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Professor Caroline Homer

Biography

Caroline is currently the Director of the Centre for Midwifery, Child and Family Health in the Faculty of Health at UTS and is registered as a midwife in Australia. She has led research into the development and implementation of innovative models of midwifery care and the development of midwifery practice and education. Her other research includes the translation of research into clinical practice particularly in maternity care, clinical risk management strategies and the development of educational strategies to prepare midwives for practice.

She holds NHMRC and ARC-linkage grants as a CI and supervises PhD, Masters and Honours students studying aspects of improving maternity services including CenteringPregnancy, quality and safety in maternity care, workforce issues for midwives, homebirth and obesity in pregnancy. She co-leads the consortium called BACI – Birth After Caesarean Interventions which is undertaking in research to promote normal birth and increase the rate of vaginal birth after caesarean section.

She is also involved in teaching midwifery students, both clinically and through UTS and teaches in the Bachelor of Midwifery, Graduate Diploma of Midwifery and Master of Midwifery programs. In 2010, she was part of the midwifery teaching team that was awarded a highly commended outcome for the UTS Learning and Teaching Awards for 2009.

Caroline also holds a Masters of Science in Medicine (Clinical Epidemiology) from the University of Sydney. She is a member of the Australian College of Midwives and is the immediate past president of the NSW Branch.

Caroline continues to provide continuity of midwifery care to women through the St George Hospital.

Professional

Current working group/committees
NHMRC Research Committee (2009-2011)
Commonwealth Department of Health and Ageing Co-Chair, National Expert Advisory Executive, Development of Antenatal Guidelines. (2008-2010)
National SIDS Council of Australia Ltd National Scientific Advisory Group (NSAG). (2007-current)
Council of Deans of Nursing and Midwifery (Australia and NZ) Research Advisory Group. (2006-current)
NSW Health Department, Maternal and Perinatal Health Priority Taskforce (2007-current)
Australian College of Midwives. Professional Development Committee (2007-current)
Australian College of Midwives NSW Branch - Midwifery Matters Sub-Committee (1999-current)
International Confederation of Midwives Research Standing Committee (2003-current)

Image of Caroline Homer
Associate Dean (International and Development), Faculty of Health
Director, Centre for Midwifery, Child and Family Health (CMCFH)
Professor of Midwifery, Faculty of Health
Associate Member, Centre for Innovation in IT Services Applications
Core Member, Health Services and Practice Research Strength
Member, WHO Collaborating Centre for Nursing, Midwifery and Health Development (WHO or WHOCC)
MScMed(ClinEpi), PhD (UTS)
Member, Perinatal Society of Australia and New Zealand
Member, Council for Remote Area Nurses of Australia
Member, Maternity Coalition
Member, Australian College of Midwives
 
Phone
+61 2 9514 4886
Room
CB10.07.260

Research Interests

Group antenatal care
Birth after caesarean section
Maternal mortality and morbidity
Birth Unit Design
Models of midwifery care
Homebirth
Clinical risk management in maternity care
Women's experiences of maternity care
Midwifery workforce issues

Current research projects
See the Centre for Midwifery, Child and Family Health's research projects.

Can supervise: Yes

Research areas
Action Research
Case Study
Grounded Theory
Midwifery
Randomised Control Trials
Survey Methods
Women's, Community and Family Health

Midwifery - undergraduate / postgraduate
Higher degrees supervision

Books

Gray, J.E., Smith, R.M. & Homer, C.S. 2008, Illustrated dictionary of midwifery: Australian and New Zealand Edition, Churchill Livingstone Elsevier, Sydney, Australia.
The Illustrated Dictionary of Midwifery is an adaptation of the popular UK dictionary, of the same name, for Australian and New Zealand student and practicing midwives. This highly illustrated dictionary contains approximately 4,000 midwifery terms and abbreviations. The Australian authors have further developed the dictionarys women-centred care approach and updated the evidence throughout.

Chapters

Atchan, M.A. & Homer, C.S. 2014, 'Routine care of postpartum women' in Elsevier (ed), Obstetrics & Gynaecology, Churchill Livingstone, Australia, pp. 219-230.
The puerperium refers to the 6 weeks during which a woman physiologically returns to her prepregnant state. These changes are a result of the withdrawal of pregnancy hormones.
Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J., Homer, C.S., Steel, A.E. & Beck, S. 2012, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature' in Adams, J., Andrews, G., Barnes, J., Broom, A. & Magin, P. (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 35-43.
The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Homer, C.S. & Broom, A. 2012, 'Evidence-Based Paradigms and Contemporary Midwifery' in Broom, A. & Adams, J. (eds), Evidence-Based Healthcare in Context: Critical Social Science Perspectives, Ashgate, Farnham, Surrey, UK, pp. 155-176.
Homer, C.S. 2011, 'Obstetric emergencies' in Curtis, K. & Ramsden, C. (eds), Emergency and Trauma Care for Nurses and Paramedics, Elsevier, Sydney, pp. 841-860.
Brodie, P.M. & Homer, C.S. 2009, 'Transforming the Culture of a Maternity Service: St George Hospital, Sydney, Australia' in Davis-FLoyd, R., Barclay, L., Daviss, B.A. & Tritten, J. (eds), Birth Models That Work, University of California Press, London, UK, pp. 187-212.
NA
Homer, C.S., Brodie, P.M. & Leap, N. 2008, 'Getting started: What is midwifery continuity of care? (Chapter 1)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 1-24.
Sandall, J., Page, L.A., Homer, C.S. & Leap, N. 2008, 'Midwifery continuity of care: What is the evidence? (Chapter 2)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 25-46.
Leap, N., Homer, C.S. & Brodie, P.M. 2008, 'Introducing continuity of care in mainstream maternity services: Building blocks for success (Chapter 4)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 67-88.
Brodie, P.M., Davis, G.K. & Homer, C.S. 2008, 'Effective collaboration with medical colleagues: making it happen' in Homer, Brodie & Leap (eds), Midwifery Continuity of Care A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 89-106.
Homer, C.S., Brodie, P.M. & Leap, N. 2008, 'Midwifery continuity of care for specific communities (Chapter 10)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 181-194.
Homer, C.S., Brodie, P.M. & Leap, N. 2008, 'Midwifery continuity of care: The future (Chapter 12)' in Homer, C., Brodie, P. & Leap, N. (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 215-219.
Homer, C.S. & Fry, M. 2007, 'Gynaecological emergencies' in Curtis, K., Ramsden, C. & Friendship, J. (eds), Emergency & Trauma Nursing, Mosby Australia, Sydney, pp. 502-515.
Homer, C.S. 2006, 'Challenges to Women's Health' in Pairman, S., Pincombe, J., Thorogood, C. & Tracy, S. (eds), Midwifery: Preparation for practice, Elsevier, Sydney, pp. 115-137.
Homer, C.S. 2005, 'Laying the foundation: the STOMP study' in Midwifery and Public Health: future directions, new opportunities, Churchill Livingstone, Philadelphia, USA, pp. 129-152.

Conferences

Homer, C.S., Rumsey, M., Brodie, P.M., Dawson, A., Copeland, F.H. & Daly, J. 2013, 'Helping build foundations for improved maternal health in PNG', International Council of Nurses 25th Quadrennial Congress.
Homer, C.S. 2013, 'Connections, Continuity and Community: Models of Care for Aboriginal and Torres Strait Islander Women', PSANZ 2013 17th Annual Congress, Wiley Blackwell, Australia.
Smith, R.M., Homer, A.K., Homer, D.J. & Homer, C.S. 2010, 'Harper's story: Teaching midwifery students about stillbirth', Journal of Paediatrics and Child Health, Blackwell Publishing, Oxford, UK, pp. 7-7.
Hoang, D.B., Lawrence, E., Ahmad, N.F., Balasubramanian, V., Homer, C., Foureur, M. & Leap, N. 2008, 'Assistive Care Loop with Electronic Maternity Records', 2008 10TH IEEE INTERNATIONAL CONFERENCE ON E-HEALTH NETWORKING, APPLICATIONS AND SERVICES, IEEE, pp. 118-123.
Davis, D.L., Homer, C.S., Foureur, M., Leap, N. & Forbes, I. 2008, 'Birthing units: Designing homely delivery spaces to promote natural birth'.

Journal articles

Farrokh-Eslamlou, H., Aghlmand, S., Eslami, M. & Homer, C.S.E. 2014, 'Impact of the World Health Organization's decision-making tool for family planning clients and providers on the quality of family planning services in Iran', Journal of Family Planning and Reproductive Health Care, vol. 40, no. 2, pp. 89-95.
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Objective: We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran. Methods: The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires. Results: Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients ' satisfaction with FP services (from 72% to 99%; p<0.05). Conclusions: The adapted WHO's DMT has the potential to improve the quality of FP services.
Dawson, A., Buchan, J., Duffield, C.M., Homer, C.S. & Wijewardena, K. 2014, 'Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence', Health Policy and Planning, vol. IN PRESS, pp. 1-13.
Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives.
Davidson, P.M., Newton, P.J., Ferguson, C., Daly, J., Elliott, D., Homer, C., Duffield, C. & Jackson, D. 2014, 'Rating and ranking the role of bibliometrics and webometrics in nursing and midwifery', The Scientific World Journal, vol. 2014.
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Background. Bibliometrics are an essential aspect of measuring academic and organizational performance. Aim. This review seeks to describe methods for measuring bibliometrics, identify the strengths and limitations of methodologies, outline strategies for interpretation, summarise evaluation of nursing and midwifery performance, identify implications for metric of evaluation, and specify the implications for nursing and midwifery and implications of social networking for bibliometrics and measures of individual performance. Method. A review of electronic databases CINAHL, Medline, and Scopus was undertaken using search terms such as bibliometrics, nursing, and midwifery. The reference lists of retrieved articles and Internet sources and social media platforms were also examined. Results. A number of well-established, formal ways of assessment have been identified, including h- and c-indices. Changes in publication practices and the use of the Internet have challenged traditional metrics of influence. Moreover, measuring impact beyond citation metrics is an increasing focus, with social media representing newer ways of establishing performance and impact. Conclusions. Even though a number of measures exist, no single bibliometric measure is perfect. Therefore, multiple approaches to evaluation are recommended. However, bibliometric approaches should not be the only measures upon which academic and scholarly performance are evaluated. 2014 Patricia M. Davidson et al.
Psaila, K., Kruske, S., Fowler, C., Homer, C. & Schmied, V. 2014, 'Smoothing out the transition of care between maternity and child and family health services: perspectives of child and family health nurses and midwives'', BMC PREGNANCY AND CHILDBIRTH, vol. 14.
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Dawson, A.J., Stasa, H., Roche, M.A., Homer, C.S.E. & Duffield, C. 2014, 'Nursing churn and turnover in Australian hospitals: Nurses perceptions and suggestions for supportive strategies', BMC Nursing, vol. 13, no. 1.
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Background: This study aimed to reveal nurses' experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.Method: A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories.Results: Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterised by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options.Conclusion: Nursing turnover is influenced by the experiences of nurses. Positive steps can be made towards improving workplace conditions and ensuring nurse retention. Improving performance management and work design are strategies that nurse managers could harness to reduce turnover. 2014 Dawson et al.; licensee BioMed Central Ltd.
Schmied, V., Fowler, C., Rossiter, C., Homer, C. & Kruske, S. 2014, 'Nature and frequency of services provided by child and family health nurses in Australia: results of a national survey', AUSTRALIAN HEALTH REVIEW, vol. 38, no. 2, pp. 177-185.
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Homer, C.S.E., Scarf, V., Catling, C. & Davis, D. 2014, 'Culture-based versus risk-based screening for the prevention of group B streptococcal disease in newborns: A review of national guidelines', Women and Birth, vol. 27, no. 1, pp. 46-51.
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Background: Maternal colonisation with group B streptococcus (GBS) is recognised as the most frequent cause of severe early onset infection in newborns. National and international guidelines outline two approaches to the prevention of early onset disease in the neonate: risk based management and antenatal culture-based screening. We undertook an analysis of existing national and international guidelines in relation to GBS in pregnancy using a standardised and validated instrument to highlight the different recommended approaches to care. Methods: English language guidelines on the screening and management of GBS colonisation in pregnant women and the prevention of early-onset group B streptococcal disease in newborns were sought. Results: Four guidelines met the inclusion criteria, one from the United States of America (USA), the United Kingdom (UK), Canada and New Zealand. All four were appraised as at a high standard in terms of development using the AGREE II tool. Both approaches were recommended in the guidelines with different regions of the world advocating different approaches often based on the same evidence. Guidelines from the USA recommend an antenatal culture-based approach while the UK guidelines recommend risk-based management. Conclusion: Based on an AGREE II analysis, the standard of the guidelines was high despite having disparate recommendations. Both approaches to the prevention of early onset GBS infection in neonates are recommended with the split being geographically-based. 2013 Australian College of Midwives.
Fowler, C.M., Schmied, V., Homer, C.S., Psalia, K., Barclay, L., Wilson, I., Kemp, L. & Fasher, M. 2014, 'Implementing a national approach to universal child and family health services in Australia: professionals' views of the challenges and opportunities', Health & Social Care in the Community.
Fox, D., Sheehan, A. & Homer, C.S. 2014, 'Experiences of Women Planning a Home Birth Who Require Intrapartum Transfer to Hospital: A Metasynthesis of the Qualitative Literature', International Journal of Childbirth, vol. 4, no. 2, pp. 103-119.
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Recent evidence supports the safety of planned home birth for low-risk women when professional midwifery care and adequate collaborative arrangements for referral and transfer are in place. The purpose of this article is to synthesize the qualitative literature on the experiences of women planning a home birth, who are subsequently transferred from home to hospital.
Roche, M.A., Duffield, C.M., Homer, C.S., Buchan, J. & Dimitrelis, S. 2014, 'The Rate and Cost of Nurse Turnover in Australia', Collegian, vol. IN PRESS.
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Homer, C.S.E., Thornton, C., Scarf, V.L., Ellwood, D.A., Oats, J.J.N., Foureur, M.J., Sibbritt, D., McLachlan, H.L., Forster, D.A. & Dahlen, H.G. 2014, 'Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data', BMC PREGNANCY AND CHILDBIRTH, vol. 14.
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Homer, C.S.E., Friberg, I.K., Dias, M.A.B., ten Hoope-Bender, P., Sandall, J., Speciale, A.M. & Bartlett, L.A. 2014, 'The projected effect of scaling up midwifery', The Lancet.
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We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care. 2014 Elsevier Ltd. All rights reserved.
Catling, C., Dahlen, H. & Homer, C.S.E. 2014, 'The influences on women who choose publicly-funded home birth in Australia', Midwifery, vol. 30, no. 7, pp. 892-898.
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Objective: to explore the influences on women who chose a publicly-funded home birth in one Australian state. Design: a constructivist grounded theory methodology was used. Setting: a publicly-funded home birth service located within a tertiary referral hospital in the southern suburbs of Sydney, Australia. Participants: data were collected though semi-structured interviews of 17 women who chose to have a publicly-funded home birth. Findings: six main categories emerged from the data. These were feeling independent, strong and confident, doing it my way, protection from hospital related activities, having a safety net, selective listening and telling, and engaging support. The core category was having faith in normal. This linked all the categories and was an overriding attitude towards themselves as women and the process of childbirth. The basic social process was validating the decision to have a home birth. Conclusion: women reported similar influences to other studies when choosing home birth. However, the women in this study were reassured by the publicly-funded system's 'safety net' and apparent seamless links with the hospital system. The flexibility of the service to permit women to change their minds to give birth in hospital, and essentially choose their birthplace at any time during pregnancy or labour was also appreciated. Implications for practice: women that choose a publicly-funded home birth service describe strong influences that led them to home birth within this model of care. Service managers and health professionals need to acknowledge the importance of place of birth choice for women. 2014 Elsevier Ltd.
Sibbritt, D.W., Catling, C.J., Adams, J., Shaw, A.J. & Homer, C.S.E. 2014, 'The self-prescribed use of aromatherapy oils by pregnant women', Women and Birth, vol. 27, no. 1, pp. 41-45.
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Background: While some studies have reported effectiveness of aromatherapy oils use during labour there is no reported evidence of efficacy or risks of aromatherapy oils use for pregnancy-related symptoms or conditions. A number of aromatherapy oils are unsafe for use by pregnant women yet there is currently no research examining the prevalence and characteristics of women who use aromatherapy oils during pregnancy. Aim: To conduct an empirical study of the prevalence and characteristics of women who use aromatherapy oils during pregnancy. Methods: The research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH), focusing on the nationally representative sample of Australian women aged 31-36 years. Data were collected via a cross-sectional questionnaire (n=8200) conducted in 2009. Results: Self-prescribed aromatherapy oils were used by 15.2% of pregnant women. Pregnant women were 1.57 (95% CI: 1.01, 2.43) times more likely to self-prescribe use of aromatherapy oils if they have allergies or hayfever, and 2.26 (95% CI: 1.34, 3.79) times more likely to self-prescribe use of aromatherapy oils if they have a urinary tract infection (UTI). Conclusion: Our study highlights a considerable use of aromatherapy oils by pregnant women. There is a clear need for greater communication between practitioners and patients regarding the use of aromatherapy oils during pregnancy, as well a need for health care practitioners to be mindful that pregnant women in their care may be using aromatherapy oils, some of which may be unsafe. 2013 Australian College of Midwives.
Hammond, A., Foureur, M. & Homer, C.S.E. 2014, 'The hardware and software implications of hospital birth room design: A midwifery perspective', Midwifery, vol. 30, no. 7, pp. 825-830.
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Objective: to explore the impacts of physical and aesthetic design of hospital birth rooms on midwives. Background: the design of a workplace, including architecture, equipment, furnishings and aesthetics, can influence the experience and performance of staff. Some research has explored the effects of workplace design in health care environments but very little research has examined the impact of design on midwives working in hospital birth rooms. Methods: a video ethnographic study was undertaken and the labours of six women cared for by midwives were filmed. Filming took place in one birth centre and two labour wards within two Australian hospitals. Subsequently, eight midwives participated in video-reflexive interviews whilst viewing the filmed labour of the woman for whom they provided care. Thematic analysis of the midwife interviews was undertaken. Findings: midwives were strongly affected by the design of the birth room. Four major themes were identified: finding a space amongst congestion and clutter; trying to work underwater; creating ambience in a clinical space and being equipped for flexible practice. Aesthetic features, room layout and the design of equipment and fixtures all impacted on the midwives and their practice in both birth centre and labour ward settings. Conclusion and implications for practice: the current design of many hospital birth rooms challenges the provision of effective midwifery practice. Changes to the design and aesthetics of the hospital birth room may engender safer, more comfortable and more effective midwifery practice. 2013 Elsevier Ltd.
Hammond, A.D., Homer, C.E. & Foureur, M. 2014, 'Messages from Space: An Exploration of the Relationship between Hospital Birth Environments and Midwifery Practice.', HERD, vol. 7, no. 4, pp. 81-95.
To explore the relationship between the birth environment and the practice of midwifery using the theoretical approach of critical realism.
ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., Homer, C.S.E., Kennedy, H.P., Matthews, Z., McFadden, A., Renfrew, M.J. & Van Lerberghe, W. 2014, 'Improvement of maternal and newborn health through midwifery', The Lancet.
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In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and beyond 2015. 2014 Elsevier Ltd. All rights reserved.
Davis Harte, J., Leap, N., Fenwick, J., Homer, C.S.E. & Foureur, M. 2014, 'Methodological insights from a study using video-ethnography to conduct interdisciplinary research in the study of birth unit design', International Journal of Multiple Research Approaches, vol. 8, no. 1, pp. 36-48.
Little is known about how the physical design of a birthing unit can influence the experiences of labour and birth for women, their supporters and midwives. We proposed that an interdisciplinary approach (disciplines of midwifery, architecture, design, communication and public health) was likely to be the most effective way to better understand the complexities and interactions of design, behaviour, communication and experiences. In this methodological paper we aim to provide a roadmap that other researchers may find helpful when considering the use of video as a data collection technique, especially in the study of the powerful and intimate setting of childbirth. The paper also outlines our process for engaging both researchers and participants in reviewing video footage with the aim to contribute multiple perspectives to the analysis process.
Homer, C.S.E., Thornton, C., Scarf, V.L., Ellwood, D.A., Oats, J.J.N., Foureur, M.J., Sibbritt, D., McLachlan, H.L., Forster, D.A. & Dahlen, H.G. 2014, 'Birthplace in New South Wales, Australia: An analysis of perinatal outcomes using routinely collected data', BMC Pregnancy and Childbirth, vol. 14, no. 1.
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Background: The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labour in one Australian state.Methods: A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study.Results: Women who planned to give birth in a birth centre or at home were significantly more likely to have a normal labour and birth compared with women in the labour ward group. There were no statistically significant differences in stillbirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences.Conclusion: This study provides information to assist the development and evaluation of different places of birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of birth in a low risk population, especially in countries like Australia where homebirth rates are low. 2014 Homer et al.; licensee BioMed Central Ltd.
Dawson, A., Brodie, P., Copeland, F., Rumsey, M. & Homer, C. 2014, 'Collaborative approaches towards building midwifery capacity in low income countries: A review of experiences', Midwifery, vol. 30, no. 4, pp. 391-402.
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Objective: to explore collaborative approaches undertaken to build midwifery education, regulation and professional association in low income countries and identify evidence of strategies that may be useful to scale-up midwifery to achieve MDG 5. Design: an integrative review involving a mapping exercise and a narrative synthesis of the literature was undertaken. The search included peer reviewed research and discursive literature published between 2002 and 2012. Findings: fifteen papers were found that related to this topic: 10 discursive papers and five research studies. Collaborative approaches to build midwifery capacity come mainly from Africa and involve partnerships between low income countries and between low and high income countries. Most collaborations focus on building capacity across more than one area and arose through opportunistic and strategic means. A number of factors were found to be integral to maintaining collaborations including the establishment of clear processes for communication, leadership and appropriate membership, effective management, mutual respect, learning and an understanding of the context. Collaborative action can result in effective clinical and research skill building, the development of tailored education programmes and the establishment of structures and systems to enhance the midwifery workforce and ultimately, improve maternal and child health. Key conclusions: between country collaborations are one component to building midwifery workforce capacity in order to improve maternal health outcomes. Implications for practice: the findings provide insights into how collaboration can be established and maintained and how the contribution collaboration makes to capacity building can be evaluated. 2013 Elsevier Ltd.
Duffield, C.M., Roche, M.A., Homer, C., Buchan, J. & Dimitrelis, S. 2014, 'A comparative review of nurse turnover rates and costs across countries.', J Adv Nurs, vol. 70, no. 12, pp. 2703-2712.
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To compare nurse turnover rates and costs from four studies in four countries (US, Canada, Australia, New Zealand) that have used the same costing methodology; the original Nursing Turnover Cost Calculation Methodology.
Javid, N., Sullivan, E., Halliday, L.E., Duncombe, G. & Homer, C.S. 2014, '"Wrapping myself in cotton wool": Australian women's experience of being diagnosed with vasa praevia', BMC Pregnancy and Childbirth, vol. 14, no. 318, pp. 1-11.
This is the first study to describe women's experience of being diagnosed with or suspected to have VP. The findings from this research reveal the dilemmas these women face even if their baby is ultimately born healthy. Their need for clear and consistent information, sensitive care, support and continuity is evident. Clinicians can use these findings in developing information, counselling and models of care for these women.
Javid, N., Sullivan, E.A., Halliday, L.E., Duncombe, G. & Homer, C.S.E. 2014, 'Wrapping myself in cotton wool: Australian women's experience of being diagnosed with vasa praevia', BMC Pregnancy and Childbirth, vol. 14, no. 1, pp. 1-11.
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Background: Vasa praevia (VP) is an obstetric condition that is associated with significant perinatal mortality and morbidity. Although the incidence of VP is low, it is one of the few causes of perinatal death that can be potentially prevented through detection and appropriate care. The experience of women diagnosed with or suspected to have VP is largely unknown. The aim of this study was to explore the experiences and impact that a diagnosis or suspected diagnosis of VP had on a group of Australian women.Method: A qualitative study using a descriptive exploratory design was conducted and Australian women diagnosed with VP were recruited via online methods in 2012. An inductive approach was undertaken and interviews were analysed using the stages of thematic analysis. Results: Of the 14 women interviewed, 11 were diagnosed with VP during pregnancy with 5 subsequently found not to have VP (non-confirmed diagnosis). Three women were diagnosed during childbirth with one neonatal death. Five major themes were identified: feeling like a ticking time bomb; getting diagnosis right; being taken seriously; coping with inconsistent information; and, just a massive relief when it was all over.Conclusions: This is the first study to describe women's experience of being diagnosed with or suspected to have VP. The findings from this research reveal the dilemmas these women face even if their baby is ultimately born healthy. Their need for clear and consistent information, sensitive care, support and continuity is evident. Clinicians can use these findings in developing information, counselling and models of care for these women.
Homer, C.S., Thornton, C., Scarf, V.L., Ellwood, D.A., Oats, J.J., Foureur, M.J., Sibbritt, D., McLachlan, H.L., Forster, D.A. & Dahlen, H.G. 2014, 'Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data.', BMC Pregnancy Childbirth, vol. 14, p. 206.
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The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labour in one Australian state.
Copeland, F., Dahlen, H.G. & Homer, C.S.E. 2014, 'Conflicting contexts: Midwives' interpretation of childbirth through photo elicitation', Women and Birth, vol. 27, no. 2, pp. 126-131.
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Introduction: This study seeks to explore midwives' perceptions about childbirth and in particular their beliefs about normality and risk. In the current climate of increasing interventions during labour, it is important to understand the thought processes that impact on midwifery care in order to examine whether these beliefs influence midwifery clinical decision-making. Method: 12 Midwives who worked in a variety of metropolitan hospitals in Sydney, Australia were interviewed about how they care for women during labour. The study utilised an inductive qualitative design using photo elicitation during the interview process. Results: Six themes emerged from the data that clearly indicated midwives felt challenged by working in a system dominated by an obstetric model of care that undermined midwifery autonomy in maintaining normal birth. These themes were: desiring normal, scanning the environment, constructing the context, navigating the way, relinquishing desire and reflecting on reality. Most midwives felt they were unable to practice in the manner they were philosophically aligned to, that is, promoting normal birth, as the medical model restricted their practice. Discussion: The polarised views of childbirth held by midwives and obstetricians do little to enhance normal birth outcomes. Midwives in this study expressed frustration that they were unable to practice midwifery in a way that reflected their belief in normal birth. This, they cite is a result of the oppressive obstetric model prevalent in maternity care facilities in Sydney and the over use of technological interventions during childbirth. 2013.
Dawson, A.J., Buchan, J., Duffield, C., Homer, C.S.E. & Wijewardena, K. 2014, 'Task shifting and sharing in maternal and reproductive health in low-income countries: A narrative synthesis of current evidence', Health Policy and Planning, vol. 29, no. 3, pp. 396-408.
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Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives. Findings indicate that shifting and sharing these tasks may increase access to and availability of maternal and reproductive health (MRH) services without compromising performance or patient outcomes and may be cost effective. However, a number of issues and barriers were identified with health workers calling for improved in-service training, supervision, career progression and incentive packages to better support their practice. Collaborative approaches involving community members and health workers at all levels have the potential to deliver MRH interventions effectively if accompanied by ongoing investment in the health care system. 2013 The Author. All rights reserved.
Homer, C.S.E., Friberg, I.K., Dias, M.A.B., Ten Hoope-Bender, P., Sandall, J., Speciale, A.M. & Bartlett, L.A. 2014, 'The projected effect of scaling up midwifery', The Lancet, vol. 384, no. 9948, pp. 1146-1157.
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We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care.
Ten Hoope-Bender, P., De Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., Homer, C.S.E., Kennedy, H.P., Matthews, Z., McFadden, A., Renfrew, M.J. & Van Lerberghe, W. 2014, 'Improvement of maternal and newborn health through midwifery', The Lancet, vol. 384, no. 9949, pp. 1226-1235.
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In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and beyond 2015.
Homer, C.S.E., Friberg, I.K. & Bastos Dias, M.A. 2014, 'Erratum: The projected eff ect of scaling up midwifery (Lancet (2014) 384 (1146-57))', The Lancet, vol. 384, no. 9948, pp. 1098-1098.
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Vallely, L.M., Homiehombo, P., Kelly-Hanku, A., Vallely, A., Homer, C.S. & Whittaker, A. 2014, 'Childbirth in a rural highlands community in Papua New Guinea: A descriptive study.', Midwifery.
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to explore men?s and women?s experiences, beliefs and practices surrounding childbirth in a rural highlands community in Papua New Guinea.
Ith, P., Dawson, A., Homer, C.S.E. & Klinken Whelan, A. 2013, 'Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia', Midwifery, vol. 29, no. 4, pp. 300-307.
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Objective: maternal and perinatal morbidity and mortality rates in Cambodia are high. The provision of quality care by skilled birth attendants (SBAs) in a supportive working environment is an important strategy to reduce morbidity and mortality. There has been little emphasis on examining this issue in Cambodia. The objective of this study was to establish SBA reported practices during labour, birth and the immediate postpartum periods and the factors affecting this. Methods: a descriptive qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic framework. Findings: SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Ten inter-related themes emerged, which described patterns of SBA practice, were identified. These were: skills in the care of labouring women; provision of support in labour; interventions in the second stage of labour; management of the third stage of labour; cleanliness during birth; immediate care of the newborn infant and immediate postnatal care; lack of policy and authority; fear of litigation; workload and lack of human resources; and financial incentives and socio-economic influences. Conclusions: a gap exists between evidence-based standards and current SBA practice during labour, birth and the immediate postpartum care. This is largely driven by the lack of a supportive working environment. Implications for practice: the findings of this research provide maternal health services, workforce planners and policy makers with valuable information to contribute to the continuous quality improvement of maternity care. The findings highlight implications for practice that may improve the quality of maternal health care. Recommendations for decision makers were made and further research is needed in order to develop theories and recommendations to improve SBA practice in Cambodia, to the benefit of the Cambodia women and newborn babies. 2012 Elsevier Ltd.
Halliday, L.E., Peek, M.J., Ellwood, D.A., Homer, C., Knight, M., Mclintock, C., Jackson-Pulver, L. & Sullivan, E.A. 2013, 'The Australasian Maternity Outcomes Surveillance System: An evaluation of stakeholder engagement, usefulness, simplicity, acceptability, data quality and stability', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 53, no. 2, pp. 152-157.
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Hatamleh, R., Shaban, I. & Homer, C.S. 2013, 'Evaluating the Experience of Jordanian Women With Maternity Care Services', Health Care for Women International, vol. 34, no. 6, pp. 499-512.
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Evaluation of womens experiences about the care they receive during childbirth is important to assess the quality of maternity services. We explored the experiences of Jordanian women to examine whether they were satisfied with their childbirth experiences.
Roth, H., Homer, C.S. & Fenwick, J.H. 2013, '"Bouncing back" response to Letter to Editor', Women and Birth, vol. 26, no. 2, pp. 159-159.
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Dahlen, H.G. & Homer, C.S.E. 2013, ''Motherbirth or childbirth'? A prospective analysis of vaginal birth after caesarean blogs', Midwifery, vol. 29, no. 2, pp. 167-173.
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Objective: vaginal birth after caesarean (VBAC) is a controversial issue with strong opinions for and against. The means in which women work through the different opinions and options using the internet should be of interest to midwives, obstetricians and policy makers. The aim of this study was to examine how women use English language internet blog sites to discuss the option of VBAC and what factors influence these women's decision to have a VBAC or repeat caesarean section. Design: a qualitative study using internet blog sites as the source of data was undertaken. Google alerts were created to search for the term VBAC in internet blogs. These alerts were sent to the first author's email account daily for a one-year period (November 2007 to October 2008) and downloaded. The content was analysed using thematic analysis. Findings: there were 311 blogs mentioning the word VBAC in the one-year period. Most of the blog sites and discussion originated from the USA. There were more blogs written during the Northern Hemisphere winter months than during other seasons. The main theme identified was a dichotomy in philosophical framework women held about birth; that is a 'motherbirth' or 'childbirth' framework. Whether women eventually wrote that they chose a VBAC or repeat caesarean or the extent to which they pursued their birth choice depended on whether they came from a perspective that a 'good parent sacrifices themselves for their baby (prioritises the baby) and takes no risks' (childbirth) or that 'giving birth matters to the woman and a happy, healthy mother is a happy healthy baby (mother and baby have equal priority)' (motherbirth). Several themes were identified including: surviving the damage; inadequate bodies; choice and control; fearing and trusting birth; negotiating the system; and minimising or overestimating risk. Key conclusion: women filtered their decision making regarding VBAC through a belief system that prioritises according to their personal approaches. Implications for clinical practice: blogging may be providing a valuable insight into factors that inform decision making and may provide a forum of information and support for women who have experienced a caesarean section. 2011 Elsevier Ltd.
Ith, P., Dawson, A. & Homer, C.S.E. 2013, 'Women's perspective of maternity care in Cambodia', Women and Birth, vol. 26, no. 1, pp. 71-75.
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Background: Consideration of the needs of pregnant women and their ability and willingness to attend maternal services and pay for them is central to the provision of accessible and acceptable maternal care. Women's satisfaction with maternal services is poorly understood in many developing countries, including Cambodia in South East Asia. The objective of this study was to investigate women's perceptions and experiences of private and public skilled birth attendants, including midwives, during childbirth in Cambodia. Methods: A qualitative design using a naturalistic inquiry approach was undertaken to seek sensitive personal issue. Thirty individual in-depth interviews were conducted with women who had recently given birth at private and public health facilities in one province in Cambodia. Data were analysed using a thematic approach. Findings: Women's choice of health facility was influenced by their perceptions of safety and staff attitudes. Reported barriers to the effective utilisation of public maternity services were costs associated with the birth, staff attitudes and a lack of supportive care during labour and in the postpartum period. Although private health care is more expensive than public health care, some women reported a preference for private birth attendants as they perceived them to provide safer and more supportive care in labour. Conclusion: Women expect, but do not always receive humane, professional, supportive and respectful treatment from public skilled birth attendants. While the removal of unexpected costs and geographical barriers are important to increasing public maternity care and service utilisation, improvements in maternity services should focus on addressing provider attitudes and enhancing communication skills during labour, birth and the immediate postpartum period. 2012 Australian College of Midwives.
Gray, J., Leap, N., Sheehy, A. & Homer, C.S.E. 2013, 'Students' perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia', Midwifery, vol. 29, no. 4, pp. 400-406.
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Background: providing opportunities for students to participate in midwifery continuity of care experiences is a challenge in many midwifery education programmes. The 'follow-through experience' was a deliberate strategy introduced into midwifery education programmes in Australia to ensure that students experienced midwifery continuity of care. The follow through experience provides an opportunity for midwifery students to follow a pre-determined number of women through pregnancy, labour and birth and into the early parenting period. Aim: the aim of this study was to explore the follow-through experience in the 3 year Bachelor of Midwifery (direct entry) in Australia to better understand its impact on midwifery students and to identify the learning that is associated with this experience. Methods: a qualitative methodology was used. Data were collected from former and current Bachelor of Midwifery students through a survey and telephone interviews. Students from all 3-year pre-registration Bachelor of Midwifery programmes in Australia were invited to participate. A thematic analysis was undertaken. Constructivist learning theories were used to identify whether learning occurred in the context of the follow-through experience. Findings: students do learn from their engagement in midwifery continuity of care experiences. Learning was characterised by the primacy of the relationship with the women. Students also identified the challenges they faced which included recruitment of women and finding the time to fully engage with the follow-through experience. Difficulties were identified around the different requirements of the follow-through experience, the lack of support at times for students and the incongruence with the existing maternity system. These issues impacted on students' ability to engage in and maximise their learning. Conclusions: the follow-through experience is an innovative midwifery education strategy that facilitates learning for midwifery students. Challenges need to be addressed at a systematic level and new strategies developed to support the learning opportunities presented by the follow-through experience. 2012 Elsevier Ltd.
Campbell, J., de Bernis, L., Downe, S., Fogstad, H., Homer, C.S., Powell Kennedy, H., Matthews, Z., Renfrew, M. & ten Hoope-Bender, P. 2013, 'Maternal health post-2015', The Lancet, vol. 381, no. 9879, pp. 1717-1718.
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We welcome the publication of the manifesto for maternal health post-2015 (Feb 23, p 601).1 Implementation of the steps outlined in this manifesto would result in substantive improvements in maternal and neonatal health. At the Global Maternal Health Conference (Arusha, Tanzania), Richard Horton gave specific attention to skilled workers, especially midwives and those providing midwifery services. But in the published manifesto,1 it has been replaced by the fully trained front-line worker, a phrase open to broad interpretation. Midwifery is essential for maternal and neonatal survival and health.25 Without its explicit inclusion in international and national strategies, the actions needed to decrease morbidity and mortality will be hard to implement fully, or, in some cases, at all. We declare that we have no conflicts of interest.
Catling-Paull, C., Coddington, R.L., Foureur, M.J. & Homer, C.S.E. 2013, 'Publicly funded homebirth in australia: A review of maternal and neonatal outcomes over 6 years', Medical Journal of Australia, vol. 198, no. 11, pp. 616-620.
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Objective: To report maternal and neonatal outcomes for Australian women planning a publicly funded homebirth from 2005 to 2010. Design, setting and subjects: Retrospective analysis of data on women who planned a homebirth and on their babies. Data for 2005-2010 (or from the commencement of a program to 2010) were requested from the 12 publicly funded homebirth programs in place at the time. Main outcome measures: Maternal outcomes (mortality; place and mode of birth; perineal trauma; type of management of the third stage of labour; postpartum haemorrhage; transfer to hospital); and neonatal outcomes (early mortality; Apgar score at 5 minutes; birthweight; breastfeeding initially and at 6 weeks; significant morbidity; transfer to hospital; admission to a special care nursery). Results: Nine publicly funded homebirth programs in Australia provided data accounting for 97% of births in these programs during the period studied. Of the 1807 women who intended to give birth at home at the onset of labour, 1521 (84%) did so. 315 (17%) were transferred to hospital during labour or within one week of giving birth. The rate of stillbirth and early neonatal death was 3.3 per 1000 births; when deaths because of expected fetal anomalies were excluded it was 1.7 per 1000 births. The rate of normal vaginal birth was 90%. Conclusion: This study provides the first national evaluation of a significant proportion of women choosing publicly funded homebirth in Australia; however, the sample size does not have sufficient power to draw a conclusion about safety. More research is warranted into the safety of alternative places of birth within Australia.
Tracy, S.K., Hartz, D.L., Tracy, M.B., Allen, J., Forti, A., Hall, B., White, J., Lainchbury, A., Stapleton, H., Beckmann, M., Bisits, A., Homer, C., Foureur, M., Welsh, A. & Kildea, S. 2013, 'Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial', LANCET, vol. 382, no. 9906, pp. 1723-1732.
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Dawson, A.J. & Homer, C.S. 2013, 'How does the mining industry contribute to sexual and reproductive health in developing countries? A narrative synthesis of current evidence to inform practice', Journal of Clinical Nursing, vol. 22, no. 23-24, pp. 3597-3609.
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Aims and objectives: To explore client and provider experiences and related health outcomes of sexual and reproductive health interventions that have been led by or that have involved mining companies. Background: Miners, and those living in communities surrounding mines in developing countries, are a vulnerable population with a high sexual and reproductive health burden. People in these communities require specific healthcare services although the exact delivery needs are unclear. There are no systematic reviews of evidence to guide delivery of sexual and reproductive health interventions to best address the needs of men and women in mining communities. Design: A narrative synthesis. Methods: A search of peer-reviewed literature from 2000-2012 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. Results: A desire for HIV testing and treatment was associated with the recognition of personal vulnerability, but this was affected by fear of stigma. Regular on-site services facilitated access to voluntary counselling and testing and HIV care, but concerns for confidentiality were a serious barrier. The provision of HIV and sexually transmitted infection clinical and promotive services revealed mixed health outcomes. Recommended service improvements included rapid HIV testing, the integration of sexual and reproductive health into regular health services also available to family members and culturally competent, ethical, providers who are better supported to involve consumers in health promotion. Conclusion: There is a need for research to better inform health interventions so that they build on local cultural norms and values and address social needs. A holistic approach to sexual and reproductive health beyond a focus on HIV may better engage community members, mining companies and governments in healthcare delivery. Relevance to clinical practice: Nurses may require appropriate workplace support and incentives to deliver sexual and reproductive health interventions in developing mining contexts where task shifting exists. 2013 John Wiley & Sons Ltd.
Dawson, A. & Homer, C.S. 2013, 'Managing the International Humanitarian and Development Health Workforce: a review of experiences and needs', Asia Pacific Journal of Health Management, vol. 8, no. 1, pp. 14-23.
The overseas development and humanitarian assistance provided by high income nations includes considerable investment directed at improving health in low and middle income countries. Governments, non-government organisations and consulting companies employ international health staff in low and middle income countries to deliver health interventions, manage programs and provide technical assistance. There are no reviews of evidence to guide the management, support and training of these staff, especially in relation to capacity building. We undertook a narrative synthesis of research to examine the needs and experiences of international health personnel engaged in development and humanitarian work. We found that altruism and a desire for professional and personal development motivated most international workers, however their roles are not always clear, affecting the delivery of quality care and services. Staff supply and skill-mix, short contracts, remuneration, leadership and workload were highlighted as issues. A lack of preparedness was also noted and staff identified strategies for coping in the field. Current efforts towards the professionalisation of health development and humanitarian staff may provide mechanisms to better support the workforce to respond and be accountable to the needs of countries. A performance management framework may need to be developed requiring research and validation
Hammond, A., Foureur, M., Homer, C.S.E. & Davis, D. 2013, 'Space, place and the midwife: Exploring the relationship between the birth environment, neurobiology and midwifery practice', Women and Birth, vol. 26, no. 4, pp. 277-281.
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Background: Research indicates that midwives and their practice are influenced by space and place and that midwives practice differently in different places. It is possible that one mechanism through which space and place influence midwifery practice is via neurobiological responses such as the production and release of oxytocin, which can be triggered by experiences and perceptions of the physical environment. Aim: To articulate the significance of space and place to midwifery and explore the relationship between the birth environment, neurobiology and midwifery practice. Discussion: Quality midwifery care requires the facilitation of trusting social relationships and the provision of emotionally sensitive care to childbearing women. The neuropeptide oxytocin plays a critical role in human social and emotional behaviour by increasing trust, reducing stress and heightening empathy, reciprocity and generosity. Principle conclusion: Through its role as a trigger for oxytocin release, the birth environment may play a direct role in the provision of quality midwifery care. 2013 Australian College of Midwives.
Sibbritt, D.W., Catling-Paull, C.J., Scarf, V.L. & Homer, C.S.E. 2013, 'The profile of women who consult midwives in Australia', Women and Birth, vol. 26, no. 4, pp. 240-245.
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Background: There is no Australian data on the characteristics of women who consult with midwives. Aim: To determine the profile of women who consult midwives in Australia. Methods: This cross-sectional research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH). Participants were the younger (31-36 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n= 801). The main outcome measure was consultation with a midwife. Findings: Of the 801 women who indicated that they were currently pregnant at the time of the survey, 19%, 42%, and 70% of women in the first, second and third trimesters respectively had consulted with a midwife. Women were more likely to consult a midwife if they: also consulted with a hospital doctor (OR = 2.70, 95% CI: 1.66, 4.40); also consulted with a complementary and alternative medicine practitioner (OR = 1.94, 95% CI: 1.25, 3.03); were depressed (OR = 1.84, 95% CI: 1.03, 3.28); constipated (OR = 1.80, 95% CI: 1.04, 3.13); or had been diagnosed or treated for hypertension during pregnancy (OR = 2.78, 95% CI: 1.27, 6.09). Women were less likely (OR = 0.34, 95% CI: 0.21, 0.56) to consult with a midwife if they had private health insurance. Conclusion: Women were more likely to consult with midwives in conjunction with consultations with hospital doctors or complementary and alternative medicine practitioners. Women with private health insurance were less likely to consult midwives. More research is necessary to determine the implications of the lack of midwifery care for these women. 2013 Australian College of Midwives.
Raymond, J.E., Homer, C.S.E., Smith, R. & Gray, J.E. 2013, 'Learning through authentic assessment: An evaluation of a new development in the undergraduate midwifery curriculum', Nurse Education in Practice, vol. 13, no. 5, pp. 471-476.
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Assessment is a powerful influence on learning, and can form an important strategy amongst a variety of teaching and learning approaches. Authentic assessment activities are designed to mimic the complexity of 'real world' situations that students may encounter in professional life, and require the application of a combination of skills related to knowledge, skills and attitude. We undertook a small-scale evaluation using a qualitative descriptive design to explore the feasibility and usefulness of an authentic assessment item that focused on a common clinical scenario in midwifery practice, female catheterisation. Seven third year Bachelor of Midwifery students and three teaching staff volunteered to participate in the project. During the process the students videoed the scenario for peer assessment, developed marking criteria, completed an online survey and participated in a focus group. The findings demonstrated that the students' confidence, knowledge and skills improved as a result of participating in the assessment item and they rated it positively for use in the Bachelor of Midwifery curriculum as a means of increasing real world assessment activities. It is anticipated that this learning strategy will be further refined and integrated in various ways into other clinical midwifery subjects in the midwifery curriculum. 2012 Elsevier Ltd.
Roth, H., Homer, C.S. & Fenwick, J. 2013, 'Letter to the Editor: "Bouncing back" response to Letter to Editor', Women and Birth, vol. 26, no. 2, pp. 159-159.
Cummins, A.M., Catling, C., Hogan, R. & Homer, C.S.E. 2013, 'Addressing culture shock in first year midwifery students: Maximising the initial clinical experience', Women and Birth.
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Background: Many Bachelor of Midwifery students have not had any exposure to the hospital setting prior to their clinical placement. Students have reported their placements are foreign to them, with a specialised confusing 'language'. It is important to provide support to students to prevent culture shock that may lead to them leaving the course. Aim: To assist first year midwifery students with the transition into clinical practice by providing a preparatory workshop. Methods: An action research project developed resources for a workshop held prior to students' first clinical placement. Four phases were held: Phase one involved holding discussion groups with students returning from clinical practice; Phase two was the creation of vodcasts; Phase three was integration of resources into the clinical subject and phase four was the evaluation and reflection on the action research project. Evaluations of the workshops were undertaken through surveying the students after they returned from their clinical placement. A descriptive analysis of the evaluations was performed. Findings: Students rated the workshop, vodcasts and the simulated handover positively. Further recommendations were that complications of labour and birth be included in their first semester as students were unexpectedly exposed to this in their first clinical placement. Conclusion: The students evaluated the workshop positively in reducing the amount of culture shock experienced on the first clinical placement. In addition the students provided further recommendations of strategies that would assist with clinical placement. 2014 Australian College of Midwives.
Lee, N., Martensson, L.B., Homer, C.S., Webster, J., Gibbons, K., Stapleton, H., Dos Santos, N., Beckmann, M., Gao, Y. & Kildea, S.V. 2013, 'Impact on Caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial', BMC Pregnancy Childbirth, vol. 13, no. 105, pp. 1-10.
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Background: Sterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate.
Sheehy, A., Davis, D. & Homer, C.S.E. 2013, 'Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence', Women and Birth, vol. 26, no. 2, pp. 152-157.
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The approach to the prevention of early onset GBS disease in the newborn varies considerably from country to country. The Centre for Disease Control in the United States advocates universal culture based screening with the administration of intra-partum antibiotics, usually benzylpenicillin or ampicillin, to women who are colonised with GBS. National groups in the UK and New Zealand advocate a risk-based approach where intra-partum antibiotics are given to women with identified risk factors. The Canadian Taskforce on preventive health care has identified a third approach; where intra-partum antibiotics are given to women with a positive GBS culture and an identified risk factor. There are no national guidelines or consensus in Australia. The aim of this paper is to explore the evidence for screening and intrapartum prophylaxis for GBS. The three main methods of detection and management of GBS in pregnancy are described and the implications for women and midwifery practice are addressed. It is hoped that this discussion will provide women, midwives and other clinicians with a summary of the evidence, risks and benefits to enable informed decision making. 2012 Australian College of Midwives.
Homer, C.S.E., Besley, K., Bell, J., Davis, D., Adams, J., Porteous, A. & Foureur, M. 2013, 'Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? A randomised controlled trial', BMC Pregnancy and Childbirth, vol. 13.
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Background: Caesarean section (CS) has short and long-term health effects for both the woman and her baby. One of the greatest contributors to the CS rate is elective repeat CS. Vaginal birth after caesarean (VBAC) is an option for many women; despite this the proportion of women attempting VBAC remains low. Potentially the relationship that women have with their healthcare professional may have a major influence on the uptake of VBAC. Models of service delivery, which enable an individual approach to care, may make a difference to the uptake of VBAC. Midwifery continuity of care could be an effective model to encourage and support women to choose VBAC.Methods/Design: A randomised, controlled trial will be undertaken. Eligible pregnant women, whose most recent previous birth was by lower-segment CS, will be randomly allocated 1:1 to an intervention group or control group. The intervention provides midwifery continuity of care to women through pregnancy, labour, birth and early postnatal care. The control group will receive standard hospital care from different midwives through pregnancy, labour, birth and early postnatal care. Both groups will receive an obstetric consultation during pregnancy and at any other time if required. Clinical care will follow the same guidelines in both groups.Discussion: This study will determine whether midwifery continuity of care influences the decision to attempt a VBAC and impacts on mode of birth, maternal experiences with care and the health of the neonate. Outcomes from this study might influence the way maternity care is provided to this group of women and thus impact on the CS rate. This information will provide high level evidence to policy makers, health service managers and practitioners who are working towards addressing the increased rate of CS.Trial registration: This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001214921. 2013 Homer et al.; licensee BioMed Central Ltd.
Vallely, L.M., Homiehombo, P., Kelly, A.M., Vallely, A., Homer, C.S.E. & Whittaker, A. 2013, 'Exploring women's perspectives of access to care during pregnancy and childbirth: A qualitative study from rural papua new guinea', Midwifery, vol. 29, no. 10, pp. 1222-1229.
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Objectives: to explore women's perceptions and experiences of pregnancy and childbirth in a rural community in PNG. Design: a qualitative, descriptive study comprising focus group discussions (FGDs) and in depth interviews. Setting: this study took place in a rural community in Eastern Highlands Province, PNG. Participants: 51 women participated in seven focus group discussions. In depth interviews were undertaken with 21 women, including women recruited at the antenatal clinic, women purposively selected in the community and three key informants in the community. Findings: the majority of women mentioned the benefits of receiving antenatal care at the health facility and the importance of a supervised, facility birth. Women faced numerous challenges with regards to accessing these services, including geographical, financial and language barriers. Cultural and customary beliefs surrounding childbirth and lack of decision making powers also impacted on whether women had a supervised birth. Key conclusions and implications for practice: distance, terrain and transport as well as decision making processes and customary beliefs influenced whether a woman did or did not reach a health facility to give birth. While the wider issue of availability and location of health services and health system strengthening is addressed shorter term, community based interventions could be of benefit. These interventions should include safe motherhood and birth preparedness messages disseminated to women, men and key family and community members. 2013 Elsevier Ltd.
Teate, A., Leap, N. & Homer, C.S.E. 2013, 'Midwives' experiences of becoming CenteringPregnancy facilitators: A pilot study in Sydney, Australia', Women and Birth, vol. 26, no. 1.
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Background: A pilot study was undertaken between 2006 and 2008 to explore the feasibility of implementing the CenteringPregnancy model of group antenatal care in Australia. The study was undertaken at two hospital antenatal clinics and two community healthcare centres in southern Sydney. This paper reports on one arm of the pilot study, known as the 'Midwives' Study', which aimed to explore the experiences of the midwives as they moved from providing traditional one-to-one antenatal care to facilitating group antenatal care. Methods: The Australian pilot study used Action Research. Eight midwives, the group facilitators, and three researchers formed the Action Research group. A qualitative descriptive approach was undertaken to describe the experiences of the midwives. Data were collected using focus groups, surveys and checklists and analysed using thematic content analysis. Findings: The midwives' initial fears and misgivings about undertaking the new role of group antenatal care gave way to a growing confidence in their abilities and group facilitation skills. They appreciated: the benefits of the CenteringPregnancy model for pregnant women; new opportunities to develop positive relationships with women and their colleagues; and the structured support and education throughout all stages of the Action Research process. Conclusion: The midwives were enthusiastic about their experiences of becoming CenteringPregnancy facilitators and described the benefits of this model of care compared to traditional one-to-one antenatal care. Support and education of the midwives through structured Action Research cycles enhanced the effective implementation of this new model. 2012 Australian College of Midwives.
Catling-Paull, C., Coddington, R.L., Foureur, M.J. & Homer, C.S.E. 2013, 'RE: Publicly funded homebirth in Australia: A review of maternal and neonatal outcomes-[3]', Medical Journal of Australia, vol. 199, no. 11, pp. 743-743.
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Homer, C.S.E. 2013, 'Home-like environments for labour and birth: Benefits for women and babies', Evidence-Based Medicine, vol. 18, no. 4.
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Campbell, J., de Bernis, L., Fogstad, H., Homer, C.S., Powell Kennedy, H., Renfrew, M. & ten Hoope-Bender, P. 2012, 'Family planning, health systems, and the health workforce', The Lancet, vol. 380, no. 9848, pp. 1147-1147.
The Lancets Family Planning Series is extremely timely and repositions an often forgotten but crucial issue. The Series addresses the reduction of population growth from the fundamentally important perspectives of sustainability, economics, human rights, policy, and health, and effectively highlights the multiple connections in todays global world. Core to making these links work is an effective health system and a competent workforce, without which the ability to ensure access to family planning is compromised.
Wheeler, J., Davis, D., Fry, M., Brodie, P. & Homer, C.S.E. 2012, 'Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature', Women and Birth, vol. 25, no. 3, pp. 107-113.
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Objective: To undertake a systematic review of the literature to determine whether Asian ethnicity is an independent risk factor for severe perineal trauma in childbirth. Method: Ovid Medline, CINAHL, and Cochrane databases published in English were used to identify appropriate research articles from 2000 to 2010, using relevant terms in a variety of combinations. All articles included in this systematic review were assessed using the Critical Appraisal Skills Programme (CASP) 'making sense of evidence' tools. Findings: Asian ethnicity does not appear to be a risk factor for severe perineal trauma for women living in Asia. In contrast, studies conducted in some Western countries have identified Asian ethnicity as a risk factor for severe perineal trauma. It is unknown why (in some situations) Asian women are more vulnerable to this birth complication. The lack of an international standard definition for the term Asian further undermines clarification of this issue. Nevertheless, there is an urgent need to explore why Asian women are reported to be significantly at risk for severe perineal trauma in some Western countries. Conclusion: Current research on this topic is confusing and conflicting. Further research is urgently required to explore why Asian women are at risk for severe perineal trauma in some birth settings. 2011 Australian College of Midwives.
Homer, C.S., Ryan, C., Leap, N., Foureur, M., Teate, A. & Catling-Paull, C.J. 2012, 'Group versus conventional antenatal care for women.', Cochrane database of systematic reviews (Online), vol. 11.
Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care is through a group model. The first objective was to compare the effects of group antenatal care versus one-to-one care on outcomes for women and their babies. The primary outcomes were preterm birth (birth occurring before 37 completed gestational weeks), low birthweight (less than 2500 g), small-for-gestational age (less than the tenth percentile for gestation and gender) and perinatal mortality. Secondary outcomes included psychological measures and satisfaction as well as labour and birth and postnatal outcomes.The second objective was to compare the effects of group care versus one-to-one care on care provider satisfaction. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 March 2012), contacted experts in the field and reviewed the reference lists of retrieved studies. All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible for inclusion but none were identified. Cross-over trials were not eligible. Two review authors independently assessed studies for inclusion and evaluated trial quality. Two authors extracted data. Data were checked for accuracy. We included two studies (1369 women). There were no statistically significant differences between women who received group antenatal care compared with standard one-to-one care in relation to the primary outcomes. In particular, there was no difference in the rate of preterm birth rate between the two groups (risk ratio (RR) 0.87; 95% confidence interval (CI) 0.47 to 1.60; two trials; N = 1315) and the proportion of low birthweight (less than 2500 g) babies was similar between the groups (RR 1.03; 95% CI 0.73 to 1.46; two trials; N = 1315).Satisfaction was rated highly in women who were allocated to group antenatal care but only measured in one trial. In this trial, the mean satisfaction with care in group antenatal care was almost five times higher compared with those allocated to standard care (N = 993). A number of outcomes related to stress, distress and depression were reported in one trial. There were no differences between the groups in any of these outcomes.There were no data available on the effects of group antenatal care on care provider satisfaction. The available evidence suggests that group antenatal care is positively viewed by women with no adverse outcomes for themselves or their babies. This review is limited owing to the small number of studies/women and the majority of the analyses are based on a single study. More research is required to determine if group antenatal care is associated with significant benefits.
Smith, R., Gray, J., Raymond, J., Catling-Paull, C. & Homer, C.S.E. 2012, 'Simulated Learning Activities: Improving Midwifery Students' Understanding of Reflective Practice', Clinical Simulation in Nursing, vol. 8, no. 9.
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Background: Graduate Diploma in Midwifery students at an Australian university poorly evaluated a compulsory theoretical subject (unit of study) titled Becoming a Reflective Practitioner over several years. Method: Authentic practice-based simulated scenarios were introduced to improve student learning and as an innovative approach to teaching reflective practice. The introduction was evaluated using student feedback surveys, pre- and post simulation knowledge questionnaires, and 6-week retention-of-knowledge questionnaires. Results: Students reported improved levels of satisfaction, greater learning, and increasing knowledge in the simulated practice area. The students rated the scenarios as useful in increasing reflective practice, but this was secondary to skill acquisition. Conclusion: Simulated activities may prove useful in developing reflective practice, but further investigation is required to examine how to shift the focus from clinical skill acquisition to reflective practice. 2012 International Nursing Association for Clinical Simulation and Learning.
Catling-Paull, C., Foureur, M.J. & Homer, C.S.E. 2012, 'Publicly-funded homebirth models in Australia', Women and Birth, vol. 25, no. 4, pp. 152-158.
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Background: Publicly-funded homebirth programs in Australia have been developed in the past decade mostly in isolation from each other and with limited published evaluations. There is also distinct lack of publicly available information about the development and characteristics of these programs. We instigated the National Publicly-funded Homebirth Consortium and conducted a preliminary survey of publicly-funded homebirth providers. Aim: To outline the development of publicly-funded homebirth models in Australia. Methods: Providers of publicly-funded homebirth programs in Australia were surveyed using an on-line survey in December 2010. Questions were about their development, use of policy and general operational issues. A descriptive analysis of the quantitative data and content analysis of the qualitative data was undertaken. Findings: In total, 12 programs were identified and 10 contributed data to this paper. The service providers reported extensive multidisciplinary consultation and careful planning during development. There was a lack of consistency in data collection throughout the publicly-funded homebirth programs due to different databases, definitions and the use of different guidelines. Discussion: Publicly-funded homebirth services followed different routes during their development, but essentially had safety and collaboration with stakeholders, including women and obstetricians, as central to their process. Conclusion: The National Publicly-funded Homebirth Consortium has facilitated a sharing of resources, processes of development and a linkage of homebirth services around the country. This analysis has provided information to assist future planning and developments in models of midwifery care. It is important that births of women booked to these programs are clearly identified when their data is incorporated into existing perinatal datasets. 2011 Australian College of Midwives.
Dahlen, H.G. & Homer, C.S.E. 2012, 'Web-based News Reports on Midwives Compared with Obstetricians: A Prospective Analysis', Birth, vol. 39, no. 1, pp. 48-56.
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Background: The media both creates and reflects public opinion. The way in which health professionals are depicted in the media is likely to influence views held by and about different health professions. The aim of this study was to examine how midwives and obstetricians are reported in English language web-based news reports from around the world. Methods: News alerts from the Internet search engine Google were created to search for the terms "midwife,""midwives,""midwifery,""obstetrics," and "obstetricians." These alerts were received over a 12-month period (May 1, 2006-April 31, 2007), downloaded, and analyzed using quantitative content analysis. Results: A total of 522 web-based news reports for midwifery and 564 for obstetrics (n=1,086) were found. Dominant categories for midwives were: "mainstreaming midwives" (models of care/rise of midwifery) (28%); "the Cinderella of the maternity care" (workforce/industrial) (27%); "delivering the baby with your hands tied" (funding, insurance, and legislation) (21%); "ask the expert" (education, research, and health advice) (8%), "recognizing midwives" (awards and announcements) (7%), "unsafe midwives" (litigation) (6%); and "the art of birth" (books, film, and photographs) (2%). Dominant categories for obstetricians were: "ask the expert" (research and advice) (26%); "doctors are heroes amongst us" (awards and announcements) (19%); "obstetric workforce woes" (workforce/industrial) (19%); "new frontiers" (trends in care and new technology) (17%); "the disappearing obstetrician" (insurance and litigation) (10%); and "human-interest news reports" (9%). Obstetricians were more likely to be recognized as experts on pregnancy and birth and receive public recognition compared with midwives. Midwives were more likely to be depicted as struggling to be a mainstream option while being hampered by lack of funding, insurance, and legislative barriers. Conclusions: Although midwives have rising acceptance, they still struggle with recognition. Obstetricians have both acceptance and recognition. Countries where midwifery is a mainstream option have more news reports related to midwifery than obstetrics. Different issues appear more dominant in some countries, such as work force in the United Kingdom and funding, insurance, and legislation in the United States. 2012, Copyright the Authors. Journal compilation 2012, Wiley Periodicals, Inc..
Fenwick, J., Hammond, A., Raymond, J., Smith, R., Gray, J., Foureur, M., Homer, C. & Symon, A. 2012, 'Surviving, not thriving: A qualitative study of newly qualified midwives' experience of their transition to practice', Journal of Clinical Nursing, vol. 21, no. 13-14, pp. 2054-2063.
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Aim and objectives. The study explored the experiences of newly qualified midwives and described the factors that facilitated or constrained their development during the transition from student to registered midwife. Background. Knowledge of the transition to midwifery practice remains limited. Design and Method. A qualitative descriptive approach was used. Sixteen graduates from one Australian University participated in a tape-recorded interview. Thematic analysis was used to analyse the data set. Results. The metaphor of 'The Pond', an environment that consists of layers of life and can be both clear and peaceful or murky and infested, was used to describe new midwives perceptions of the context and culture of hospital-based maternity care. For some, 'The Pond' was a harsh environment that often became toxic. The 'Life-raft' metaphor was used to describe the importance of midwife-to-midwife relationships. The theme of 'Swimming' captured the consequence of positive interactions with colleagues and a supportive environment, whilst 'Sinking' described the consequence of poor relationships with midwives and a difficult working environment. Conclusion. The study highlights the importance of positive midwife-to-midwife relationships on the transition from student to registered midwife. There was also evidence that continuity with women and midwifery colleagues enhanced confidence and restored faith in normal birth. At the same time, it was clear that the midwifery culture of some institutions remains highly contested with midwives struggling to provide woman-centred care and often challenged by the risk-averse nature of maternity care. Relevance to Clinical Practice. Whilst further work is required, the findings provide a deeper understanding of individual midwives' transition period. The importance of forming longitudinal relationships not only with women but with midwifery colleagues is highlighted. Developing continuity models that adequately support graduates and student's needs are likely to assist in addressing practices issues in both the academic and clinical setting. 2012 Blackwell Publishing Ltd.
Homer, C.S., Armari, E. & Fowler, C.M. 2012, 'Bed-sharing with infants in a time of SIDS awareness', Neonatal, Paediatric and Child Health Nursing, vol. 15, no. 2, pp. 9-13.
Risks associated with maternal-infant bed-sharing are widely documented and promoted. This study aims to examine sleep patterns and strategies including bed-sharing. Women aged over 18 who have infants aged up to 24 months were eligible to participate in an anonymous online questionnaire in March 2010. A representative sample of 1,000 respondents was randomly selected from a total sample of 2000. The challenge of facilitating infant sleeping was highlighted, with 92% of respondents having difficulties at some point. Almost all (97%) felt sleep-deprived at some time, with almost half reporting that they were always or regularly deprived of sleep. Sleep deprivation exacerbated exhaustion or feeling run down (75%), irritability (70%), made mothers less patient with their infants (63%) and put additional strain on their relationship with their partner (37%). Strategies to facilitate infant sleeping included rocking and patting (50%), giving a dummy/comforter (46%) and allowing the baby to fall asleep in their arms (47%) or after feeding (45%). Just under half (41%) utilised bed-sharing as a sleep strategy at night. Bed-sharing was more likely to be used if babies experienced frequent waking at night and unstable sleep patterns. Maternal-infant bed-sharing continues to be an infant sleep strategy used by mothers, despite the risks involved. This study highlights that mothers still continue to bed-share despite preventative health campaigns and the known risks. Thus, health promotion should be modified to include a stronger emphasis on risk minimisation strategies.
Ith, P., Dawson, A. & Homer, C. 2012, 'Quality of maternity care practices of skilled birth attendants in Cambodia', International Journal of Evidence-Based Healthcare, vol. 10, no. 1, pp. 60-67.
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Background: The World Health Organization's recommended package of interventions for the integrated management of pregnancy and childbirth provides guidance for the use of evidence-based interventions to ensure the best outcomes for mother and newborn. However, the extent to which skilled birth attendants (SBAs) follow evidence-based guidelines is not known. There are few studies into childbirth practices of SBAs in Cambodia. The aim of this study was to observe practices of SBAs during labour, birth and the immediate post-partum period and their consistency with evidence-based guidelines. Methods: A structured non-participant observation study was undertaken. Data were collected using an observational checklist of evidence-based practices adapted from the Cambodian clinical assessment tools for associate degree in midwifery. Maternity care settings in one provincial hospital, two district referral hospitals and two health centres in one province of Cambodia were purposively selected. Results: Twenty-five SBAs who attended 40 women during labour, birth and the postnatal period were observed. The results showed that the use of the partograph was low; birth companions were not permitted; cleanliness during birth was lacking; management of the third stage of labour was inappropriate; monitoring of mother and baby in the early postnatal period was lacking; the SBAs lacked skills in neonatal resuscitation; skin-to-skin contact with the newborn and early breastfeeding were rare; and intramuscular injection of vitamin K varied. Conclusion: The findings suggest that the current SBA practices during labour, birth and the immediate postpartum period in one province of Cambodia are not consistent with evidence-based guidelines. Service improvements that address evidence-based practices are likely to have an impact on clean and safe childbirth, thereby enhancing outcomes for Cambodia women. 2012 The Authors International Journal of Evidence-Based Healthcare 2012 The Joanna Briggs Institute.
Shahheidari, M. & Homer, C.S. 2012, 'Impact of the Design of Neonatal Intensive Care Units on Neonates, Staff, and Families', Journal of Perinatal and Neonatal Nursing, vol. 26, no. 3, pp. 260-266.
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Newborn intensive care is for critically ill newborns requiring constant and continuous care and supervision. The survival rates of critically ill infants and hospitalization in neonatal intensive care units (NICUs) have improved over the past 2 decades because of technological advances in neonatology. The design of NICUs may also have implications for the ealth of babies, parents, and staff. It is important therefore to articulate the design features of NICU that are associated with improved outcomes. The aim of this study was to explore the main features of the NICU design and to determine the advantages and limitations of the designs in terms of outcomes for babies, parents, and staff, predominately nurses. A systematic review of English-language, peer-reviewed articles was conducted for a period of 10 years, up to January 2011. Four online library databases and a number of relevant professional Web sites were searched using key words. There were 2 main designs of NICUs: open bay and single family room. The open-bay environment develops communication and interaction with medical staff and nurses and has the ability to monitor multiple infants simultaneously. The single-family rooms were deemed superior for patient care and parent satisfaction. Key factors associated with improved outcomes included increased privacy, increased parental involvement in patient care, assistance with infection control, noise control, improved sleep, decreased length of hospital stay, and reduced rehospitalization. The design of NICUs has implications for babies, parents, and staff. An understanding of the positive design features needs to be considered by health service planners, managers, and those who design such specialized units.
Shaban, I., Barclay, L., Lock, L. & Homer, C. 2012, 'Barriers to developing midwifery as a primary health-care strategy: A Jordanian study', MIDWIFERY, vol. 28, no. 1, pp. 106-111.
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Vaughan, G., Pollock, W., Peek, M.J., Knight, M., Ellwood, D., Homer, C.S., Pulver, L.J., McLintock, C., Ho, M. & Sullivan, E.A. 2012, 'Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 52, no. 2, pp. 195-203.
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Background: The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi-centre population health study is considered low risk with minimal ethical impact. Objective: To describe the ethics/governance review pathway undertaken by AMOSS. Method: Prospective, descriptive study during 2009-2011 of the governance/ethical review processes required to gain approval for Australian and New Zealand (ANZ) maternity units with more than 50 births per year (n = 303) to participate in AMOSS. Results: Review processes ranged from a single application for 24 NZ sites, a single application for eligible hospitals in two Australian states, full Health Research Ethics Committee (HREC) applications for individual hospitals, through simple letters of support. As of September 2011, 46 full/expedited ethics applications, 131 site governance applications and 136 letters of support requests were made over 33 months, involving an estimated 3261 hours by AMOSS staff/investigators, and an associated resource burden by participating sites, to obtain approval to receive nonidentifiable data from 291 hospitals. Conclusion: The AMOSS research system provides an important resource to enhance knowledge of conditions that cause rare and serious maternal morbidity. Yet the highly variable ethical approval processes required to implement this study have been excessively repetitive and burdensome. This process jeopardises timely, efficient research project implementation, without corresponding benefits to research participants. The resource burden to establish research governance for AMOSS confirms the urgent need for the Harmonisation of Multi-centre Ethical Review (HoMER) to further streamline ethics/governance review processes for multi-centre research. 2012 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Gray, J.E., Leap, N., Sheehy, A. & Homer, C.S.E. 2012, 'The 'follow-through' experience in three-year Bachelor of Midwifery programs in Australia: A survey of students', Nurse Education in Practice, vol. 12, no. 5, pp. 258-263.
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Introduction: The follow-through experience in Australian midwifery education is a strategy that requires midwifery students to 'follow' a number of women through pregnancy, labour and birth and into the parenting period. Background: The experience was introduced by the Australian College of Midwives as part of national standards for the three-year Bachelor of Midwifery programs. Anecdotally, the introduction caused considerable debate. A criticism was that these experiences were incorporated with little evidence of their value. Methods: An online survey was undertaken to explore the follow-through experience from the perspectives of current and former students. There were 101 respondents, 93 current students with eight recent graduates. Results: Participants were positive about developing relationships with women. They also identified aspects of the follow-through experience that were challenging. Support to assist with the experience was often lacking and the documentation required varied. Despite these difficulties, 75% felt it should be mandatory as it facilitated positive learning experiences. Discussion: The follow-through experience ensured that students were exposed to midwifery continuity of care. The development of relationships with women was an important aspect of learning. Conclusion: Despite these challenges, there were significant learning opportunities. Future work and research needs to ensure than an integrated approach is taken to enhance learning. 2012 Elsevier Ltd.
Homer, C.S.E., Griffiths, M., Brodie, P.M., Kildea, S., Curtin, A.M. & Ellwood, D.A. 2012, 'Developing a Core Competency Model and Educational Framework for Primary Maternity Services: A national consensus approach', Women and Birth, vol. 25, no. 3, pp. 122-127.
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Background: An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals. Participants: Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services. Methods: A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation. Findings: A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups' education and practice. Conclusions: The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services. 2011 Australian College of Midwives.
Barclay, L., Gao, Y., Homer, C.S. & Wild, K. 2012, 'Unintended Consequences of Policy Decisions to Reduce Maternal Mortality in the Asia Pacific', International Journal of Childbirth, vol. 2, no. 4, pp. 222-229.
Objectives: To describe the role of midwives and maternity care in three low resource settings and to challenge some policy options introduced to reduce maternal mortality for women residing in rural and remote areas.
Homer, C.S.E. & Catling-Paull, C. 2012, 'Safe timing for an urgent Caesarean section: What is the evidence to guide policy?', Australian Health Review, vol. 36, no. 3, pp. 277-281.
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Objective. To determine, from the evidence, what is the optimum decision to delivery (DDI) intervals in emergency Caesarean sections (CS). The aim of the study was to help guide policy in maternity services and identify issues relating to DDI and safe practice in maternity care. Method. A systematic review of the literature was undertaken. Assessment of the quality of eligible papers was undertaken using the Critical Appraisal Skills Program (CASP) rating. Results. There is no strong evidence that a DDI of 30min or less is associated with improved outcomes for babies or mothers. Some evidence suggests that a DDI of greater than 30min but less than 75min confers benefit, but these findings were confounded by the indications for the emergency CS. Conclusion. Urgent CS should occur as soon as possible, but there is insufficient evidence to support a definite time frame, such as 30min. A consistency of approach and nomenclature in describing the urgency of CS is necessary, which would enable criteria for further audit regarding DDI. Staff training should be addressed to improve transfer systems for CS. Antenatal risk assessment and congruence with role delineation and service delivery capacity is important. What is known about the topic? The 30-min rule has been cited and used globally as best practice, despite the low level of supporting evidence. What does this paper add? There is no strong evidence that DDIs of less than 30min are associated with improved neonatal or maternal outcomes. A DDI of greater than 30min but less than 75min confers some benefit, but this is tempered by the urgency of the CS. What are the implications for practitioners? Urgent CS should occur as soon as possible, but there is insufficient evidence to support a definite time frame, such as 30min. A consistency of approach and nomenclature in describing the urgency of CS is necessary, which would enable criteria for further audit regarding DDI. Staff training should be addressed regarding efficient systems during transfer for CS. Careful antenatal risk assessment and congruence with role delineation and service delivery capacity is important in making recommendations for place of birth for women. 2012 AHHA.
Homer, C.S., Lees, T., Stowers, P., Aiavao, F., Sheehy, A.D. & Barclay, L. 2012, 'Traditional Birth Attendants in Samoa: Integration With the Formal Health System', International Journal of Childbirth, vol. 2, no. 1, pp. 5-11.
A traditional birth attendant (TBA) is a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs. In many parts of the world, TBAs continue to provide a significant proportion of maternity care during pregnancy, birth, and the postpartum period. In Samoa, TBAs are recognized part of both the formal and informal health care system. The aim of this research was to examine the contribution that TBAs made in the provision of maternity care in Samoa. A descriptive study was undertaken, and 100 TBAs who had attended more than 400 births a year were interviewed as part of a broader Safe Motherhood Needs Assessment. The findings highlighted that although TBAs can work in collaboration with individual health providers or facilities or be integrated into the health system, TBAs were often practicing autonomously within their communities, independent of collaborative links. This study showed that formal recognition and registration of TBAs would improve the recording of births and augment their partnership to the formal health care system. This formal registration process has since been implemented to improve monitoring and evaluation and assist future research with this important group.
Roth, H., Homer, C.S. & Fenwick, J.H. 2012, '"Bouncing back": How Australia's leading women's magazines portray the postpartum 'body'', Women and Birth, vol. 25, pp. 128-134.
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To examine how the Australian media portrays the childbearing body through the use of celebrity stories in women's magazines. The study aimed to provide insight into socially constructed factors that might influence women's body image and expectations during pregnancy and the early postnatal period.
Smith, R., Brodie, P. & Homer, C.S.E. 2012, 'Reviewing and reflecting on practice: The midwives experiences of credentialling', Women and Birth, vol. 25, no. 4, pp. 159-165.
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Research question: What are the experiences of midwives working in midwifery-led models of care in NSW who undertake the credentialling process? Background: In 2005, the NSW Health Department issued a directive requiring midwives who worked in midwifery-led models of care to undergo a process known as credentialling. Credentialling involved a four-step process: self-assessment, face-to-face panel review of midwifery practice, assessment of emergency management skills and discussion of a case study from practice. Method: A descriptive exploratory study examined the experiences of the midwives who undertook the credentialling process in NSW. Data were collected through in-depth, semi-structured interviews with 12 midwives who had experienced credentialling and analysed using descriptive and thematic analysis. Findings: The themes were preparing for credentialling; doing credentialling; achieving credentialling; valuing credentialling; and, improving credentialling. Initially, the midwives were self-focused in their understanding and impressions of the value of credentialling. There were a number of contentions including seeing credentialling as another 'hoop to jump through' or a need to 'tick the box' and not as a framework for practice. Some viewed it as a necessary move to increase professionalism and facilitate practice review. Others felt they were being unfairly targeted as not all midwives were expected to undertake it. The midwives were cognisant of the need for a process that encouraged responsibility for ongoing professional development and continuing competence and believed the process would be useful in promoting deeper reflection on practice. Implications for practice: Credentialling was recognised as being valuable for all midwives to undertake as it encourages both a review of, and reflection on, practice. The process has further developed into Midwifery Practice Review (MPR) and is administered by the national professional association for midwifery. 2011 Australian College of Midwives.
Ith, P., Dawson, A. & Homer, C.S. 2012, 'Challenges to Reaching MDG5: A Qualitative Analysis of the Working Environment of Skilled Birth Attendants in Cambodia', International Journal of Childbirth, vol. 2, no. 3, pp. 153-162.
Objective: To explore the working environment of skilled birth attendants (SBAs) in one region in Cambodia and the factors affecting their motivation and performance.
Campbell, J., de Bernis, L., Fogstad, H., Homer, C.S., Powell Kennedy, H., Limbu, M., Matthews, Z., Renfrew, M. & ten Hoope-Bender, P. 2012, 'Family planning, health systems, and the health workforce', The Lancet, vol. 380, pp. 1147-1147.
Homer, C.S., Ryan, C., Leap, N., Foureur, M., Teate, A. & Catling-Paull, C.J. 2012, 'Group versus conventional antenatal care for women.', Cochrane Database Syst Rev, vol. 11, p. CD007622.
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Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care is through a group model.
Pierce, H., Homer, C.S., Dahlen, H.G. & King, J. 2012, 'Pregnancy-related lumbopelvic pain: listening to Australian women.', Nurs Res Pract, vol. 2012, p. 387428.
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Objective. To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Design. Cross-sectional, descriptive study. Setting. An Australian public hospital antenatal clinic.
Homer, C.S.E., Foureur, M.J., Allende, T., Pekin, F., Caplice, S. & Catling-Paull, C. 2012, ''It's more than just having a baby' women's experiences of a maternity service for Australian Aboriginal and Torres Strait Islander families', Midwifery, vol. 28, no. 4.
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Objective: the Malabar Community Midwifery Link Service was developed to meet the needs of women from Aboriginal and Torres Strait Islander communities in suburban Sydney, Australia. This paper reports the evaluation from the perspective of the Aboriginal and Torres Strait Islander women who accessed the service. Methods: a descriptive study using quantitative and qualitative approaches was undertaken for the first two years of the service. Clinical outcomes for women who gave birth in 2007 and 2008 were collected prospectively. A focus group with Aboriginal and Torres Strait Islander women was conducted, then tape recorded, transcribed verbatim and analysed qualitatively. Findings: 353 women gave birth through the Malabar service during 2007 and 2008. Over 40% of the babies born were identified as Aboriginal and Torres Strait Islander. Almost all the women had their first antenatal visit before 20 weeks of pregnancy. The service was successful in reducing the number of women smoking cigarettes during pregnancy. Women felt the service provided ease of access, continuity of care and caregiver, trust and trusting relationships. Conclusions: the Malabar service is an excellent example of a primary health care model of care that is meeting the needs of the community. Improving maternal and neonatal outcomes takes considerable time as the underlying causes of the disparities are complex. Implications: further research into ways to ensure that services like Malabar can address issues like smoking in pregnancy and the range of social and emotional issues faced by Australian Aboriginal and Torres Strait Islander women and families needs to be undertaken. More community-based appropriate services should be developed for these families. 2011 Elsevier Ltd.
Homer, C.S.E., Johnston, R. & Foureur, M.J. 2011, 'Birth after caesarean section: Changes over a nine-year period in one Australian state', Midwifery, vol. 27, no. 2, pp. 165-169.
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Objectives: to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality. Design and setting: cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998-2006. Participants: women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria. Measurements: data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400. g birth weight in the state. Findings: over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31-19%). The proportion of women who 'attempted a vaginal birth' also declined (49-35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers 'attempted' a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers 'attempted' a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small. Key conclusions: rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings. Implications for practice: decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours. 2009 Elsevier Ltd.
Sullivan, K., Lock, L. & Homer, C.S.E. 2011, 'Factors that contribute to midwives staying in midwifery: A study in one area health service in New South Wales, Australia', Midwifery, vol. 27, no. 3, pp. 331-335.
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Objective: the Australian health workforce is experiencing workforce shortages like many other countries. Managing retention is one important element of workforce planning. Determining the drivers of retention in midwifery can assist workforce planning. The objective of this study was to determine the factors that contribute to the retention of midwives, that is, why do midwives stay? Design: a descriptive design was undertaken in two phases. Phase one used focus groups to adapt a questionnaire used in the 'Why Midwives Stay' study in England for the Australian context. Phase two used the questionnaire to collect qualitative and quantitative data. Setting: one area health service in New South Wales, Australia. Participants: 392 midwives employed in the area health service either full-time, part-time or on a casual basis were invited to participate and 209 (53%) responded. Findings: the majority of respondents were women aged 23-69 years (mean age 42 years). Just over half had received their midwifery qualification through the hospital-based system which was usual prior to 1994 reflecting the age of the cohort. The top three reasons for staying in midwifery were 'I enjoy my job', 'I am proud to be a midwife' and 'I get job satisfaction'. Job satisfaction was received when midwives felt that they made a difference to women, had positive interactions with women in their care and saw women happy. The motivation to keep going was achieved through having a positive outlook; having job satisfaction, and, having work colleagues with a sense of belonging. Implications for practice: the findings have implications for the organisation of care, models of care, and management systems. Health services and departments of health need to consider these issues especially in an environment of workforce shortages. Addressing the way care is arranged and how staff are supported may lead to higher retention rates, thus reducing costs. 2011 Elsevier Ltd.
Catling-Paull, C., Johnston, R., Ryan, C., Foureur, M.J. & Homer, C.S.E. 2011, 'Clinical interventions that increase the uptake and success of vaginal birth after caesarean section: A systematic review', Journal of Advanced Nursing, vol. 67, no. 8, pp. 1646-1661.
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Aim. The aim of this study was to review clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section. Background. Repeat caesarean section is the main reason for the increase in surgical births. The risk of uterine rupture in women who have prior caesarean sections prevents many clinicians from recommending vaginal birth after caesarean. Despite this, support for vaginal birth after caesarean continues. Data sources. A search of five databases and a number of relevant professional websites was undertaken up to December 2008. Review methods. A systematic review of quantitative studies that involved a comparison group and examined a clinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. An assessment of quality was made using the Critical Skills Appraisal Programme. Results. Induction of labour using artificial rupture of membranes, prostaglandins, oxytocin infusion or a combination, was associated with lower vaginal birth rates. Cervical ripening agents such as prostaglandins and transcervical catheters may result in lower vaginal birth rates compared with spontaneous labour. The impact of epidural anaesthesia in labour on vaginal birth after caesarean success is inconclusive. X-ray pelvimetry is associated with reduced uptake of vaginal birth after caesarean and higher caesarean section rates. Scoring systems to predict likelihood of vaginal birth are largely unhelpful. There is insufficient data in relation to vaginal birth after caesarean section between different closure methods for the primary caesarean section. Conclusion. Clinical factors can affect vaginal birth after caesarean uptake and success. 2011 The Authors. Journal of Advanced Nursing 2011 Blackwell Publishing Ltd.
Homer, C.S.E., Kurinczuk, J.J., Spark, P., Brocklehurst, P. & Knight, M. 2011, 'Planned vaginal delivery or planned caesarean delivery in women with extreme obesity', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 118, no. 4, pp. 480-486.
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Objective To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index ? 50 kg/m2). Design A national cohort study using the UK Obstetric Surveillance System (UKOSS). Setting All hospitals with consultant-led maternity units in the UK. Population Five hundred and ninety-one extremely obese women delivering in the UK between September 2007 and August 2008. Methods Prospective cohort identification through UKOSS routine monthly mailings. Main outcome measures Anaesthetic, postnatal and neonatal complication rates. Results After adjustment, there were no significant differences in anaesthetic, postnatal or neonatal complications between women with planned vaginal delivery and planned caesarean delivery, with the exception of shoulder dystocia (3% versus 0%, P = 0.019). There were no significant differences in any outcomes in the subgroup of women who had no identified medical or antenatal complications. Conclusions This study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes. RCOG 2011 BJOG An International Journal of Obstetrics and Gynaecology.
Shaban, I., Hatamleh, R., Khresheh, R. & Homer, C.S. 2011, 'Childbirth practices in Jordanian public hospitals: consistency with evidence-based maternity care?', International Journal of Evidence-Based Healthcare, vol. 9, pp. 25-31.
Background: In 1996, the World Health Organization stated that `childbirth is a natural process and in normal birth, there should be a valid reason to interfere with this natural process and encouraged practices that are evidence-based. The practices encouraged included avoiding unnecessary augmentation of labour, facilitating upright position for birth and restricting the use of routine episiotomy. Many countries have been slow to fully implement evidence-based practice in maternity care. The aim of this study was to examine maternity hospital practices in Jordan and assess their consistency with evidence-based maternity care. Methods: An explorative research design with non-participant observation was used. Data were collected from low-risk women during labour and birth using a questionnaire for maternal characteristics and an observational checklist. A proportional stratified sample was selected to recruit from three major public hospitals in Jordan. Data were analysed using descriptive statistics. Results: A total of 460 women were observed during labour and birth. The majority were multiparous (80%). A range of interventions were observed in women having a normal labour including augmentation (95%), continuous external fetal monitoring (77%), lithotomy position for birth (100%), and more than one third (37%) had an episiotomy with varying degrees of laceration (58%). Conclusions: Childbirth practices were largely not in accordance with the World Health Organization evidencebased practices for normal birth. High levels of interventions were observed, many of which may not have been necessary in this low-risk population. Further work needs to occur to explore the reasons why evidence-based practice is not implemented in these hospitals.
Homer, C.S.E. 2011, 'The 'Ready for Child' structured antenatal training programme increases likelihood of mother's arriving at the maternity ward in active labour and decreases use of epidural analgesia', Evidence-Based Nursing, vol. 14, no. 1, pp. 16-17.
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Catling-Paull, C., Dahlen, H. & Homer, C.S. 2011, 'Multiparous women's confidence to have a publicly-funded homebirth: a qualitative study.', Women Birth, vol. 24, no. 3, pp. 122-128.
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Hospital birth is commonly thought to be a safer option than homebirth, despite many studies showing similar rates of safety for low risk mothers and babies when cared for by qualified midwives with systems of back-up in place. Recently in Australia, demand has led to the introduction of a small number of publicly-funded homebirth programs. Women's confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored.
Catling-Paull, C., Johnston, R., Ryan, C., Foureur, M.J. & Homer, C.S. 2011, 'Non-clinical interventions that increase the uptake and success of vaginal birth after caesarean section: A systematic review', Journal of Advanced Nursing, vol. 67, no. 8, pp. 1662-1676.
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Aim. The aim of this study was to review non-clinical interventions that increase the uptake and/or the success rates of vaginal birth after caesarean section. Background. Increases in rates of caesarean section are largely due to repeat caesarean section in a subsequent pregnancy. Concerns about vaginal birth after caesarean section have centred on the risk of uterine rupture. Nonetheless, efforts to increase the vaginal birth rate in these women have been made. This study reviews these in relation to non-clinical interventions. Data sources. Literature was searched up until December 2008 from five databases and a number of relevant professional websites. Review methods. A systematic review of quantitative studies that evaluated a non-clinical intervention for increasing the uptake and/or the success of vaginal birth after caesarean section was undertaken. Only study designs that involved a comparison group were included. Further exclusions were imposed for quality using the Critical Skills Appraisal Programme. Results. National guidelines influence vaginal birth after caesarean section rates, but a greater effect is seen when institutions develop local guidelines, adopt a conservative approach to caesarean section, use opinion leaders, give individualized information to women, and give feedback to obstetricians about mode of birth rates. Individual clinician characteristics may impact on the number of women choosing and succeeding in vaginal birth after caesarean section. There is inconsistent evidence that having private health insurance may be a barrier to the uptake and success of vaginal birth after caesarean section. Conclusion. Non-clinical factors can have a significant impact on vaginal birth after caesarean section uptake and success. 2011 The Authors. Journal of Advanced Nursing 2011 Blackwell Publishing Ltd.
Foureur, M.J., Leap, N., Davis, D.L., Forbes, I.F. & Homer, C.S.E. 2011, 'Testing the birth unit design spatial evaluation tool (BUDSET) in Australia: A pilot study', Health Environments Research and Design Journal, vol. 4, no. 2, pp. 36-60.
Objective: To pilot test the Birth Unit Design Spatial Evaluation Tool (BUDSET) in an Australian maternity care setting to determine whether such an instrument can measure the optimality of different birth settings. Background: Optimally designed spaces to give birth are likely to influence a woman's ability to experience physiologically normal labor and birth. This is important in the current industrialized environment, where increased caesarean section rates are causing concerns. The measurement of an optimal birth space is currently impossible, because there are limited tools available. Methods: A quantitative study was undertaken to pilot test the discriminant ability of the BUDSET in eight maternity units in New South Wales, Australia. Five auditors trained in the use of the BUDSET assessed the birth units using the BUDSET, which is based on 18 design principles and is divided into four domains (Fear Cascade, Facility, Aesthetics, and Support) with three to eight assessable items in each. Data were independently collected in eight birth units. Values for each of the domains were aggregated to provide an overall Optimality Score for each birth unit. Results: A range of Optimality Scores was derived for each of the birth units (from 51 to 77 out of a possible 100 points). The BUDSET identified units with low-scoring domains. Essentially these were older units and conventional labor ward settings. Conclusion: The BUDSET provides a way to assess the optimality of birth units and determine which domain areas may need improvement. There is potential for improvements to existing birth spaces, and considerable improvement can be made with simple low-cost modifications. Further research is needed to validate the tool. 2011, Vendome Group, LLC. All rights reserved.
Adams, J., Lui, C.-.W., Sibbritt, D., Broom, A., Wardle, J. & Homer, C. 2011, 'Attitudes and referral practices of maternity care professionals with regard to complementary and alternative medicine: An integrative review', Journal of Advanced Nursing, vol. 67, no. 3, pp. 472-483.
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Aim. This paper presents an integrative literature review examining the attitudes and referral practices of midwives and other maternity care professionals with regard to complementary and alternative treatment and its use by pregnant women. Background. Use of complementary and alternative medicine during pregnancy is a crucial healthcare issue. Recent discussion has identified the need to develop an integrated approach to maternity care. However, there is a lack of understanding of attitudes and behaviours of maternity care professionals towards these treatments. Data sources. A database search was conducted in MEDLINE, CINAHL, Health Source, AMED and Maternity and Infant Care for the period 1999-2009. Review methods. An integrative review method was employed. Studies were selected if they reported results from primary data collection on professional practice/referral or knowledge/attitude towards complementary and alternative medicine by obstetricians, midwives and allied maternity care providers. Results. A total of 21 papers covering 19 studies were identified. Findings from these studies were extracted, grouped and examined according to three key themes: 'prevalence of practice, recommendation and referral', 'attitudes and views' and 'professionalism and professional identity'. Conclusion. There is a need for greater respect and cooperation between conventional and alternative practitioners as well as communication between all maternity care practitioners and their patients about the use of complementary and alternative medicine. There is a need for in-depth studies on the social dimension of practice as well as the inter- and intra-professional dynamics that shape providers' decision to use or refer to complementary and alternative medicine in maternity care. 2011 Blackwell Publishing Ltd.
Hammond, A., Gray, J., Smith, R., Fenwick, J. & Homer, C.S. 2011, 'Same...same but different: Expectations of graduates from two midwifery education courses in Australia', Journal of Clinical Nursing, vol. 20, no. 15-16, pp. 2315-2324.
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Aims and objectives. To identify the expectations and workforce intentions of new graduate midwives from two different pre-registration educational courses at one Australian university. Background. In Australia there are two different educational pathways to midwifery qualification, one offered for registered nurses, commonly at a postgraduate level and the other for non-nurses, at an undergraduate level. The knowledge about midwifery graduates in general is reasonably limited and there is no specific research that examines the similarities and differences between graduates from the two different courses. Design. A cross-sectional design was used. Method. Data were collected by questionnaire from both undergraduate and postgraduate midwifery graduates in 2007 and 2008 at one Australian university. Data were analysed using descriptive statistics. Results. Almost all the graduates from the two different pre-registration courses intended to enter the midwifery workforce with both groups rating the factors that influenced this decision similarly. There were, however, significant differences in graduates age and their intention to work part time. Their views of their ideal roles and subsequent uptake into formal new graduate transition programmes differed. Graduates from the two courses also reported philosophical differences regarding their concepts of job satisfaction and ways their jobs could be improved. Conclusions. The graduates from the two different courses showed sufficient significant differences to warrant consideration in current workforce planning for midwifery. Relevance to clinical practice. The factors that influence the career decisions of new graduate midwives can positively impact educational and workforce planning. The findings may be able to help inform strategies to address turnover and attrition in midwifery. 2011 Blackwell Publishing Ltd.
Homer, C.S.E., Biggs, J., Vaughan, G. & Sullivan, E.A. 2011, 'Mapping maternity services in Australia: Location, classification and services', Australian Health Review, vol. 35, no. 2, pp. 222-229.
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Objective. To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. Design. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 26). Results. A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Conclusion. Maternity service provision varies across the country and is defined predominately by location and annual birth rate. What is known about the topic? In 2007, over 99% of the 289496 women who gave birth in Australia did so in a hospital. It is estimated that there are more than 300 maternity units in the country, ranging from large tertiary referral centres in major cities to smaller maternity units in rural towns, some of which only provide postnatal care with the woman giving birth at a larger facility. Geographical location, population and ability to attract a maternity workforce determine the number of maternity units within a region, although the means of determining the number of maternity units within a region is often unclear. In recent years, a large number of small maternity units have closed, particularly in rural areas, often due to difficulties securing an adequate workforce, particularly midwives and general practitioner obstetricians. There is a lack of understanding about the nature of maternity service provision in Australia and considerable differences across states and territories. What does this paper add? This paper provides a description of the geographic distribution and level of maternity services, the demand on services, the available obstetric interventions, the level of staffing (paediatric and anaesthetic) and support services available and the private and public mix of maternity units. The paper also provides an exploration of the different interventions and discusses whether these are appropriate, given the level of acuity and access to emergency Caesarean section services. What are the implications for practitioners? This study provides useful information particularly for policy-makers, managers and practitioners. This is at a time when considerable maternity reform is underway and changes at a broader level to the health system are planned. Understanding the nature of maternity services is critical to this debate and ongoing planning decisions. 2011 AHHA.
Smith, R.M., Homer, C.S., Homer, A.K. & Homer, D.J. 2011, 'Learning about grief and loss through Harper's story', MIDIRS Midwifery Digest, vol. 21, no. 1, pp. 19-22.
Sheehy, A., Foureur, M., Catling-Paull, C. & Homer, C. 2011, 'Examining the content validity of the birthing unit design spatial evaluation tool within a woman-centered framework.', J Midwifery Womens Health, vol. 56, no. 5, pp. 494-502.
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The environment for birth influences women in labor. Optimal birthing environments have the potential to facilitate normal labor and birth. The measurement of optimal birth units is currently not possible because there are no tools. An audit tool, the Birth Unit Design Spatial Evaluation Tool (BUDSET), was developed to assess the optimality of birthing environments. The BUDSET is based on 4 domains (fear cascade, facility, aesthetics, support), each comprising design principles that are further differentiated into specific assessable design items. In the process of developing measurement tools, content validity must be established. The aim of this study was to establish the content validity of the BUDSET from the perspective of women and midwives.
Catling-Paull, C., Mcdonnell, N., Moores, A. & Homer, C.S.E. 2011, 'Maternal mortality in Australia: Learning from maternal cardiac arrest', Nursing and Health Sciences, vol. 13, no. 1, pp. 10-15.
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Cardiac arrest in pregnancy is fortunately a rare event that few midwives will see during their career. The increase in maternal age, the Body Mass Index, cesarean sections, multiple pregnancies, and comorbidities over recent years have increased the probability of cardiac arrest. The early warning signs of impending maternal cardiac arrest are either absent or go unrecognized. Maternal mortality reviews highlight the deficiencies that maternity care providers have in managing cardiac arrest in pregnancy. The aim of this article is to address the knowledge deficiencies of health professionals by reviewing the physiological changes in pregnant women that complicate the management of cardiopulmonary resuscitation, using a case scenario. There are key differences in the management of pregnant women, when compared to standard adult resuscitation. The outcome is dependent on the speed of the response and the consideration of a number of crucial pregnancy-specific interventions. Staff members need to be adequately trained in order to deal with maternal cardiac arrest and have access to training packages and in-service education programs. As cardiac arrest in pregnancy is a rare event, emergency drill simulations are an important component of ongoing education. 2011 Blackwell Publishing Asia Pty Ltd..
Teate, A., Leap, N., Rising, S.S. & Homer, C.S.E. 2011, 'Women's experiences of group antenatal care in Australia-the CenteringPregnancy Pilot Study', Midwifery, vol. 27, no. 2, pp. 138-145.
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Objective: to describe the experiences of women who were participants in the Australian CenteringPregnancy Pilot Study. CenteringPregnancy is an innovative model of care where antenatal care is provided in a group environment. The aim of the pilot study was to determine whether it would be feasible to implement this model of care in Australia. Design: a descriptive study was conducted. Data included clinical information from hospital records, and antenatal and postnatal questionnaires. Setting: two metropolitan hospitals in Sydney, Australia. Participants: 35 women were recruited to the study and 33 ultimately received all their antenatal care (eight sessions) through five[CH1] CenteringPregnancy groups. Findings: difficulties with recruitment within a short study timeline resulted in only 35 (20%) of 171 women who were offered group antenatal care choosing to participate. Most women chose this form of antenatal care in order to build friendships and support networks. Attendance rates were high and women appreciated the opportunity and time to build supportive relationships through sharing knowledge, ideas and experiences with other women and with midwives facilitating the groups. The opportunity for partners to attend was identified as important. Clinical outcomes for women were in keeping with those for women receiving standard care; however, the numbers were small. Conclusion: the high satisfaction of the women suggests that CenteringPregnancy is an appropriate model of care for many women in Australian settings, particularly if recruitment strategies are addressed and women's partners can participate. Implications for practice: CenteringPregnancy group antenatal care assists women with the development of social support networks and is an acceptable way in which to provide antenatal care in an Australian setting. Recruitment strategies should include ensuring that practitioners are confident in explaining the advantages of group antenatal care to women in early pregnancy. Further research needs to be conducted to implement this model of care more widely. 2009 Elsevier Ltd.
Davidson, P.M., Homer, C.S.E., Duffield, C. & Daly, J. 2011, 'A moment in history and a time for celebration: The performance of nursing and midwifery in Excellence in Research for Australia', Collegian, vol. 18, no. 2, pp. 43-44.
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Schmied, V., Donovan, J., Kruske, S., Kemp, L., Homer, C. & Fowler, C. 2011, 'Commonalities and challenges: A review of Australian state and territory maternity and child health policies', CONTEMPORARY NURSE, vol. 40, no. 1, pp. 106-117.
Pierce, H.M., Homer, C.S., Dahlen, H. & King, J. 2011, 'Pregnancy-Related Lumbopelvic Pain: Listening to Australian Women', Nursing Research and Practice, vol. 2012, no. Art387428, pp. 1-10.
To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Cross-sectional, descriptive study. An Australian public hospital antenatal clinic. Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women.Main OutcomeMeasures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a). Results. There was a high prevalence of self reported LPP during the pregnancy (71%). An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition.Most women (71%) had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy.
Dahlen, H.G., Homer, C.S.E., Leap, N. & Tracy, S.K. 2011, 'From social to surgical: Historical perspectives on perineal care during labour and birth', Women and Birth, vol. 24, no. 3, pp. 105-111.
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A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98-138. A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention - most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a re-emergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice. 2010 Australian College of Midwives.
Homer, C.S. 2011, 'The 'Ready for Child' structured antenatal training programme increases likelihood of mother's arriving at the maternity ward in active labour and decreases use of epidural analgesia.', Evid Based Nurs, vol. 14, no. 1, pp. 16-17.
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Catling-Paull, C., Dahlen, H. & Homer, C.S.E. 2011, 'Corrigendum to "Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study" [Women and Birth 24 (2011) 122-128]', Women and Birth, vol. 24, no. 4, pp. 180-180.
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Dahlen, H.G., Barclay, L.M. & Homer, C.S.E. 2010, 'The novice birthing: theorising first-time mothers' experiences of birth at home and in hospital in Australia', Midwifery, vol. 26, no. 1, pp. 53-63.
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Objective: to explore first-time mothers' experiences of birth at home and in hospital in Australia. Design: a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Setting: Sydney, Australia. Participants: 19 women were interviewed. Seven women who gave in a public hospital and seven women who gave birth for the first time at home were interviewed and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. Findings: three categories emerged from the analysis: preparing for birth, the novice birthing and processing the birth. These women shared a common core experience of seeing that they gave birth as 'novices'. The basic social process running through their experience of birth, regardless of birth setting, was that, as novices, they were all 'reacting to the unknown'. The mediating factors that influenced the birth experiences of these first-time mothers were preparation, choice and control, information and communication, and support. The quality of midwifery care both facilitated and hindered these needs, contributing to the women's perceptions of being 'honoured'. The women who gave birth at home seemed to have more positive birth experiences. Implications for practice: identifying the novice status of first-time mothers and understanding the way in which they experience birth better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing. It demonstrates how midwives can contribute to positive birth experiences by being aware that first-time mothers, irrespective of birth setting, are essentially reacting to the unknown as they negotiate the experience of birth. 2008 Elsevier Ltd. All rights reserved.
Catling, C., Johnston, R.A., Ryan, C., Foureur, M. & Homer, C.S. 2010, 'Interventions for increasing the uptake or success of vaginal birth after caesarean section: A Technical Report', pp. 1-94.
Schmied, V., Mills, A., Kruske, S., Kemp, L., Fowler, C. & Homer, C. 2010, 'The nature and impact of collaboration and integrated service delivery for pregnant women, children and families', JOURNAL OF CLINICAL NURSING, vol. 19, no. 23-24, pp. 3516-3526.
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Allen, S., Chiarella, M. & Homer, C.S.E. 2010, 'Lessons learned from measuring safety culture: An Australian case study', Midwifery, vol. 26, no. 5, pp. 497-503.
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Background: adverse events in maternity care are relatively common but often avoidable. International patient safety strategies advocate measuring safety culture as a strategy to improve patient safety. Evidence suggests it is necessary to fully understand the safety culture of an organisation to make improvements to patient safety. Aim: this paper reports a case study examining the safety culture in one maternity service in Australia and considers the benefits of using surveys and interviews to understand safety culture as an approach to identify possible strategies to improve patient safety in this setting. Setting: the study took place in one maternity service in two public hospitals in NSW, Australia. Concurrently, both hospitals were undergoing an organisational restructure which was part of a major health reform agenda. The priorities of the reform included improving the quality of care and patient safety; and, creating a more efficient health system by reducing administration inefficiencies and duplication. Design: a descriptive case study using three approaches: Safety Attitudes Questionnaire and Safety Climate Scale surveys administered to maternity health professionals (59/210, 28% response rate) measured six safety culture domains: Safety climate, Teamwork climate, Job satisfaction, Perceptions of management, Stress recognition and Working conditions. Semi-structured interviews (15) with key maternity, clinical governance and policy stakeholders augmented the survey data and explored the complex issues associated with safety culture. A policy audit and chronological mapping of the key policies influencing safety culture identified through the surveys and interviews within the maternity service. Findings: the safety culture was identified to warrant improvement across all six safety culture domains. There was reduced infrastructure and capacity to support incident management activities required to improve safety, which was influenced by instability from the organisational restructure. There was a perceived lack of leadership at all levels to drive safety and quality and improving the safety culture was neither a key priority nor was it valued by the organisation. Conclusion: the safety culture was complex as was undertaking this study. We were unable to achieve a desired 60% response rate highlighting the limitations of using safety culture surveys in isolation as a strategy to improve safety culture. Qualitative interviews provided greater insight into the factors influencing the safety culture. The findings of this study provide evidence of the benefits of including qualitative methods with quantitative surveys when examining safety culture. Undertaking research in this way requires local engagement, commitment and capacity from the study site. The absence of these factors is likely to limit the practicality of this approach in the clinical setting. Significance: the use of safety culture surveys as the only method of assessing safety culture is of limited value in identifying strategies to potentially improve the safety culture. 2010 Elsevier Ltd.
Foureur, M., Davis, D., Fenwick, J., Leap, N., Iedema, R., Forbes, I. & Homer, C.S.E. 2010, 'The relationship between birth unit design and safe, satisfying birth: Developing a hypothetical model', Midwifery, vol. 26, no. 5, pp. 520-525.
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Recent advances in cross-disciplinary studies linking architecture and neuroscience have revealed that much of the built environment for health-care delivery may actually impair rather than improve health outcomes by disrupting effective communication and increasing patient and staff stress. This is also true for maternity care provision, where it is suggested that the design of the environment can also impact on the experiences and outcomes for birthing women.The aim of this paper is to describe the development of a conceptual model based on literature and understandings of design, communication, stress and model of care. The model explores potential relationships among a set of key variables that need to be considered by researchers wishing to determine the characteristics of optimal birth environments in relation to birth outcomes for women and infants. The conceptual model hypothesises that safe satisfying birth is reliant on the level of stress experienced by a woman and the staff around her, stress influences the quality of communication with women and between staff, and this process is mediated by the design of the birth unit and model of care.The conceptual model is offered as a starting point for researchers who have an appreciation of the complexity of birth and the ability to bring together colleagues from a range of disciplines to explore the pre-requisites for safe and effective maternity care in new ways. 2010 Elsevier Ltd.
Homer, C.S.E., Kurinczuk, J.J., Spark, P., Brocklehurst, P. & Knight, M. 2010, 'A novel use of a classification system to audit severe maternal morbidity', Midwifery, vol. 26, no. 5, pp. 532-536.
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Objective: obstetric haemorrhage remains a significant cause of maternal morbidity and mortality worldwide and is significant in terms of patient safety and quality of care. One drastic outcome of haemorrhage is the need for peripartum hysterectomy. A classification system that can be used to audit severe events such as peripartum hysterectomy would be a useful adjunct to patient safety systems, but it would need to account for pre-existing risk factors, such as previous caesarean section. One system that accounts for important risk factors is the Robson Ten Group Classification System (TGCS). The aim of this study was to examine whether the TGCS could be extended in a novel way to classify who required peripartum hysterectomy. Setting: population-based matched case-control study data from the UK Obstetric Surveillance System was used. All eligible UK hospitals participated. Participants: women who underwent peripartum hysterectomy between February 2005 and February 2006 and their matched controls. Methods: cases and controls were categorised using the TGCS. The odds of having a peripartum hysterectomy in each classification group were calculated using logistic regression. An adjusted analysis was undertaken controlling for potential confounders. Findings: 307 of the 315 women who had a peripartum hysterectomy were classified into one of the 10 groups; 606 of the 608 control women were classified. Women who underwent a peripartum hysterectomy were predominantly from the more complex classification groups. After adjusting for age, ethnicity and socio-economic status, the groups with an increased odds of peripartum hysterectomy were those who had a previous caesarean section. Conclusions: the TGCS can be used in a novel way, that is, to examine an outcome other than caesarean section, and could be part of a new system to monitor patient safety. Population-based data were used as an example of how an existing classification system could be used in a different way from that for which it was created, and could make comparisons across institutions and countries while adjusting for case mix in a simple manner. The TGCS may not necessarily be a useful way to monitor other events in childbirth. Further work is needed to develop other classification systems which could be used as a benchmarking tools to monitor patient safety in maternity care. 2010 Elsevier Ltd.
Foureur, M.J., Leap, N., Davis, D.L., Forbes, I.F. & Homer, C.S.E. 2010, 'Developing the birth unit design spatial evaluation tool (BUDSET) in Australia: A qualitative study', Health Environments Research and Design Journal, vol. 3, no. 4, pp. 43-57.
Objective: To develop a tool known as the Birth Unit Design Spatial Evaluation Tool (BUDSET), to assess the optimality of birth unit design. Background: The space provided for childbirth influences the physiology of women in labor. Optimal birth spaces are likely to enable women to have physiologically normal labor and birth. The measurement of an optimal birth space is currently impossible, because limited tools are available. Research into optimal birth unit design is also limited. Methods: The BUDSET was developed using a qualitative study. Data collection included an extensive literature review, interviews with key informants (architects, midwife clinicians, and researchers) and an expert panel. A Pattern Language format was used to synthesize the literature and data obtained from the key informants. Results: The BUDSET is based on 18 design principles and is divided into four domains (Fear Cascade; Facility; Aesthetics; Support) with three to eight assessable items in each. Conclusion: Birth units must be designed so that they facilitate and support the physiology of normal childbirth. The BUDSET may provide a way to assess the optimality of birth units and determine which domain areas may need to be improved.
Dahlen, H.G., Barclay, L. & Homer, C.S.E. 2010, ''Reacting to the unknown': Experiencing the first birth at home or in hospital in Australia', Midwifery, vol. 26, no. 4, pp. 415-423.
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Objective: to explore the experiences of a small group of first-time mothers giving birth at home or in hospital. Design: a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Setting: Sydney, Australia. Participants: 19 women were interviewed. Seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were interviewed, and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. Results: these women shared common experiences of giving birth as 'novices'. Regardless of birth setting, they were all 'reacting to the unknown'. As they entered labour, the women chose different levels of responsibility for their birth. They also readjusted their expectations when the reality of labour occurred, reacted to the 'force' of labour, and connected or disconnected from the labour and eventually the baby. Implications for practice: knowing that first-time mothers, irrespective of birth setting, are essentially 'reacting to the unknown' as they negotiate the experience of birth, could alter the way in which care is provided and increase the sensitivity of midwives to women's needs. Most importantly, midwives need to be aware of the need to help women adjust their expectations during labour and birth. Identifying the 'novice' status of first-time mothers also better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing. 2008.
Dahlen, H.G., Barclay, L.M. & Homer, C.S. 2010, 'Processing the first birth: Journeying into 'motherland'', Journal of Clinical Nursing, vol. 19, no. 13-14, pp. 1977-1985.
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Aims and objectives: To explore first-time mothers' experiences of birth at home and in hospital in Australia. Background: The first birth has unique physical and psychological impacts on women. With the first birth, women become mothers. Design: A grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Methods: Nineteen women were interviewed in Sydney, Australia. The experiences of seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were contrasted with two mothers who gave birth for the first time in birth centres, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. Results: Following the birth, women 'processed the birth' by 'remembering', 'talking (storytelling)' and 'feeling'. This activity appeared to help most women resolve their feelings about the birth and understand what it actually means to be a new mother. 'Personal and social integration' occurred for most women as they entered 'motherland'. Conclusion: First-time mothers appear to 'process the birth' to a greater extent than multiparous women because they are experiencing this for the first time. These women also have limited social networks in 'motherland', and these are facilitated through sharing the experiences of their labour or 'processing the birth'. Relevance to clinical practice: Identifying the novice status of first-time mothers and understanding the way they process the birth can help health providers to be sensitive to the specific needs of primiparous women. In particular, their need to tell their birth stories following birth; understanding that these stories help women to process the birth and connect to other women. 2010 The Authors. Journal compilation 2010 Blackwell Publishing Ltd.
Dahlen, H.G., Barclay, L.M. & Homer, C.S. 2010, 'The novice birthing: theorising first-time mothers' experiences of birth at home and in hospital in Australia.', Midwifery, vol. 26, no. 1, pp. 53-63.
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to explore first-time mothers' experiences of birth at home and in hospital in Australia.
Foureur, M., Ryan, C.L., Nicholl, M. & Homer, C. 2010, 'Inconsistent evidence: analysis of six national guidelines for vaginal birth after cesarean section.', Birth, vol. 37, no. 1, pp. 3-10.
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Guidelines are increasingly used to direct clinical practice, with the expectation that they improve clinical outcomes and minimize health care expenditure. Several national guidelines for vaginal birth after cesarean section (VBAC) have been released or updated recently, and their range has created dilemmas for clinicians and women. The purpose of this study was to summarize the recommendations of existing guidelines and assess their quality using a standardized and validated instrument to determine which guidelines, if any, are best able to guide clinical practice.
Dahlen, H.G. & Homer, C.S.E. 2010, 'Infant feeding in the first 12 weeks following birth: A comparison of patterns seen in Asian and non-Asian women in Australia', Women and Birth, vol. 23, no. 1, pp. 22-28.
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Background: There is a belief amongst midwives that Asian women are less likely to breastfeed compared to non-Asian women. The aim of this research was to compare the infant feeding decisions of Asian and non-Asian women on discharge from two Sydney hospitals, and at 6 and 12 weeks following birth. Participants: 235 Asian and 462 non-Asian first time mothers. Methods: A secondary analysis was undertaken into data from a randomised clinical trial of a perineal management technique (perineal warm packs). Simple descriptive statistics were used for analysis and Chi-square and logistic regression was used to examine differences between women from Asian and non-Asian backgrounds. Results: Compared with non-Asian women, Asian women were no less likely to exclusively breastfeed on discharge from hospital (83% vs. 87%, OR 0.7, 95% CI 0.4-1.2), at 6 weeks (60% vs. 61%, OR 1, 95% CI 0.7-1.4) or 12 weeks postpartum (51% vs. 56%, OR 0.8, 95% CI 0.6-1.2). They were, however, significantly more likely to be partially breastfeeding on discharge from hospital (10% vs. 2%, OR 5.3, 95% CI 2.3-12.4), at 6 weeks (22% vs. 11%, OR 1.9, 95% CI 1.2-3.2) and 12 weeks postpartum (17% vs. 8%, OR 2.2, 95% CI 1.2-3.9). Discussion: Asian women were more likely than non-Asian women to be giving their baby some breast milk at 6 and 12 weeks postpartum when partial breastfeeding was taken into account. This contradicts popular beliefs amongst midwives regarding the infant feeding practices of Asian women. Conclusion: Further research into this important issue is needed in order to improve breastfeeding support for women from different cultural backgrounds. The issue of causes of, and variations in, the levels of partial breastfeeding between different ethnic groups needs more investigation. Crown Copyright 2009.
Dahlen, H.G., Homer, C.S.E., Tracy, S.K. & Bisits, A.M. 2010, 'Planned home and hospital births in South Australia, 1991-2006: Differences in outcomes [1]', Medical Journal of Australia, vol. 192, no. 12, pp. 726-726.
Homer, C.S. 2010, 'The homebirth debate in Australia: A clash of philosophies', Precedent, vol. -, no. 98, pp. 38-42.
Smith, R., Leap, N. & Homer, C. 2010, 'Advanced midwifery practice or advancing midwifery practice?', Women Birth, vol. 23, no. 3, pp. 117-120.
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Advanced midwifery practice is a controversial notion in midwifery, particularly at present in Australia. The proposed changes in legislation around access to the publicly funded Medical Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) in 2009-2010 have meant that the issue of advanced midwifery practice has again taken prominence. Linking midwifery access to MBS and PBS to a safety and quality framework that includes an 'advanced midwifery credentialling framework' is particularly challenging. The Haxton and Fahy paper in the December 2009 edition of Women and Birth is timely as it enables a reflection upon these issues and encourages debate and discussion about exactly what is midwifery, what are we educating our students for and is working to the full scope of practice practising at advanced level? This paper seeks to address some of these questions and open up the topic for further debate.
Homer, C.S.E., Catling-Paull, C.J., Sinclair, D., Faizah, N., Balasubramanian, V., Foureur, M.J., Hoang, D.B. & Lawrence, E. 2010, 'Developing an interactive electronic maternity record', British Journal of Midwifery, vol. 18, no. 6, pp. 384-389.
Women have a strong need to be involved in their own maternity care. Pregnancy hand-held records encourage women's participation in their maternity care; gives them an increased sense of control and improves communication among care providers. They have been successfully used in the UK and New Zealand for almost 20 years. Despite evidence that supports the use of hand-held records, widespread introduction has not occurred in Australia. The need for an electronic version of pregnancy hand-held records has become apparent, especially after the introduction of the Electronic Medical Record in Australia. A personal digital assistant (PDA) was developed as an interactive antenatal electronic maternity record that health-care providers could use in any setting and women could access using the internet. This article will describe the testing of the antenatal electronic maternity record.
Homer, C.S.E., Passant, L., Brodie, P.M., Kildea, S., Leap, N., Pincombe, J. & Thorogood, C. 2009, 'The role of the midwife in Australia: views of women and midwives', Midwifery, vol. 25, no. 6, pp. 673-681.
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Objective: to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design: a multi-method approach with qualitative data collected from surveys with women and interviews with midwives. Setting: participants represented each state and territory in Australia. Participants: midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. Key conclusions: midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. Implications for practice: a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role. 2007.
Homer, C.S.E., Hanna, E. & McMichael, A.J. 2009, 'Climate change threatens the achievement of the millennium development goal for maternal health', Midwifery, vol. 25, no. 6, pp. 606-612.
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Homer, C.S.E., Henry, K., Schmied, V., Kemp, L., Leap, N. & Briggs, C. 2009, ''It looks good on paper': Transitions of care between midwives and child and family health nurses in New South Wales', Women and Birth, vol. 22, no. 2, pp. 64-72.
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Background: The way in which women and their babies transition from maternity services to the care of child and family health nurses differs across Australia. The aim of the study was to understand the transition of care from one service to another and how to promote collaboration in the first few weeks after the birth. Method: A descriptive study was undertaken. All midwifery, child and family health and Families NSW managers in NSW were invited to participate by completing a questionnaire. Results: There was a wide range of transition of care models. These varied by setting, geography, context and history. Three main models emerged from the analysis. These were as follows:1.Structured, non-verbal communication system that relied on paper-based or computerised systems. This included either centralised referral or centre-based referral processes.2.Liaison person model which was similar to purposeful contact, but with everything vested in one clinician who is responsible for the coordination and organisation.3.Purposeful contact model which was mostly for identified at-risk women and included continuity of care with formal networks and face to face contact. Discussion: There were a range of different models of transition of care identified in NSW depending on local context, expertise, interests and policies. Some are very structured and others have developed and evolved over time. Many models seem to be dependant on the goodwill and enthusiasm of individual clinicians. Conclusion: A more coordinated and systematised approach needs to be developed. Collaboration and communication between midwives and child and family health nurses is essential if the needs of families are to be addressed during this transition period. 2009 Australian College of Midwives.
Schmied, V., Cooke, M., Gutwein, R., Steinlein, E. & Homer, C. 2009, 'An evaluation of strategies to improve the quality and content of hospital-based postnatal care in a metropolitan Australian hospital', JOURNAL OF CLINICAL NURSING, vol. 18, no. 13, pp. 1850-1861.
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Homer, C., Clements, V., McDonnell, N., Peek, M. & Sullivan, E. 2009, 'Maternal mortality: What can we learn from stories of postpartum haemorrhage?', Women and Birth, vol. 22, no. 3, pp. 97-104.
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Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality. Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring. This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994-2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care. 2009 Australian College of Midwives.
Foureur, M., Brodie, P. & Homer, C. 2009, 'Midwife-centered versus woman-centered care: a developmental phase?', Women Birth, vol. 22, no. 2, pp. 47-49.
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McMurtrie, J.E., Catling, C., Teate, A., Caplice, S.L., Chapman, M. & Homer, C.S. 2009, 'The St. George Homebirth Program: An evaluation of the first 100 booked women', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 49, no. 6, pp. 631-636.
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Background: The St. George Homebirth Program was the first publicly funded homebirth model of care set up in New South Wales. This program provides access to selected women at low obstetric risk the option of having their babies at home. There are only four other publicly funded homebirth programs operating in Australia. Aims: To report the outcomes of the first 100 women booked at the St. George Homebirth Program. Methods: A prospective descriptive study was undertaken. Data were collected on the first 100 women who gave birth between November 2005 and March 2009. Two databases were accessed and missing data were followed up by review of the relevant charts. Results: Of the first 100 booked women, 63 achieved a homebirth, 30 were transferred to hospital or independent midwifery care in the antenatal period and seven were transferred intrapartum. Two women were transferred to hospital in the early postnatal period, one for a postpartum haemorrhage and one for hypotension. One baby suffered mild respiratory distress, was treated in the emergency department and was discharged home within four hours. Conclusion: The St. George Hospital homebirth program has provided reassuring outcomes for the first 100 women it has cared for over the past four years. Wider availability of this service could be achieved provided there is the appropriate close collaboration between providers and effective processes for consultation, referral and transfer. The outcomes of women and babies in publicly funded homebirth programs deserve further study, and the development of a national prospective database of all planned homebirths would contribute to this knowledge.
Adams, J., Lui, C.-.W., Sibbritt, D., Broom, A., Wardle, J., Homer, C. & Beck, S. 2009, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature', Birth, vol. 36, no. 3, pp. 237-245.
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Background: The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care. 2009, Wiley Periodicals, Inc.
Bowyer, L., Catling, C., Diamond, T., Homer, C.S., Davis, G.K. & Craig, M.S. 2009, 'Vitamin D, PTH and calcium levels in pregnant women and their neonates', Clinical Endocrinology, vol. 70, no. 3, pp. 372-377.
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To determine the prevalence of vitamin D deficiency in pregnant women and their neonates and to examine factors associated with vitamin D deficiency. Population-based study of pregnant women and their neonates from South-eastern Sydney, Australia. Serum 25 hydroxy-vitamin D (25-OHD), PTH, calcium, albumin, phosphate and alkaline phosphatase were measured in women at 23-32 weeks gestation and on cord blood at delivery. Maternal skin phototype was recorded using the Fitzpatrick scale. Vitamin D deficiency (defined as 25-OHD <= 25 nmol/l) was found in 144 of 971 (15%) women and 98 of 901 (11%) neonates. Median 25-OHD was 52 nmol/l (range 17-174) in mothers and 60 nmol/l (17-245) in neonates. Maternal 25-OHD levels varied by season, with lowest levels in late winter/early spring (P < 0.001). Factors associated with maternal vitamin D deficiency in multiple logistic regression were (OR, 95% CI): maternal birthplace outside Australia: 2.2 (1.4-3.5, P = 0.001), dark skin phototype: 2.7 (1.6-4.5, P < 0.001), wearing a veil: 21.7 (11.7-40.3, P < 0.001) and younger maternal age: 0.93 (0.89-0.97, P = 0.001). Maternal vitamin D deficiency increased the risk of neonatal vitamin D deficiency (OR 17.2, 95% CI 8.8-34.3) and birth weight was lower among infants of deficient vs. sufficient mothers: mean (SD) 3245 g (545) vs. 3453 g (555), P < 0.001. Vitamin D deficiency is common among pregnant women; immigrant, veiled and dark skinned women are at greatest risk. Maternal vitamin D deficiency increases the risk of neonatal vitamin D deficiency and lower birth weight.
Dahlen, H.G., Homer, C.S.E., Cooke, M., Upton, A.M., Nunn, R.A. & Brodrick, B.S. 2009, ''Soothing the ring of fire': Australian women's and midwives' experiences of using perineal warm packs in the second stage of labour', Midwifery, vol. 25, no. 2.
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Objective: to determine women's and midwives' experiences of using perineal warm packs in the second stage of labour. Design: as part of a randomised controlled trial (Warm Pack Trial), women and midwives were asked to complete questionnaires about the effects of the warm packs on pain, perineal trauma, comfort, feelings of control, satisfaction and intentions for use during future births. Setting: two hospitals in Sydney, Australia. Participants: a randomised controlled trial was undertaken. In the late second stage of labour, nulliparous women (n=717) giving birth were randomly allocated to having warm packs (n=360) applied to their perineum or standard care (n=357). Standard care was defined as any second stage practice carried out by midwives that did not include the application of warm packs to the perineum. Three hundred and two nulliparous women randomised to receive warm packs (84%) received the treatment. Questionnaires were completed by 266 (88%) women who received warm packs, and 270 (89%) midwives who applied warm packs to these women. Intervention: warm, moist packs were applied to the perineum in the late second stage of labour. Findings: warm packs were highly acceptable to both women and midwives as a means of relieving pain during the late second stage of labour. Almost the same number of women (79.7%) and midwives (80.4%) felt that the warm packs reduced perineal pain during the birth. Both midwives and women were positive about using warm packs in the future. The majority of women (85.7%) said that they would like to use perineal warm packs again for their next birth and would recommend them to friends (86.1%). Likewise, 91% of midwives were positive about using the warm packs, with 92.6% considering using them in the future as part of routine care in the second stage of labour. Key conclusions: responses to questionnaires, eliciting experiences of women and midwives involved in the Warm Pack Trial, demonstrated that the practice of applying perineal warm packs in the late second stage of labour was highly acceptable and effective in helping to relieve perineal pain and increase comfort. Implications for practice: perineal warm packs should be incorporated into second stage pain relief options available to women during childbirth. 2007 Elsevier Ltd. All rights reserved.
Schmied, V., Cooke, M., Gutwein, R., Steinlein, E. & Homer, C. 2008, 'Time to listen: strategies to improve hospital-based postnatal care.', Women Birth, vol. 21, no. 3, pp. 99-105.
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In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care.
Forbes, I., Homer, C.S., Foureur, M. & Leap, N. 2008, 'Birthing Unit Designs', World Health Design, vol. 1, no. 3, pp. 47-53.
Griffiths, M. & Homer, C.S. 2008, 'Developing a review process for Australian midwives: a report of the Midwifery Practice Review Project process', Women and Birth, vol. 21, no. 3, pp. 119-126.
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Objective To develop a formal, robust and transparent process that supports and enables midwives to reflect on their own midwifery practice in relation to recognised professional standards and to identify, prioritise and act upon individual professional development and learning needs for the provision of safe, high quality care to women and their families within the full scope of midwifery practice. This process was part of a national project commissioned by the Australian College of Midwives and funded by the Australian Council for Safety and Quality in Health Care and is part of the Continuing Professional Development, MidPLUS program developed by the Australian College of Midwives. Approach A multi-method, staged approach was used to develop the national Midwifery Practice Review process. Data to inform the development of the Midwifery Practice Review process was collected through a literature review, workshop consultations, written submissions and the pilot testing of a draft process. Finally, a national training workshop was undertaken to train reviewers to carry out reviews and to ensure the final process was validated and was feasible and acceptable to midwives and consumers. Setting Maternity care settings in each state and territory throughout Australia. Participants Midwives, other health professionals and consumers of midwifery care. Findings The Midwifery Practice Review process was developed through research and national consultation prior to being validated in practice.
Homer, C.S., Brown, M.A., Mangos, G. & Davis, G.K. 2008, 'Non-proteinuric pre-eclampsia: A novel risk indicator in women with gestational hypertension', Journal of Hypertension, vol. 26, no. 2, pp. 295-302.
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OBJECTIVE: To determine whether outcomes differed for women with pre-eclampsia according to the presence of proteinuria and whether non-proteinuric pre-eclampsia is similar to gestational hypertension. DESIGN: From 1987 to 2005, at three hospitals in Sydney, Australia, women referred to the obstetric medicine team were recruited. Outcomes for three groups were compared: proteinuric pre-eclampsia, non-proteinuric pre-eclampsia and gestational hypertension. RESULTS: Women with proteinuric pre-eclampsia were more likely to have severe hypertension (39 versus 30%, P = 0.003), deliver preterm infants (39 versus 30%, P = 0.007) and had a higher perinatal mortality rate (25.2 versus 5.7 per 1000, P = 0.02) than those with non-proteinuric pre-eclampsia, who were more likely to have thrombocytopenia and liver disease. Women with non-proteinuric pre-eclampsia were more likely to have multiple pregnancies (3.9 versus 9.9%, P < 0.001), experience severe hypertension (8.9 versus 29.7%, P < 0.001), and deliver preterm infants (11.3 versus 30.2%, P < 0.001) who were small for gestational age (12.7 versus 20.9%, P < 0.001) than those with gestational hypertension. CONCLUSION: This study highlights differences between non-proteinuric pre-eclampsia and gestational hypertension. The subclassification of 'non-proteinuric pre-eclampsia' should be added to existing classification systems to alert clinicians to potential risks. 2008 Lippincott Williams & Wilkins, Inc.
Dahlen, H.G. & Homer, C.S. 2008, 'Perinael trauma and postpartum perineal morbidity in asian and non-asian primiparous women giving birth in Australia', Journal of Obstetric, Gynaecological & Neonatal Nursing, vol. 37, no. 4, pp. 455-463.
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Objectives: To describe the postpartum perineal morbidity of primiparous women who had a vaginal birth and compare outcomes between Asian and non-Asian women in the first 2 days following the birth and at 6 and 12 weeks postpartum. Design: Data from a randomized clinical trial of a perineal management technique (perineal warm packs) were used to address the study objective. Setting: Two maternity hospitals in Sydney, Australia. Participants: Primiparous women who had a vaginal birth in the trial were included (n=697). One third of the women were identified as "Asian." Results: Compared with non-Asian women, Asian women were significantly more likely to have an episiotomy; require perineal suturing; sustain a third- or fourth-degree perineal tear; and report their perineal pain as being moderate to severe on day 1 following the birth. Asian women were less likely to give birth in an upright position or to resume sexual intercourse by 6 or 12 weeks following the birth. Conclusion: More research is needed into methods that could reduce the high rates of perineal trauma experienced by Asian women, and midwives need to be able to offer appropriate support for Asian women.
Dahlen, H.G. & Homer, C.S.E. 2008, 'What are the views of midwives in relation to perineal repair?', Women and Birth, vol. 21, no. 1, pp. 27-35.
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Purpose: To determine the views of midwives towards perineal repair and the most effective way to teach and support midwives in developing this skill. Procedure: A questionnaire was distributed to 111 midwives who attended a 1-day seminar. Information was sought on a range of views relating to perineal repair, including experience, confidence, education and accreditation, attitudes and trends. Findings: One hundred and six (96%) questionnaires were returned. All respondents (100%) believed midwives should be taught to undertake perineal repair. The most important reason was to provide continuity of care for women. Experience increased confidence and enjoyment in undertaking perineal repair as well as lessening fears over the impact of suturing on women. Experience did not significantly impact on concerns regarding legal implications associated with perineal repair. Three quarters of respondents reported that midwifery students should have practical experience of perineal repair. There was strong support for doctors and midwives to undertake perineal repair education together (96%), preferably in a 1-day workshop format (56%); for standards to be set by the professional colleges (midwifery and obstetrics) (66%); for midwives and doctors to be accredited as competent before performing perineal repair independently (>90%) and for regular updates in perineal repair (93%). The majority of midwives (73%) felt that they were more likely to suture than 5 years ago, due mainly to a greater appreciation of woman centred care (35%). Over 60% of midwives said they would not suture a first-degree tear more than half of the time and 13% would not suture a second-degree tear more than half of the time. Principle conclusion: A desire to provide continuity of care appears to be a major motivator for midwives to learn to undertake perineal repair. There is need for standards to be set for perineal repair to encourage consistency in education. Perineal repair programs that involve midwives and doctors training together have strong support from midwives but it is unclear if doctors would also support this. Further research is needed to support or refute the trend for midwives to not suture some perineal trauma. Crown Copyright 2008.
Dahlen, H.G., Ryan, M., Homer, C.S.E. & Cooke, M. 2007, 'An Australian prospective cohort study of risk factors for severe perineal trauma during childbirth', Midwifery, vol. 23, no. 2, pp. 196-203.
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Objective: to determine risk factors for the occurrence of severe perineal trauma (third and fourth degree tears) during childbirth. Design: a prospective cohort study was conducted using the hospital's computerised obstetric information system. Additional data were gathered on women who sustained severe perineal trauma. Descriptive statistics and logistic regression were used to assess risk factors for severe perineal trauma. Midwives were asked to comment on possible reasons for severe perineal trauma. Written responses made by midwives were analysed using content analysis. Discussion groups with midwives were held to further explore their experiences. Setting: Royal Prince Alfred Hospital, Sydney, Australia. Participants: all women having vaginal births (n=6595) in a 2-year period between 1 April 1998 and 31 March 2000, in both the birth centre and the labour ward. Measurements and findings: 2% of women (n=134) experienced severe perineal trauma. One hundred and twenty-two women had third-degree tears and 12 had fourth-degree tears. Primiparity, instrumental delivery, Asian ethnicity and heavier babies were associated with an elevated risk of severe perineal trauma. Midwives identified several factors they believed contributed to severe perineal trauma. These were lack of effective communication with the woman during the birth, different birth positions, delivery technique, ethnicity and obstetric influences. Key conclusions: findings support current knowledge that primiparity, instrumental birth, heavier babies and being of Asian ethnicity are associated with increased rates of severe trauma. Specific attention needs to be paid to the strong association found between being of Asian ethnicity and experiencing severe perineal trauma. Implications for practice: further identification and validation of the concerns expressed by midwives to reduce severe perineal trauma is warranted so that preventative strategies can be used and researched. 2006 Elsevier Ltd. All rights reserved.
Roberts, L.M., Homer, C.S.E., Davis, G.K. & Miller, T.D. 2007, 'Misoprostol to induce labour: A review of its use in a NSW hospital', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 47, no. 4, pp. 291-296.
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Background: Induction of labour (IOL) is a common procedure in maternity care. Misoprostol is a prostaglandin E 1 analogue that is effective, cheap and easily stored but not licensed for this use in Australia. Despite evidence supporting the use of misoprostol for IOL, few Australian maternity units use it. Aims: To review the outcomes of women who received vaginal misoprostol for IOL. Methods: A retrospective review of all births induced with vaginal misoprostol from July 1998 to October 2005 at one hospital in New South Wales. Women who had an IOL for multiple pregnancy, known fetal death or congenital abnormality were excluded. Results: In total, 1998 women with a normal, viable, single fetus received vaginal misoprostol for IOL. More than half (57%) of women did not require augmentation during labour. More than one third (37%) had epidural analgesia, 25% had an emergency Caesarean section, 7% had a post-partum haemorrhage and 16% of babies were admitted to the special care nursery. Uterine rupture occurred in two women, one of whom had a history of uterine surgery. There were two neonatal deaths, both because of Group B Streptococcus infection. Conclusions: In this cohort of women, misoprostol was an effective and safe agent to induce labour. Recent legal concerns at this hospital make its future use in normal clinical practice unlikely. 2007 The Authors Journal compilation 2007 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Davis, G.K., Mackenzie, C., Brown, M.A., Homer, C.S., Holt, J., McHugh, L. & Mangos, G. 2007, 'Predicting transformation from gestational hypertension to preeclampsia in clinical practice: A possible role for 24 hour ambulatory blood pressure monitoring', Hypertension in Pregnancy, vol. 26, no. 1, pp. 77-87.
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Objective: To identify parameters that may assist clinicians in predicting which women will develop preeclampsia (PE) after initially presenting with gestational hypertension (GH). Methods: 118 women were recruited to the study with GH or PE. They were divided into three groups based on their diagnosis at delivery- (1) GH, (2) PE from the time of presentation, (3) those with an initial diagnosis of GH who progressed to PE. Women underwent 24 hour ambulatory blood pressure monitoring (ABPM) and had serum estrogen, progesterone, ?-HCG, leptin and adiponectin measured as possible predictors of transformation of GH to PE. Results: Women who presented with GH, and progressed to PE, presented four weeks earlier (33 vs 37 weeks, p < 0.001) than those who did not progress. Women with PE, either as their initial diagnosis or after progression from GH, were delivered earlier (p < 0.001) and had more small for gestational age (SGA) babies than women with GH at delivery (p < 0.05). Those who developed PE after presenting with GH generally had higher blood pressures than those who remained as GH, significant for awake and 24 hour systolic blood pressures (p < 0.05). ?-HCG, estrogen, progesterone or leptin values were similar across the groups. Adiponectin was higher in women with established PE at presentation compared to women with GH (p = 0.02) but adiponectin failed to discriminate those women with an initial diagnosis of GH who progressed to PE. Conclusion: 24 hr ABPM may provide a non-invasive method of identifying this 'at risk' GH population, particularly in the case of early presentation.
Buckland, S.S. & Homer, C.S.E. 2007, 'Estimating blood loss after birth: Using simulated clinical examples', Women and Birth, vol. 20, no. 2, pp. 85-88.
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Aim: To determine the accuracy of the estimation of blood loss using simulated clinical examples. Setting: Over 100 attendees came together at a seminar about postpartum haemorrhage in June 2006. Five blood loss assessment stations were constructed, each containing a simulated clinical example. Each station was numbered and was made up of a variety of equipment used in birthing suites. Over 5 L of 'artificial' blood was made. The artificial blood was similar to the colour and consistency of real blood. Sample: A convenience sample of 88 participants was given a response sheet and asked to estimate blood loss at each station. Participants included midwives, student midwives and an obstetrician. Results: Blood in a container (bedpan, kidney dish) was more accurately estimated than blood on sanitary pads, sheets or clothing. Lower volumes of blood were also estimated correctly by more participants than the higher volumes. Discussion: Improvements are still needed in visual estimation of blood loss following childbirth. Education programs may increase the level of accuracy. Conclusion: We encourage other clinicians and educators to embark upon a similar exercise to assist midwives and others to improve their visual estimation of blood loss after birth. Accurate estimations can ensure that women who experience significant blood loss can receive appropriate care and the published rates of postpartum haemorrhage are correct. 2007 Australian College of Midwives.
Dahlen, H.G., Homer, C.S.E., Cooke, M., Upton, A.M., Nunn, R. & Brodrick, B. 2007, 'Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: A randomized controlled trial', Birth, vol. 34, no. 4, pp. 282-290.
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Background: Perineal warm packs are widely used during childbirth in the belief that they reduce perineal trauma and increase comfort during late second stage of labor. The aim of this study was to determine the effects of applying warm packs to the perineum on perineal trauma and maternal comfort during the late second stage of labor. Methods: A randomized controlled trial was undertaken. In the late second stage of labor, nulliparous women (n = 717) giving birth were randomly allocated to have warm packs (n = 360) applied to their perineum or to receive standard care (n = 357). Standard care was defined as any second-stage practice carried out by midwives that did not include the application of warm packs to the perineum. Analysis was on an intention-to-treat basis, and the primary outcome measures were requirement for perineal suturing and maternal comfort. Results: The difference in the number of women who required suturing after birth was not significant. Women in the warm pack group had significantly fewer third- and fourth-degree tears and they had significantly lower perineal pain scores when giving birth and on "day 1" and "day 2" after the birth compared with the standard care group. At 3 months, they were significantly less likely to have urinary incontinence compared with women in the standard care group. Conclusions: The application of perineal warm packs in late second stage does not reduce the likelihood of nulliparous women requiring perineal suturing but significantly reduces third- and fourth-degree lacerations, pain during the birth and on days 1 and 2, and urinary incontinence. This simple, inexpensive practice should be incorporated into second stage labor care. 2007, Blackwell Publishing, Inc.
Homer, C.S.E., Passant, L., Kildea, S., Pincombe, J., Thorogood, C., Leap, N. & Brodie, P.M. 2007, 'The development of national competency standards for the midwife in Australia', Midwifery, vol. 23, no. 4, pp. 350-360.
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Objective: to develop and validate national competency standards for midwives in Australia. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design: a multi-method, staged approach was used to collect data through a literature review, workshop consultations, interviews, surveys and written submissions in order to develop national competency standards for Australian midwives. Subsequently, direct observation of practice in a range of settings ensured validation of the competencies. Setting: maternity-care settings in each state and territory in Australia. Participants: midwives, other health professionals and consumers of midwifery care. Findings: The national competency standards for the midwife were developed through research and consultation before being validated in practice. Key conclusions: the national competency standards are currently being implemented into education, regulation and practice in Australia. These will be minimum competency standards required of all midwives who seek authority to practise as a midwife in Australia. It is expected that all midwives will demonstrate that they are able to meet the competency standards relevant to the position they hold. Implications for practice: the competency standards establish a national standard for midwives and reinforce responsibility and accountability in the provision of quality midwifery care through safe and effective practice. In addition, individual midwives may use the competency standards as the basis of their ongoing professional development plans. 2006 Elsevier Ltd. All rights reserved.
Homer, C.S. & Dahlen, H.G. 2007, 'Obstetric-induced incontinence: A black hole of preventable morbidity? An 'alternative' opinion', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 47, no. 2, pp. 86-90.
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Homer, C.S.E. 2006, 'Challenging midwifery care, challenging midwives and challenging the system', Women and Birth, vol. 19, no. 3, pp. 79-83.
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The purpose of this paper is to generate debate and discussion about the state of midwifery services in Australia today. While numerous reports have been published that highlight what women want in maternity care, widespread change has not occurred. This paper presents the story of Alice (a real woman with a fictitious name). Alice's story highlights the challenges that women face in dealing with a system that is often inflexible. While the health systems, and those who work within them, usually have the best intentions to try to provide the type of care that women want, they are not always successful. The paper summarises the evidence and support for models of continuity of midwifery care and outlines a series of strategies to ensure that change can occur. Finally, the paper challenges all midwives to work towards widespread, system-level change in Australian maternity services. 2006 Australian College of Midwives.
Homer, C.S. 2006, 'Maternal death: a time for reflection', Women and Birth, vol. 19, no. 2, pp. 37-38.
Homer, C.S. 2006, 'Re: Collaboration in maternity care. A response to 'what do I think of midwife-led units?'', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 46, no. 3, pp. 262-264.
Brown, M.A., Holt, J., Mangos, G., Murray, N., Curtis, J. & Homer, C.S. 2005, 'Microscopic hematuria in pregnancy: Relevance to pregnancy outcome', American Journal of Kidney Diseases, vol. 45, no. 4, pp. 667-673.
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The significance of dipstick or microscopic hematuria in pregnancy is uncertain, with some studies suggesting this is associated with a greater risk for preeclampsia. We sought to determine the prevalence and clinical significance of microscopic hematuria during pregnancy. METHODS: This was a prospective case-control study in the antenatal Clinic of St George Hospital, Kogarah, Australia, a teaching hospital without tertiary referral antenatal care, with approximately 2,600 deliveries per year. One thousand pregnant women attending for routine antenatal care were invited to have a routine urinalysis performed and be referred to a nephrology clinic for further investigation if dipstick microscopic hematuria was detected on more than 1 occasion before 32 weeks' gestation. Main outcome measures were the prevalence of dipstick hematuria, prevalence of hematuria confirmed by urine microscopy, and the development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby. RESULTS: One hundred seventy-eight of 902 women (20%) who entered the study had dipstick hematuria on at least 2 occasions in pregnancy; 66 of 126 women (53%) who had hematuria before 32 weeks attended the nephrology clinic, where microscopic hematuria was confirmed in 40 women (61%). Renal imaging results were normal in all except 1 woman, and all women had a serum creatinine level of 0.90 mg/dL or less (< or =80 micromol/L). The development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby were similar in women with and without dipstick hematuria. Microscopic hematuria persisted in half (15 women) of those who attended for follow-up after 3 months postpartum. CONCLUSION: Dipstick hematuria is very common during pregnancy, but rarely signifies a disorder likely to impact on the pregnancy outcome. Postpartum follow-up is recommended to detect women who have persistent hematuria and presumed underlying mild glomerulonephritis.
Homer, C.S. 2005, 'Sexually transmitted diseases and pregnancy', Australian Midwifery News, vol. 5, no. 3, pp. 28-29.
Brown, M.A., Mangos, G., Davis, G.K. & Homer, C.S. 2005, 'The natural history of white coat hypertension during pregnancy', British Journal of Obstetrics and Gynecology, vol. 112, no. 5, pp. 601-606.
Objective White coat hypertension (WCH) is a common phenomenon with a long term prognosis intermediate between those with true hypertension and true normotension. The natural history of this phenomenon throughout pregnancy remains unknown. We assessed the likelihood of women with an initial diagnosis of WCH developing pre-eclampsia (PE) as their pregnancy progressed. Design Prospective observational study. Setting St George Hospital, a teaching and University hospital. Population Two hundred and forty-one pregnant women with an early pregnancy diagnosis of essential hypertension (EH). Methods Eighty-six women had this diagnosis (EH) confirmed pre-pregnancy by 24-hour ambulatory blood pressure monitoring (ABPM) or repeated automated home blood pressure (BP) self-measurement. The remaining 155 underwent 24-hour ABPM in early pregnancy to establish their diagnosis. Women found to have WCH did not receive antihypertensives during their pregnancy, whereas those with confirmed EH received oxprenolol or methyldopa. Women with WCH had repeated 24-hour ABPM and/or BP assessments in a pregnancy day assessment unit until delivery. Main outcome measure The development of PE in women with WCH or EH.
Homer, C.S. 2004, 'Informed consent and childbirth: coming to terms with the 21st century', Australian Midwifery Journal, vol. 17, no. 3, pp. 9-11.
Homer, C.S. & Brickwood, K.J. 2004, ''Helping partners quit' - A project to help pregnant women and their partners to stop smoking', Achievements in Nursing, vol. 6, pp. 5-7.
Homer, C.S. 2004, 'Shoulder dystocia', Australian Midwifery News, vol. 14, no. 4, pp. 13-16.
Homer, C.S., Roberts, L., Bowyer, L. & Brown, M.A. 2004, 'Multi-centre research involving review of medical records: negotiating the obstacle course of ethics approval', Medical Journal of Australia, vol. 180, no. 3, pp. 139-139.
Roberts, L.M., Bowyer, L., Homer, C.S. & Brown, M.A. 2004, 'Multicentre research: Negotiating the ethics approval obstacle course', Medical Journal of Australia, vol. 180, no. 3, pp. 139-139.
Roberts, L.M., Bowyer, L., Homer, C.S. & Brown, M.A. 2004, 'Erratum: Multicentre research: Negotiating the ethics approval obstacle course (The Medical Journal of Australia (2004) vol. 180 (139))', Medical Journal of Australia, vol. 180, no. 6, pp. 262-262.
Roberts, L.M., Bowyer, L., Homer, C.S. & Brown, M.A. 2004, 'Multicentre research: negotiating the ethics approval obstacle course (vol 180, pg 139, 2004)', MEDICAL JOURNAL OF AUSTRALIA, vol. 180, no. 6, pp. 262-262.
Homer, C.S., Davis, G.K. & Urquhart, V. 2003, 'Getting research into practice using protocol development', Achievements in Nursing, vol. 5, pp. 24-26.
Brown, M.A., Homer, C.S., Davis, G.K. & Mangos, G. 2003, 'In reply: The clinical utility of routine urinalysis in pregnancy', Medical Journal fo Australia, vol. 178, no. 10, pp. 524-525.
Homer, C.S., Passant, L. & Wills, J. 2003, 'From student to midwife: the experiences of newly graduated midwives working in an innovative model of midwifery care', Australian Journal of Midwifery, vol. 16, no. 4, pp. 18-21.
In 2001, a new model of midwifery care was established in the Birth Centre at St George Hospital, a metropolitan hospital in NSW. The new model was designed to encompass the principles and recommendations from numerous government reports and research. The model also build on the previous successful implementation of a team midwifery program (Homer et al 2001b; Homer et al 2001a). Four newly graduated midwives, together with four more experienced midwives were employed to work in the models of midwifery care. This small study evaluates the first 10 months' using qualitative and quantitative data.
Catling, C. & Homer, C.S. 2003, 'Ensuring Consumer Consultation in the Provision of Maternity Care at St. George Hospital', Achievements in Nursing, vol. 5, pp. 11-15.
Brown, M.A., Homer, C.S., Davis, G.K. & Mangos, G. 2003, 'The clinical utility of routine urinalysis in pregnancy - Reply', MEDICAL JOURNAL OF AUSTRALIA, vol. 178, no. 10, pp. 524-525.
Murphy, D.J., Redman, C.W., Brown, M.A., Homer, C.S.E., Davis, G.K. & Mangos, G. 2003, 'The clinical utility of routine urinalysis in pregnancy (multiple letters)', Medical Journal of Australia, vol. 178, no. 10, pp. 524-525.
Homer, C.S.E., Davis, G.K., Cooke, M. & Barclay, L.M. 2002, 'Women's experiences of continuity of midwifery care in a randomised controlled trial in Australia', Midwifery, vol. 18, no. 2, pp. 102-112.
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Objective: to compare the experiences of women who received a new model of continuity of midwifery care with those who received standard hospital care during pregnancy, labour, birth and the postnatal period. Design: a randomised controlled trial was conducted. One thousand and eighty-nine women were randomly allocated to either the new model of care, the St George Outreach Maternity Project (STOMP), or standard care. Women completed a postal questionnaire eight to ten weeks after the birth. Participants: women in the trial were of mixed obstetric risk status and more than half the sample were born in a non-English speaking country. Findings: questionnaires were returned from 69% of consenting women. STOMP women were significantly more likely to have talked with their midwives and doctors about their personal preferences for childbirth and more likely to report that they knew enough about aspects of labour and birth, particularly induction of labour, pain relief and caesarean section. Almost 80% of women in the STOMP group experienced continuity of care, that is, one of their team midwives was present, during labour and birth. STOMP women reported a significantly higher 'sense of control during labour and birth.' Sixty-three per cent of STOMP women reported that they 'knew' the midwife who cared for them during labour compared with 21% of control women. In a secondary analysis, women who had a midwife during labour who they felt that they knew, had a significantly higher sense of 'control' and a more positive birth experience compared with women who reported an unknown midwife. Postnatal care elicited the greatest number of negative comments from women in both the STOMP and the control group. Conclusion: The reorganisation of maternity services to enable women to receive continuity of care has benefits for women. The benefits of a known labour midwife needs further research. 2002 Elsevier Science Ltd. All rights reserved.
Homer, C.S., Sheehan, A. & Cooke, M. 2002, 'Initial infant feeding decisions and duration of breastfeeding in women from English, Arabic and Chinese-speaking backgrounds in Australia.', Breastfeeding review : professional publication of the Nursing Mothers" Association of Australia, vol. 10, no. 2, pp. 27-32.
Anecdotally, concerns are often expressed about the varying infant feeding decisions among women from different cultural groups. This paper reports the early infant feeding decisions and duration of breastfeeding in 986 women from English, Chinese and Arabic-speaking backgrounds in Sydney during 1997 and 1998. Data were collectedfrom an audit of medical records and through a questionnaire at eight weeks postpartum. Chinese-speaking women were less likely to express an intention to breastfeed and fewer initiated breastfeeding compared with other women. Arabic-speaking women had significantly longer duration rates compared with other women. A greater proportion of the Chinese-speaking women who initiated breastfeeding were still breastfeeding at eight weeks compared with English-speaking women. This study suggests that there are differences in the infant feeding decisions between English, Arabic and Chinese-speaking women. Clinicians need to further understand cultural differences when providing care, education and support in a multicultural context.
Urquhart, V., Homer, C.S., Farrell, T.J., Steinlein, E. & Sutherland-Fraser, S.J. 2002, 'Urinary catheterisation of women undergoing an elective caesarean section: A quality improvement project', Achievements in Nursing, vol. 4, pp. 38-39.
This paper describes a quality assurance project, which was undertaken between the Divisions of Women's and Children's Health and Surgery at St George Hospital. The aim of the project was to determine the optimal venue for insertion of a urinary catheter prior to an elective caesarean section. Prior to this project, the urinary catheter had been inserted on the ward before women were transferred to the Operating Theatre (OT). The project sought to answer the question: would women prefer to have their urinary catheter inserted on the ward or in the OT after their epidural anaesthesia had commenced?
Homer, C.S. 2002, 'Immersion in Water During First Stage of Labor', Birth, vol. 29, no. 1, pp. 76-77.
Murray, N., Homer, C.S.E., Davis, G.K., Curtis, J., Mangos, G. & Brown, M.A. 2002, 'The clinical utility of routine urinalysis in pregnancy: A prospective study', Medical Journal of Australia, vol. 177, no. 9, pp. 477-480.
Objectives: To determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre-eclampsia. Can routine urinalysis during pregnancy be discontinue in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit? Design: Prospective observational study. Setting: A metropolitan public hospital and a private hospital in Sydney (NSW). Participants: One thousand women were enrolled at their first antenatal visit (March to November 1999), and 913 completed the study. Outcome measures: The primary outcome was a diagnosis of de novo hypertension (gestational hypertension, pre-eclampasia, or pre-eclampsia superimposed on chronic hypertension). Results: Thirty-five women had dipstick proteinuria at the first antenatal visit. In 25 (71%) of these women, further dipstick proteinuria was detected during pregnancy, and two (6%) were diagnosed with pre-eclampsia. Of the 867 without dipstick proteinuria at the first visit, 338 (39%) had dipstick proteinuria (> 1+) at some time during pregnancy. There were no statistically significant differences in the proportion of women with and without dipstick proteinuria at their first visit who developed hypertension during pregnancy. Only six women developed proteinuria before the onset of hypertension. Women who had an abnormal result of a midstream urine test at their first visit, compared with women with a normal result, were more likely to have a urinary tract infection diagnosed during pregnancy; however, the numbers were small. Conclusion: In the absence of hypertension, routine urinalysis during pregnancy is a poor predictor of pre-eclampsia. Therefore, after an initial screening urinalysis, routine urinalysis could be eliminated from antenatal care without adverse outcomes for women.
Davis, G.K., Homer, C.S.E. & Brown, M.A. 2002, 'Hypertension in pregnancy: Do consensus statements make a difference?', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 42, no. 4, pp. 369-373.
Objectives. (i) To document variation in management of hypertension in pregnancy; (ii) to determine whether this variation falls within current management guidelines; and (iii) to make recommendations for developing future guidelines. Design. Questionnaire-based survey. Setting. Australia and New Zealand. Population. All specialist obstetricians. Methods. Questionnaires were sent to 1198 obstetricians in Australia and New Zealand. Those returned by respondents currently in obstetric practice were analysed. Information was obtained on their current clinical practices relating to the diagnosis and management of hypertension in pregnancy. Results. Of 1198 obstetricians surveyed, 973 (81%) replied. Of these, 686 (71%) were responsible for obstetric care. Considerable variation in practice was found, particularly in relation to the measurement of blood pressure, the determination of hypertension and significant proteinuria, and the decision to institute antihypertensive drug treatment. The recommendations of the Australasian 1993 Consensus Statement appeared to have had little influence on practice. There has been a striking increase in the use of magnesium sulphate for the prevention of convulsions in preeclampsia. Conclusions. There is significant variation in management of hypertensive pregnancies that differs from current guidelines. It is not known whether this diversity adversely affects clinical outcomes. Until further outcome evidence is available, consensus statements may be better confined to basic aspects of management for which there is high level evidence.
Homer, C.S. 2002, 'Private health insurance uptake and the impact on normal birth and costs: a hypothetical model.', Australian health review : a publication of the Australian Hospital Association, vol. 25, no. 2, pp. 32-37.
Recent Australian government policy has encouraged large numbers of women of childbearing age to enter private health insurance. This paper describes how increased uptake of private health insurance may impact on the rate of normal birth, caesarean section and the costs of providing maternity care in low risk primiparous women in New South Wales. A hypothetical model was developed using data from the NSW Midwives Data Collection. Costs were calculated using data established from previous research in NSW (Homer et al 2001). It suggests that, as the proportion of low risk primiparous women with private health insurance increases, the rate of normal birth may decrease with a subsequent increase in rate of caesarean section. As the rate of caesarean section rises, the cost of providing intrapartum and postpartum care may also increase. I argue that increased rates of private health insurance membership have the potential to increase the rate of caesarean section and the cost of providing maternity care to low risk women. It is evident that government policy can impact on the outcome of maternity care in Australia in ways that might not have been predicted. Paradoxically, the care of healthy childbearing women may cost the Australian government more to provide in the future.
Homer, C.S.E. 2002, 'Using the Zelen design in randomized controlled trials: Debates and controversies', Journal of Advanced Nursing, vol. 38, no. 2, pp. 200-207.
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Background. The use of the randomized consent design (commonly known as the Zelen design) is a controversial issue in randomized controlled trials. In the Zelen design, participants are randomly allocated prior to seeking consent. Those participants allocated to the intervention group are then approached and offered the intervention, which they can decline or accept. Zelen first proposed the design in 1979. It has been used infrequently since this time, although there are some notable exceptions in nursing, midwifery and some medical specialities. Aim. This paper describes the Zelen design, including the two forms used (the single and double consent versions) and discusses the advantages and disadvantages of using such a design. Methods. An explanation of the differences between the Zelen design and a conventional randomized controlled trial is presented. In a conventional design, detailed knowledge of the alternative interventions is given to the prospective participant. The participant gives consent and is allocated to one of the groups. In a Zelen design, participants are randomly allocated and then approached and offered the group to which they were allocated. The Zelen design is used firstly, to reduce disappointment bias in the conventional consent-randomization process, and secondly, to remove subjective bias in the recruitment process. There are concerns relating to the use of the Zelen design, including ethical concerns relating to the timing of random allocation and consent and the collection of clinical data. Conclusion. It is hoped that by presenting issues pertaining to the Zelen design, other nursing and midwifery researchers may be prompted to consider its use when designing clinical research. The Zelen design is controversial, and debate about its merits and shortcomings is useful. This paper contributes to the ongoing debate.
Homer, C.S., Farrell, T.J., Davis, G.K. & Brown, M.A. 2002, 'Women's worry and the risk-associated pregnancy team', British Journal of Midwifery, vol. 10, no. 6, pp. 356-359.
Considerable attention is paid to the treatment and clinical outcomes of `atrisk pregnancies but the level of worry experienced by these women has not been addressed. A multidisciplinary team, known as the Risk Associated Pregnancy (RAP) team, cared for 159 women with risk-associated pregnancies. Their level of worry was compared with that of 699 women with normal pregnancies (NPs): 360 receiving continuity of midwifery care and 339 receiving standard care. Underlying level of anxiety was similar among groups. Women managed by the RAP team reported a lower level of worry than women in either of the NP groups.
Homer, C.S., Matha, D.V., Jordan, L.G., Wills, J. & Davis, G.K. 2001, 'Community-based continuity of midwifery care versus standard hospital care: a cost analysis.', Australian health review : a publication of the Australian Hospital Association, vol. 24, no. 1, pp. 85-93.
This paper reports the costs of providing a new model of maternity care compared to standard care in an Australian public hospital. The mean cost of providing care per woman was lower in the group who had the new model of care compared with standard care ($2,579 versus $3,483). Cost savings associated with new model of care were maintained even after costs associated with admission to special care nursery were excluded. The cost saving was also sustained even when the caesarean section rate in the new model of care increased to beyond that of the standard care group.
Karantanis, E., Alcock, D., Phelan, L.K., Homer, C.S.E. & Davis, G.K. 2001, 'Introducing external cephalic version to clinical practice', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 41, no. 4, pp. 395-397.
A service offering external cephalic version to all women with breech presentations at 36-38 weeks' gestation was introduced at St George Hospital in July 1997. This paper describes how this service was established and reports the clinical outcomes over the first three years; 116 external cephalic versions (ECV) were attempted on 114 women and success was achieved in 58 women (51%). Of the 58 women, 43 (74%) subsequently had vaginal deliveries. There were no fetal deaths, immediate Caesarean sections, or placental abruptions as a result of the ECV procedure. There were two (2%) episodes of transient fetal bradycardia following ECV, both of which returned to normal with a subsequent normal neonatal outcome. Pre- and post-ECV Kleihauer levels were collected with no increase in levels as a result of the ECV. ECV is a procedure that can, and should, be provided as part of a public hospital service.
Homer, C.S.E., Davis, G.K., Brodie, P.M., Sheehan, A., Barclay, L.M., Wills, J. & Chapman, M.G. 2001, 'Collaboration in maternity care: A randomised controlled trial comparing community-based continuity of care with standard hospital care', British Journal of Obstetrics and Gynaecology, vol. 108, no. 1, pp. 16-22.
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Objective: To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design: Randomised controlled trial. Setting: A public teaching hospital in metropolitan Sydney, Australia. Sample: 1089 women randomised to either the community-based model (n = 550) or standard hospital-based care (n = 539) prior to their first antenatal booking visit at an Australian metropolitan public hospital. Main outcome measures: Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results: There was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR = 0.6, 95% CI 0.4-0.9, P = 0.02). There were no other significant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P = 0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births. Conclusion: Community-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.
Homer, C.S. 2000, 'Incorporating cultural diversity randomised controlled trials in Midwifery', Midwifery, vol. 16, no. 4, pp. 252-259.
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Homer, C.S.E., Davis, G.K. & Brodie, P.M. 2000, 'What do women feel about community-based antenatal care?', Australian and New Zealand Journal of Public Health, vol. 24, no. 6, pp. 590-595.
Objective: This study evaluated women's perceptions of a new community-based model of continuity of antenatal care, the St George Outreach Maternity Project (STOMP). The model was established in an attempt to address some of the ongoing concerns and criticisms regarding antenatal care in Australia: lack of continuity of care and caregiver; prolonged waiting times; and inaccessible clinics. Methods: A randomised controlled trial was conducted with 1,089 women (550 in the experimental group and 539 in the control group). The experimental group (the STOMP group) received antenatal care from small teams of midwives and an obstetrician in community-based settings. Data were collected using a questionnaire administered at 36 weeks' gestation, with a response rate of 75%. Results: Women in the STOMP group reported waiting significantly less time for antenatal visits with easier access to care. STOMP group women also reported a higher perceived 'quality' of antenatal care compared with the control group. STOMP group women saw slightly more midwives and fewer doctors than control group women did. Conclusion and implications: This model of care has implications for the planning and provision of antenatal services within the Australian public health system, which is increasingly moving towards a community-based emphasis. Antenatal care is a service that can be successfully transferred into community-based settings with benefits for women.
Homer, C.S., Davis, G.K., Petocz, P. & Barclay, L. 2000, 'Birth Centre or Labour Ward? A comparison of the clinical outcomes of low-risk women in a NSW Hospital', Australian Journal of Advanced Nursing, vol. 18, no. 1, p. 37115.
The objective of this study was to compare the obstetric outcomes, primarily caesarean section rates, of low-risk women presenting in spontaneous labour to the birth centre with those attending the hospital's conventional labour ward.
Homer, C.S.E., Davis, G.K. & Everitt, L.S. 1999, 'The introduction of a woman-held record into a hospital antenatal clinic: The bring your own records study', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 39, no. 1, pp. 54-57.
We report the introduction of a woman-held record into an antenatal clinic in a NSW teaching hospital using a randomized controlled trial. In 1997, 150 women were randomized to either retaining their entire antenatal record through pregnancy (women-held group) or to holding a small, abbreviated card, as was standard practice (control group). A questionnaire was distributed to women to measure sense of control, involvement in care and levels of communication. Availability of records at antenatal visits was also measured. Women in both groups were satisfied with their allocated method of record keeping, however, those in the women-held group were significantly more likely to report feeling in 'control' during pregnancy. Women in the control group were more likely to feel anxious and helpless and less likely to have information on their records explained to them by their caregiver. The number of records available at each clinic was similar in both groups.
Barclay, K.M., Chamberlain, M.E., Homer, C.S.E. & Barclay, L.M. 1998, 'Early discharge and risk for postnatal depression', MEDICAL JOURNAL OF AUSTRALIA, vol. 168, no. 8, pp. 419-420.

Reports

Sandall, J., Homer, C.S., Sadler, E., Rudisill, C., Bbourgeault, I.L., Bewley, S., Nelson, P., Cowie, L., Cooper, C. & Curry, N. The King's Fund 2011, Staffing in Maternity Units, pp. 1-53, London, UK.
This report was commissioned by The King's Fund to answer a fundamental question: Can the safety of maternity services be improved by more effectively deploying existing staffi ng resources? There is much debate at present about staffing levels in maternity. The independent inquiry into the safety of maternity services commissioned by The King's Fund suggested that, while staffing levels are important, employing more staff may not necessarily improve safety. The inquiry found that the effective deployment of the right staff doing the right thing at the right time in the right place is the key to improvement (The King's Fund 2008, p 48). Current financial pressures mean that it is unrealistic to expect significant increases in numbers of staff. As such, maternity services - and the National Health Service (NHS) as a whole - will need to focus on developing new ways of working in order to maintain, and increase, levels of safety and quality within the resources available.
Duffield, C.M., Roche, M.A., O'Brien-Pallas, L., Diers, D., Aisbett, C., Aisbett, K. & Homer, C.S. University of Technology, Sydney 2009, Nursing workload and staffing: Impact on patients and staff, pp. 1-161.