Screening for childbirth fear – When and why?

Screening for childbirth fear – When and why?

ACM2015 Oral Presentations / Women and Birth 28S (2015) S7–S32 [O64] Antenatal breastfeeding education: Strategies for midwives Jane Svensson Royal H...

341KB Sizes 0 Downloads 53 Views

ACM2015 Oral Presentations / Women and Birth 28S (2015) S7–S32

[O64] Antenatal breastfeeding education: Strategies for midwives Jane Svensson Royal Hospital for Women, Randwick, Australia Introduction: Breastfeeding is an unparalleled method of food for healthy growth and development of infants, and pregnancy provides numerous teachable moments for antenatal breastfeeding education, yet Midwives struggle to provide more than the basic, physicality of breastfeeding to women during pregnancy. This project aimed to rectify this through the development of strategies based on biological and social research, and adult learning theory, all now provided in a comprehensive Handbook. The Australian Government confirmed breastfeeding status through the release of the Australian National Breastfeeding Strategy 2010-2015, and the 2012 NHMRC Infant Feeding Guidelines. Recent Australian Institute of Health and Welfare figures indicate, that whilst the breastfeeding initiation rate is high (96%), there is a rapid decline in the number of women breastfeeding by the time the infant is four weeks of age (61%), with only 15% of infants being exclusively breastfed around six months. Further it appears that the initiation and duration rates amongst Indigenous women and those from some culturally and the linguistically diverse backgrounds are lower. Contrary to the long-held belief of practitioners, expectant parents are thirsty for antenatal breastfeeding education and they can learn. Method: Needs assessment conducted over 6 months in 2013/ 2014 confirmed this. It included:  in-depth interviews and focus groups of:  23 expectant parents – women and partners  46 new parents  26 professionals from a range of disciplines.  review of breastfeeding, health education and adult learning literature  documentation, books, fact sheets, brochures and DVDs collected and reviewed from sources, including BFHI, and UNICEF. Results and conclusion: Women and partners continue to struggle in the early weeks with their baby, but when asked they are able to clearly articulate their need for antenatal breastfeeding education to go beyond the physicality of the experience. This paper reveals what they really want and encourages midwives to embrace teachable moments. http://dx.doi.org/10.1016/j.wombi.2015.07.097 [O65] Reducing painful nipple trauma and associated breastfeeding complications Robyn Thompson 1,*, Sue Kildea 2, Sue Kruske 3, Lesley Barclay AO 4 1

Australian Catholic University & Midwifery Research Unit, Brisbane, Australia 2 Midwifery Research Unit, Mater Research Institute, University of Queensland, Australia 3 Maternal and Child Health Institute for Urban Indigenous Health, Brisbane, Australia 4 The University of Sydney, Sydney, Australia *Corresponding author. Introduction: Breastfeeding complications impact on establishing and sustaining breastfeeding. Data collected during an

S29

In-Home Breastfeeding programme that provided assistance for women with complications (2003–2007), were analysed to inform this work. Aim: To address the main characteristics and experiences of the women presenting for assistance through the programme and explore the implications of the findings for women, midwifery and breastfeeding practice. Methods: A complex range of experiences were captured in a database including photos of trauma resulting from early breastfeeding. Results: High rates of nipple trauma were reported. These were confirmed by statistical analysis of 653 detailed maternal-infant records. The analysis confirmed three anatomical predictors (cross-cradle technique, nipple malalignment and facio-mandibular asymmetry) that significantly contributed to painful nipple trauma. Almost 50% of the baby’s were fed non-human milk in the first three postpartum days. The outcomes were mostly commonly related to delay and interruption to the first and early breastfeeds and the teaching of confusing techniques. Three short (one minute), video clips support the presentation, with photos and descriptions that show the range of nipple trauma. Conclusion: Midwives need to review their practices, understand the importance of not delaying or interrupting the first breastfeed, resist teaching restrictive methods that potentially result in nipple trauma, understand the related anatomy and expected behavioural changes and avoid introducing non-human milk in the first 72 h. Midwives can promote instinctive, neurosensory mammalian behaviours to initiate and establish breastfeeding. http://dx.doi.org/10.1016/j.wombi.2015.07.098 [O66] Screening for childbirth fear – When and why? Jocelyn Toohill 1,*, Debra K. Creedy 1, Jenny Gamble 1, Jennifer Fenwick 1,2 1

Griffith Health Institute, Queensland, Australia Gold Coast University Hospital, Queensland, Australia *Corresponding author. 2

Introduction: Around one in four women have high childbirth fear. Evidence indicates fearful women are more likely to experience depression before and after birth, have heightened pain levels in labour, have more difficult and longer labours, experience higher incidence of operative birth and subsequently develop trauma symptoms. In Australia women are not routinely screened for childbirth fear however in Scandinavian countries women with childbirth fear receive continuity of midwife antenatal care with most reports in those countries focused to severe levels of fear. Aim: To explore the relative benefits of screening women for childbirth fear at high or severe levels. Method: This is a secondary analysis of data from women participating in a RCT (Birth Emotions and Looking to Improve Expectant Fear). In total, 1410 women in their second trimester of pregnancy from 3 metropolitan hospitals in South East Queensland were screened for childbirth fear using the Wijma Delivery Expectancy Questionnaire (W-DEQ). Women with high and severe score levels were compared to women without these levels for differences in predictors for fear. Logistic regression modeling was used to ascertain if screening for high or severe levels of fear is most optimal. Results: 1386 women completed the W-DEQ. There were no differences on demographic variables between women with severe

S30

ACM2015 Oral Presentations / Women and Birth 28S (2015) S7–S32

or high fear. Depression symptoms, decisional conflict and low self-efficacy predicted both high and severe fear levels. Nulliparity was a predictor of high fear. A previous operative birth and having an unsupportive partner were predictors of high fear in multiparous women. Conclusion: Screening women for high fear in second trimester is prudent. This provides for early identification and early planning to meet women’s individualized support needs and possible avoidance of fear levels increasing. This is important given the known obstetric and emotional morbidity associated with childbirth fear. http://dx.doi.org/10.1016/j.wombi.2015.07.099 [O67] Midwives’ experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia Angela Dawson 1, Sabera Turkmani 1,*, Nesrin Varol 2, Elizabeth Sullivan 1, Caroline S.E. Homer 1 1

University of Technology Sydney, Sydney, Australia University of Sydney, Sydney, Australia *Corresponding author. 2

Introduction: Female genital mutilation (FGM) has serious health consequences, including adverse obstetric outcomes and significant physical, sexual and psychosocial complications for girls and women. Migration to Australia of women with FGM from high-prevalence countries requires relevant expertise to provide women and girls with FGM with specialised health care. Midwives, as the primary providers of women during pregnancy and childbirth, are critical to the provision of this high quality care. Aim: To provide insight into midwives’ views of and experiences working with women affected by FGM. Methods: A descriptive qualitative study was undertaken using focus group discussions with midwives from four purposively selected antenatal clinics and birthing units in three hospitals in urban New South Wales. The transcripts were analysed thematically. Results: Midwives demonstrated knowledge and recalled skills in caring for women with FGM. However, many lacked confidence in these areas. Participants expressed fear and a lack of experience caring for women with FGM. Midwives described practice issues, including the development of rapport with women, working with interpreters, misunderstandings about the culture of women, inexperience with associated clinical procedures and a lack of knowledge about FGM types and data collection. Conclusion: Midwives require education, training and supportive supervision to improve their skills and confidence when caring for women with FGM. Community outreach through improved antenatal and postnatal home visitation can improve the continuity of care provided to women with FGM. http://dx.doi.org/10.1016/j.wombi.2015.07.100 [O68] AMOSS and AMIHS partnership to make a difference: Rheumatic heart disease in pregnancy Geraldine Vaughan 1,2,*, Linda Bootle 3, Lisa Jackson Pulver 4, Michael Peek 5, Elizabeth Sullivan 1

1

University of Technology Sydney, Sydney, Australia University of New South Wales, Sydney, Australia 3 Aboriginal Maternal Infant Health Service, Western NSW Local Health District, Australia 4 Muru Marri Indigenous Health Unit, University of New South Wales, Sydney, Australia 5 Sydney Medical School Nepean, The University of Sydney, Australia *Corresponding author. 2

Introduction: While rare overall in Australia, rheumatic heart disease (RHD) is significantly more prevalent in Aboriginal and Torres Strait Islander, Maori and Pacific Islander women, and women from resource poor countries. RHD is up to twice as common in women. Maternity services – particularly those provided by midwives and Aboriginal Health Workers – provide a critical point in time where previously unknown RHD can be diagnosed and the impact of the disease can be monitored. The Australasian Maternity Outcomes Surveillance System (AMOSS) study is an NHMRC-funded project researching clinical pathways of pregnant women with RHD across ANZ. It is also conducting qualitative research exploring women’s journeys, and challenges of health services in care of women with RHD in pregnancy (RHDP). Aims: To improve awareness and knowledge among Australian health services of the impact of rheumatic heart disease in pregnancy (RHD-P) through collaborative partnership. Approach: A collaboration between AMOSS and Western NSW Local Health District Aboriginal Maternal Infant Health Service (AMIHS) is supporting improved awareness of the impact of this disease among maternity care providers in NSW. AMIHS is a community-based maternity service, with a midwife and Aboriginal Health Worker working in partnership with Aboriginal families to provide culturally appropriate care to Aboriginal women and babies. AMIHS is advising on specific ways to improve knowledge in the maternity workforce about the impact of this disease in pregnancy. It has representation on the AMOSS RHD-P Advisory Group, and in January 2015, over 20 Aboriginal and non-Aboriginal AMIHS staff reviewed pilot RHD-P educational resources targeted at the health workforce. The collaboration will inform dissemination strategies of the RHD-P project findings. Conclusion: The AMIHS/AMOSS partnership is developing improved knowledge about RHD-P, which in turn supports earlier diagnosis, multidisciplinary care and monitoring for women with RHD in order to promote optimal outcomes for mother and baby. http://dx.doi.org/10.1016/j.wombi.2015.07.101 [O69] The evidence behind Calmbirth Christine Vose Calmbirth, Parkways, Australia Introduction: Calmbirth is an Australian course that was developed by midwives for Australian birthing women. It is a highly professional course that is open to midwives and is a great addition to every midwife’s skill set. Calmbirth is evidence based and has remarkably positive outcomes in terms of client satisfaction, reduced need for intervention, reduced fetal and maternal morbidity and enhanced epigenetic effects. Aim: To outline the research behind Calmbirth and relate the current findings from client surveys that compares Australian birth outcomes with Birth outcomes for over 1000 clients who undertook a Calmbirth course. The paper will finish with an outline of some of the key Calmbirth techniques and, time