014). Conclusion: The majority of New Zealand midwives make appropriate professional judgements in regard to the management of second degree perineal trauma. However, maternal postnatal health could be enhanced if midwives increased their use of evidence-based perineal practice, which is more likely after they have received recent education in perineal management. http://dx.doi.org/10.1016/j.wombi.2015.07.046 [O14] The effect of waterbirth on neonatal mortality and morbidity Rowena Davies 1,2,*, Deborah Davis 1,2, Melissa Pearce 2,3, Nola Wong 2,3 1
University of Canberra, Canberra, Australia The Australian Capital Regional Centre for Evidence Based Midwifery, Canberra, Australia 3 Centenary Hospital for Women and Children, Canberra, Australia *Corresponding author. 2
Introduction: The practice of waterbirth remains controversial. Professional guidelines argue there is insufficient evidence available to guide waterbirth practice and consider waterbirth an experimental procedure. Much of the criticism directed at waterbirth focuses on the potential impact to the neonate. Aim: To systematically review the evidence regarding the effect of waterbirth, compared to landbirth, on the mortality and morbidity of neonates born to low risk women. Methods: This review considered randomised controlled trials and observational studies, assessing eligible studies for quality using Joanna Briggs Institute appraisal instruments. Outcomes measured included: mortality, resuscitation or respiratory distress syndrome, infection, APGAR scores at 1, 5 and 10 min, admission to Neonatal Intensive Care or Special Care Nurseries, cord pH values, cord avulsion, hyponatremia, hypoxic ischemic encephalopathy and injury. Results: Meta-analysis of 5 min Apgar scores showed statistically significant results favouring waterbirth. This varied from 1 min Apgar score which favoured landbirth, however results should be interpreted with caution. Data measuring cord pH were
examining this new phenomenon of the interaction between women and birth through this technological interface that gives direct access to the birthing room experience. http://dx.doi.org/10.1016/j.wombi.2015.07.044 [O12] ‘Expecting and connecting’: Evaluation of a collaborative antenatal service Lauren Kearney 1, Alison Craswell 2,*, Rachel Reed 3 1
University of the Sunshine Coast, Queensland, Australia University of Wollongong, Wollongong, Australia 3 Independent Midwife and Lecturer, Australia *Corresponding author. 2
Introduction: A midwifery-led, group antenatal care service, ‘Expecting and Connecting’, was established in 2013 at the Sunshine Coast on the campus of the local University, in collaboration with the local health service. Based on the Centering Pregnancy model, the service incorporates antenatal health care, education and peer-to-peer support delivered via group facilitation. A key aspect of the service is the integration of midwifery students and midwifery academics as part of the team providing care, specifically in the context of the continuity of care clinical experience requirements of their midwifery education. Methods: A two-phase mixed methods study design was undertaken to evaluate the program. Qualitative data were collected from students, midwives and mothers engaged with the service regarding their experience and perceptions of ‘Expecting and Connecting’. The second phase (ongoing casecontrol study) examines clinical outcomes between ‘Expecting and Connecting’ and standard hospital care, specifically caesarean section, preterm and low birth weight, pain relief used in labour, mode of birth and breastfeeding exclusivity and duration. Results: Preliminary qualitative findings are overwhelmingly positive with all participants agreeing on the value of the service and a desire for it to continue and expand. Emergent themes around expansion of role, women centred care and student learning align with other literature in this area. Quantitative analysis of a matched cohort set (case-control study) will also be presented examining health outcomes. Conclusions: The implications of these findings for policy makers are that community based group antenatal care is both desired and achievable. It also provides important insight into the student learning experience within this context, specifically in the domain of the continuity of care requirements for their midwifery degree. http://dx.doi.org/10.1016/j.wombi.2015.07.045
[O13] Perineal research in New Zealand midwifery practice Robin Cronin Victoria University of Wellington, Wellington, New Zealand Introduction: Management of perineal trauma after a normal birth in New Zealand is ordinarily a midwifery responsibility, although there is no formal requirement for midwives to update their perineal knowledge, and little is known about midwives’ perineal care.
S11
Aim: To report on part of a survey that was designed to identify midwives management of second degree perineal trauma, influences on their practice, and the level to which their practice reflects best evidence. Methods: A descriptive approach using an online survey was used to access the population of 2910 New Zealand midwives providing current perineal management in 2013; 744 (25%) met the inclusion criteria. Quantitative data were collected and associations examined using chi-square and Fisher’s exact test. Results: The presentation will identify midwives’ management of the last second degree tear treated. New Zealand midwifery practice compared favourably to overseas research and perineal morbidity was uncommon, however, there is potential for improvement with respect to rectal examination, suturing technique throughout all layers of repair, choice of analgesia, and documentation of repair. Training in perineal repair within the last two years, reported by 54% of midwives, was associated with an increased likelihood of evidence-based suturing techniques (p = 0.002), rectal examination during assessment of trauma (p = 0.019), improved perineal documentation (consent for treatment, p = 0.005; discussion of care, p = 0.005; diagram of tear, p = 0.007) and visualisation of healing (p = 0.014). Conclusion: The majority of New Zealand midwives make appropriate professional judgements in regard to the management of second degree perineal trauma. However, maternal postnatal health could be enhanced if midwives increased their use of evidence-based perineal practice, which is more likely after they have received recent education in perineal management. http://dx.doi.org/10.1016/j.wombi.2015.07.046 [O14] The effect of waterbirth on neonatal mortality and morbidity Rowena Davies 1,2,*, Deborah Davis 1,2, Melissa Pearce 2,3, Nola Wong 2,3 1
University of Canberra, Canberra, Australia The Australian Capital Regional Centre for Evidence Based Midwifery, Canberra, Australia 3 Centenary Hospital for Women and Children, Canberra, Australia *Corresponding author. 2
Introduction: The practice of waterbirth remains controversial. Professional guidelines argue there is insufficient evidence available to guide waterbirth practice and consider waterbirth an experimental procedure. Much of the criticism directed at waterbirth focuses on the potential impact to the neonate. Aim: To systematically review the evidence regarding the effect of waterbirth, compared to landbirth, on the mortality and morbidity of neonates born to low risk women. Methods: This review considered randomised controlled trials and observational studies, assessing eligible studies for quality using Joanna Briggs Institute appraisal instruments. Outcomes measured included: mortality, resuscitation or respiratory distress syndrome, infection, APGAR scores at 1, 5 and 10 min, admission to Neonatal Intensive Care or Special Care Nurseries, cord pH values, cord avulsion, hyponatremia, hypoxic ischemic encephalopathy and injury. Results: Meta-analysis of 5 min Apgar scores showed statistically significant results favouring waterbirth. This varied from 1 min Apgar score which favoured landbirth, however results should be interpreted with caution. Data measuring cord pH were