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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 for the  Development of Antenatal Guidelines. (2008-current))
NSW Health Department, Maternal and Perinatal Health Priority Taskforce (2007-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
Member, WHO Collaborating Centre for Nursing, Midwifery and Health Development (WHO or WHOCC)
Core Member, CHSP - Health Services and Practice
Associate Member, INEXT - Innovation in IT Services and Applications
MScMed(ClinEpi), PhD (UTS)
Member, Council for Remote Area Nurses of Australia
Member, Australian College of Midwives
Member, Maternity Coalition
Member, Perinatal Society of Australia and New Zealand
 
Phone
+61 2 9514 4886

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

Global maternal and child health

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

Development - maternal and child health

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 dictionaryâs women-centred care approach and updated the evidence throughout.

Chapters

Cummins, A. & Homer, C.S. 2015, 'Obstetric Emergencies' in Emergency and Trauma Care for Nurses and Paramedics, Elsevier, Sydney.
Atchan, M.A. & Homer, C.S. 2014, 'Routine care of postpartum women' in Abbott, J., Bowyer, L. & Finn, M. (eds), Obstetrics & Gynaecology: An Evidence Based Guide, Elsevier, Australia, pp. 219-230.
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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.
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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. & Friendship, J. (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.
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Brodie, P. & Homer, C. 2009, 'Transforming the culture of a maternity service' in Birth Models That Work, pp. 187-212.
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.
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Conferences

Fox, D., Sheehan, A. & Homer, C.S.E. 2015, 'Birthplace in Australia: Midwives' experiences of intrapartum homebirth transfer', WOMEN AND BIRTH, pp. S15-S15.
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Dawson, A., Turkmani, S., Varol, N., Sullivan, E. & Homer, C. 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia', Super Midwives - Making a Difference, Australian College of Midwives, 19th Biennial Conference, Gold Coast, Australia.
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Catling, C., Coddington, R., Foureur, M. & Homer, C.S.E. 2014, 'Publicly-funded homebirth in Australia: outcomes over 6 years', International Confederation of Midwives 30th Triennial Conference, Prague, Czech Republic.
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Dawson, A., Homer, C. & Brodie, P. 2014, 'How should we collaborate to build midwifery capacity in low income countries?', 30th ICM Congress, Prague.
Progress towards MDG5 cannot be achieved without midwives and midwifery organisations coming together to support midwifery education, regulation and professional association efforts in low and middle income countries. Capacity building is critical to scaling up the midwifery workforce and improving maternal and child health. A number of symposia have sought to develop ways to build midwifery capacity through collaboration. This includes the 2010 meeting of the Global Advisory Group for Nursing and Midwifery Development that focused on developing policy and technical guidance in key areas including inter-professional collaboration. Other forums have emphasised partnership through pairing organizations (twinning), networking as well as bilateral and global collaboration. However, despite considerable effort towards building midwifery capacity through collaboration there is little high level evidence about the effectiveness of such strategies. The aim of this paper is to provide an overview of approaches to collaboration documented in peer-reviewed research papers that were examined as part of a meta-synthesis study. We will discuss the complexities of collaborative efforts between midwifery organizations from different nations and describe a framework to guide practice. The presentation will present experiences of international midwifery collaboration from the literature that have sought to build capacity through the provision of tools, training midwives to develop appropriate clinical or research skills, building adequate numbers of skilled midwives, supervisor networks and incentives, establishing appropriately managed facilities as well as systems to facilitate effective decision making, information gathering and accountable midwifery care. We will examine these efforts in the light of social theory, including power relations, concepts of reciprocity and empowerment. This paper will present an innovative framework for the design and evaluation of midwifery coll...
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, Melbourne.
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, Adelaide.
Catling, C., Coddington, R., Foureur, M. & Homer, C.S.E. 2013, 'Publicly-funded homebirth in Australia: outcomes over 6 years', Perinatal Society of Australia and New Zealand 17th Annual Congress 'Controversies in perinatal care, Adelaide.
Catling, C., Coddington, R., Foureur, M. & Homer, C.S.E. 2013, 'Maternal and neonatal outcomes from publicly-funded homebirth models in Australia', . Australian College of Midwives 18th Biennial Conference, 'Life, Art and Science in Midwifery, Hobart.
Dawson, A., Homer, C., Brodie, P., Rumsey, M. & Copeland, F. 2013, 'We kam longwe so far: Building Midwifery Capacity in Papua New Guinea. Innovative approaches for women's health. Are the current initiatives adequate?', Pacific Society of Reproductive Health Biennial Conference, Honiara, The Solomon Islands.
Background In early 2012, the AusAID funded WHO PNG Maternal and Child Health Initiative (MCHI) was established to improve maternal health outcomes in Papua New Guinea in close partnership with the PNG National Department of Health. The WHO Collaborating Centre at UTS is subcontracted by WHO PNG to deliver a range of activities focused on improving the standard of midwifery clinical teaching and practice in four teaching sites. This has included the placement of 8 clinical midwifery facilitators to work alongside PNG midwifery educators, 2 obstetricians providing clinical care and education in rural areas, the provision of learning resources and training and education and capacity building workshops. Two obstetricians were also placed in two rural hospitals to assist in the delivery of obstetric care and training. Methods Multiple data collection tools are being used to collect both qualitative and qualitative data. These include In-country visits where interviews and focus groups were conducted with various stakeholders. Additionally surveys and reports were collected from educators, students, and faculty staff to the contribution that this capacity building initiative is making to the strengthening of teaching and learning and regulation. Findings The findings are currently being presented to WHO PNG and AusAID as part of a Mid Term Review. The findings will be presented at the PSRH Conference. Conclusion The MCHI is a new, and solid beginning towards the scale up of midwifery in PNG but only through on-going investment and development can the impact that can be made by midwives at population level be fully realized.
Dawson, A., Ith, P. & Homer, C. 2012, 'Quality of maternity care practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia', International Confederation of Midwives Asia Pacific Regional Conference, Hanoi, Viet Nam.
The proportion of births attended by skilled birth attendants (SBAs) has been used as a proxy indicator to monitor progress towards achievement of Millennium Development Goal five which aims to reduce maternal mortality by three quarters by 2015. However, there has been little emphasis on examining the provision of quality of maternity care practices in Cambodia. The objective of this study was to seek to understand SBAs' perceptions and practices and the factors affecting their practice during labour, birth and the immediate postpartum. Methods: A qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses-midwives and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic approach. Findings: SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Eight inter-related themes emerged which described patterns of SBA practice.. 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; lack of policy and authority; fear of litigation; workload and lack of human resources; and, financial incentives and socioeconomic 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. The findings of this research provide maternal health services, workforce planners and policy makers with valuable information to improve maternal health. Recommendations for decision makers are made that maybe transferrable to other developing country contexts.
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, ISA and ISPID Joint Conference, Blackwell Publishing, Sydney, Australia, pp. 7-7.
Hoang, D.B., Lawrence, E.M., Ahmad, N., Balasubramanian Appiah, V., Homer, C.S., Foureur, M. & Leap, N. 2008, 'Assistive Care Loop with Electronic Maternity Records', 2008 10th IEEE International Conference on e-Health Networking, Applications and Services, International Conference on e-Health Networking, Applications and Services, IEEE, Biopolis, Singapore, pp. 118-123.
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Surprisingly women-held pregnancy health records (paper based) are still predominantly used in most hospitals in Australia. These records are not standardized as each hospital or state has a slightly different version. Early efforts have been made to standardize pregnancy records and make them available electronically. Electronic record systems do not allow dynamic interaction between users and they are not accessible when users are mobile. This paper describes an assistive maternity care (AMC) system that addresses a number of important issues: 1) transforming a women-held paper-based record for pregnancy care into an electronic maternity record (EMR); 2) investigating mechanisms to make the record active; 3) creating a system whereby details of the pregnant women and their carers can be recorded, updated over wired and wireless networks; and 4) creating a pregnancy care loop over which midwives and doctors and pregnant women under their care can communicate effectively anywhere, anytime for the duration of pregnancy.
Davis, D.L., Homer, C.S., Foureur, M., Leap, N. & Forbes, I. 2008, 'Birthing units: Designing homely delivery spaces to promote natural birth', Health Facilities Design and Development 2008, Brisbane, Australia.

Journal articles

West, F., Homer, C. & Dawson, A. 2016, 'Building midwifery educator capacity in teaching in low and lower-middle income countries. A review of the literature', Midwifery, vol. 33, pp. 12-23.
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© 2015 Elsevier Ltd. Aim and objective: midwifery educators play a critical role in strengthening the midwifery workforce in low and lower-middle income countries (LMIC) to ensure that women receive quality midwifery care. However, the most effective approach to building midwifery educator capacity is not always clear. This paper will explore approaches used to build midwifery educator capacity in LMIC and identify evidence to inform improved outcomes for midwifery education. Design: a structured search of bibliographic electronic databases (CINAHL, OVID, MEDLINE, PubMed) and the search engine Google Scholar was performed. It was decided to also review peer reviewed research, grey literature and descriptive papers. Papers were included in the review if they were written in English, published between 2000 and 2014 and addressed building knowledge and/or skills in teaching and/or clinical practice in midwifery educators who work in training institutions in LMIC. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was used to guide the reporting process. The quality of papers was appraised in discussion with all authors. The findings sections of the research papers were analysed to identify successful elements of capacity building approaches. Findings: eighteen (six research and 12 discursive) papers were identified as related to the topic, meeting the inclusion criteria and of sufficient quality. The findings were themed according to the key approaches used to build capacity for midwifery education. These approaches are: skill and knowledge updates associated with curriculum review, involvement in leadership, management and research training and, participation in a community of practice within regions to share resources. Key conclusions: the study provides evidence to support the benefits of building capacity for midwifery educators. Multilevel approaches that engaged individuals and institutions in building capacity alongside an enablin...
Harte, J.D., Homer, C.S., Sheehan, A., Leap, N. & Foureur, M. 2016, 'Using video in childbirth research: Ethical approval challenges.', Nursing ethics.
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Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers.This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits.The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal communication and the experiences of childbearing women, midwives and supporters.Six women, 11 midwives and 11 childbirth supporters were filmed during the women's labours in hospital birth units and interviewed 6 weeks later.The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation.The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process.The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies.Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-b...
Dawson, A., Kililo, M., Geitab, L., Mola, G., Brodie, P., Rumsey, M., Copeland, F., Neill, A. & Homer, C. 2016, 'Midwifery capacity building in Papua New Guinea: Key achievements and ways forward', Women and Birth, vol. 29, no. 2, pp. 180-188.
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Catling, C., Petrovska, K., Watts, N., Bisits, A. & Homer, C.S. 2016, 'Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.', Women and Birth.
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Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth.A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically.Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper.In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way.
Catling, C.J. & Homer, C.S. 2016, 'Twenty-five years since the Shearman Report: How far have we come? Are we there yet?', Women and Birth, vol. 29, no. 1, pp. 93-99.
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In 1989, the first major state-wide report into maternity services, known as the Shearman Report after its author, was released in New South Wales, the most populous state in Australia.This paper reflects upon the report and tracks the progress of five of its key recommendations. The recommendations are still some of the major issues facing maternity services across the country. These are: community-based maternity care, rural maternity services, hospital visiting rights for privately practising midwives, obstetric intervention, and midwifery continuity of maternity care.In some ways, much has changed in 25 years including the terminology used in the report, the importance of midwifery continuity of care and the woman-centred nature of many services. However, in other ways, there is still a long way to go to address these major issues. Despite more than a quarter of a century, many recommendations have not been fulfilled, especially access to care in rural areas, rates of obstetric intervention, and the issue of visiting rights for privately practising midwives which has gone backwards.A continued and renewed effort is needed to ensure that the forward thinking recommendations of the Shearman Report are ultimately realised for all women and their families.
Hoope-Bender, P.T., Lopes, S.T., Nove, A., Michel-Schuldt, M., Moyo, N.T., Bokosi, M., Codjia, L., Sharma, S. & Homer, C. 2016, 'Midwifery 2030: a woman's pathway to health. What does this mean?', Midwifery, vol. 32, pp. 1-6.
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The 2014 State of the World's Midwifery report included a new framework for the provision of woman-centred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low-income countries, and in any type of health system). In this paper, we describe the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation. The Pathway was developed by a process of consultation with an international group of midwifery experts. It considers four stages of a woman's reproductive life: (1) pre-pregnancy, (2) pregnancy, (3) labour and birth, and (4) postnatal, and describes the care that women and adolescents need at each stage. Underpinning these four stages are ten foundations, which describe the systems, services, workforce and information that need to be in place in order to turn the Pathway from a vision into a reality. These foundations include: the policy and working environment in which the midwifery workforce operates, the effective coverage of sexual, reproductive, maternal, newborn and adolescent services (i.e. going beyond availability and ensuring accessibility, acceptability and high quality), financing mechanisms, collaboration between different sectors and different levels of the health system, a focus on primary care nested within a functional referral system when needed, pre- and in-service education for the workforce, effective regulation of midwifery and strengthened leadership from professional associations. Strengthening of all of these foundations will enable countries to turn the Pathway from a vision into reality.
Yoshida, S., Martines, J., Lawn, J.E., Wall, S., Souza, J.P., Rudan, I., Cousens, S., Aaby, P., Adam, I., Adhikari, R.K., Ambalavanan, N., Arifeen, S.E., Aryal, D.R., Asiruddin, S., Baqui, A., Barros, A.J., Benn, C.S., Bhandari, V., Bhatnagar, S., Bhattacharya, S., Bhutta, Z.A., Black, R.E., Blencowe, H., Bose, C., Brown, J., Bührer, C., Carlo, W., Cecatti, J.G., Cheung, P.Y., Clark, R., Colbourn, T., Conde-Agudelo, A., Corbett, E., Czeizel, A.E., Das, A., Day, L.T., Deal, C., Deorari, A., Dilmen, U., English, M., Engmann, C., Esamai, F., Fall, C., Ferriero, D.M., Gisore, P., Hazir, T., Higgins, R.D., Homer, C.S., Hoque, D.E., Irgens, L., Islam, M.T., de Graft-Johnson, J., Joshua, M.A., Keenan, W., Khatoon, S., Kieler, H., Kramer, M.S., Lackritz, E.M., Lavender, T., Lawintono, L., Luhanga, R., Marsh, D., McMillan, D., McNamara, P.J., Mol, B.W., Molyneux, E., Mukasa, G.K., Mutabazi, M., Nacul, L.C., Nakakeeto, M., Narayanan, I., Olusanya, B., Osrin, D., Paul, V., Poets, C., Reddy, U.M., Santosham, M., Sayed, R., Schlabritz-Loutsevitch, N.E., Singhal, N., Smith, M.A., Smith, P.G., Soofi, S., Spong, C.Y., Sultana, S., Tshefu, A., van Bel, F., Gray, L.V., Waiswa, P., Wang, W., Williams, S.L., Wright, L., Zaidi, A., Zhang, Y., Zhong, N., Zuniga, I. & Bahl, R. 2016, 'Setting research priorities to improve global newborn health and prevent stillbirths by 2025.', Journal of global health, vol. 6, no. 1, p. 010508.
In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025.We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakehol...
Catling, C., Petrovska, K., Watts, N.P., Bisits, A. & Homer, C.S. 2016, 'Care during the decision-making phase for women who want a vaginal breech birth: Experiences from the field.', Midwifery, vol. 34, pp. 111-116.
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few women are given the option of a vaginal breech birth in Australia, unless the clinicians feel confident and have the skills to facilitate this mode of birth. Few studies describe how clinicians provide care during the decision-making phase for women who choose a vaginal breech birth. The aim of this study was to explore how experienced clinicians facilitated decisions about external cephalic version and mode of birth for women who have a breech presentation.a descriptive exploratory design was undertaken with nine experienced clinicians (obstetricians and midwives) from two tertiary hospitals in Australia. Data were collected through face to face interviews and analysed thematically.five obstetricians and four midwives participated in this study. All were experienced in caring for women having a vaginal breech birth and were currently involved in providing such a service. The themes that arose from the data were: Pitching the discussion, Discussing safety and risk, Being calm and Providing continuity of care.caring for women who seek a vaginal breech birth includes careful selection of appropriate women, full discussions outlining the risks involved, and undertaking care with a calm manner, ensuring continuity of care. Health services considering establishing a vaginal breech service should consider that these elements are included in the establishment and implementation processes.
Homer, C.S.E., Malata, A. & ten Hoope-Bender, P. 2016, 'Supporting women, families, and care providers after stillbirths', LANCET, vol. 387, no. 10018, pp. 516-517.
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Cummins, A.M., Denney-Wilson, E. & Homer, C.S. 2016, 'The mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia.', Nurse education in practice.
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The aim of this paper was to explore the mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia. Most new graduates find employment in hospitals and undertake a new graduate program rotating through different wards. A limited number of new graduate midwives were found to be working in midwifery continuity of care. The new graduate midwives in this study were mentored by more experienced midwives. Mentoring in midwifery has been described as being concerned with confidence building based through a personal relationship. A qualitative descriptive study was undertaken and the data were analysed using continuity of care as a framework. We found having a mentor was important, knowing the mentor made it easier for the new graduate to call their mentor at any time. The new graduate midwives had respect for their mentors and the support helped build their confidence in transitioning from student to midwife. With the expansion of midwifery continuity of care models in Australia mentoring should be provided for transition midwives working in this way.
Scarf, V., Catling, C., Viney, R. & Homer, C.S. 2016, 'Costing alternative birth settings for women at low risk of complications: A systematic review', PLoS One.
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Cummins, A., Denney-Wilson, E. & Homer, C.S. 2016, 'The challenge of employing and managing new graduate midwives in midwifery group practices in hospitals', Journal of Nursing Management.
Vallely, L.M., Homiehombo, P., Walep, E., Moses, M., Tom, M., Kelly-Hanku, A., Vallely, A., Nataraye, E., Ninnes, C., Mola, G.D., Morgan, C., Kaldor, J.M., Wand, H., Whittaker, A. & Homer, C.S. 2016, 'Feasibility and acceptability of clean birth kits containing misoprostol for self-administration to prevent postpartum hemorrhage in rural Papua New Guinea.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 133, no. 3, pp. 301-306.
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To determine the feasibility and acceptability of providing clean birth kits (CBKs) containing misoprostol for self-administration in a rural setting in Papua New Guinea.A prospective intervention study was conducted between April 8, 2013, and October 24, 2014. Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena. Participants received individual instruction and were then given a CBK containing 600g misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their understanding of correct use of items in the CBK. Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up.Among 200 participants, 106 (53.0%) had an unsupervised birth, and 99 (93.4%) of these women used the CBK. All would use the CBK again and would recommend it to others. Among these 99 women, misoprostol was self-administered by 98 (99.0%), all of whom would take the drug again and would recommend it to others.The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities. Large-scale interventions should be planned to further evaluate impact and acceptability.
Davis, D.L. & Homer, C.S.E. 2016, 'Birthplace as the midwife's work place: How does place of birth impact on midwives?', Women and Birth.
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© 2016 Australian College of Midwives. Background: In, many high and middle-income countries, childbearing women have a variety of birthplaces available to them including home, birth centres and traditional labour wards. There is good evidence indicating that birthplace impacts on outcomes for women but less is known about the impact on midwives. Aim: To explore the way that birthplace impacts on midwives in Australia and the United Kingdom. Method: A qualitative descriptive study was undertaken. Data were gathered through focus groups conducted with midwives in Australia and in the United Kingdom who worked in publicly-funded maternity services and who provided labour and birth care in at least two different settings. Findings: Five themes surfaced relating to midwifery and place including: 1. practising with the same principles; 2. creating ambience: controlling the environment; 3. workplace culture: being watched 4. Workplace culture: "busy work" versus "being with"; and 5. midwives' response to place. Discussion: While midwives demonstrate a capacity to be versatile in relation to the physicality of birthplaces, workplace culture presents a challenge to their capacity to "be with" women. Conclusion: Given the excellent outcomes of midwifery led care, we should focus on how we can facilitate the work of midwives in all settings. This study suggests that the culture of the birthplace rather than the physicality is the highest priority.
Lack, B.M., Smith, R.M., Arundell, M.J. & Homer, C.S. 2016, 'Narrowing the Gap? Describing women's outcomes in Midwifery Group Practice in remote Australia.', Women and birth : journal of the Australian College of Midwives.
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In Australia, Aboriginal women and babies experience higher maternal and perinatal morbidity and mortality rates than their non-Aboriginal counterparts. Whilst midwifery led continuity of care has been shown to be safe for women and their babies, with benefits including reducing the preterm birth rate, access to this model of care in remote areas remains limited. A Midwifery Group Practice was established in 2009 in a remote city of the Northern Territory, Australia, with the aim of improving outcomes and access to midwifery continuity of care.The aim of this paper is to describe the maternal and newborn outcomes for women accessing midwifery continuity of care in a remote context in Australia.A retrospective descriptive design using data from two existing electronic databases was undertaken and analysed descriptively.In total, 763 women (40% of whom were Aboriginal) gave birth to 769 babies over a four year period. There were no maternal deaths and the rate of perinatal mortality was lower than that across the Northern Territory. Lower rates of preterm birth (6%) and low birth weight babies (5%) were found in comparison to population based data.Continuity of Midwifery Care can be effectively provided to remote dwelling Aboriginal women and appears to improve outcomes for women and their infants.
Schmied, V., Homer, C.S., Fowler, C.M., Psalia, K., Barclay, L., Wilson, I., Kemp, L., Fasher, M. & Kruske, S. 2015, 'Implementing a national approach to universal child and family health services in Australia: professionals' views of the challenges and opportunities', Health and Social Care in the Community, vol. 23, no. 2, pp. 159-170.
Australia has a well-accepted system of universal child and family health (CFH) services. However, government reports and research indicate that these services vary across states and territories, and many children and families do not receive these services. The aim of this paper was to explore professionals' perceptions of the challenges and opportunities in implementing a national approach to universal CFH services across Australia. Qualitative data were collected between July 2010 and April 2011 in the first phase of a three-phase study designed to investigate the feasibility of implementing a national approach to CFH services in Australia. In total, 161 professionals participated in phase 1 consultations conducted either as discussion groups, teleconferences or through email conversation. Participants came from all Australian states and territories and included 60 CFH nurses, 45 midwives, 15 general practitioners (GPs), 12 practice nurses, 14 allied health professionals, 7 early childhood education specialists, 6 staff from non-government organisations and 2 Australian government policy advisors. Data were analysed thematically. Participants supported the concept of a universal CFH service, but identified implementation barriers. Key challenges included the absence of a minimum data set and lack of aggregated national data to assist planning and determine outcomes; an inconsistent approach to transfer of information about mothers and newborns from maternity services to CFH nursing services or GPs; poor communication across disciplines and services; issues of access and equity of service delivery; workforce limitations and tensions around role boundaries. Directions for change were identified, including improved electronic data collection and communication systems, reporting of service delivery and outcomes between states and territories, professional collaboration, service co-location and interprofessional learning and development.
Roche, M.A., Duffield, C.M., Homer, C.S., Buchan, J. & Dimitrelis, S. 2015, 'The Rate and Cost of Nurse Turnover in Australia', Collegian, vol. 22, no. 4, pp. 353-358.
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Nurse turnover is a critical issue facing workforce planners across the globe, partic- ularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs associated with nurse turnover are attracting more attention; however, existing measurements of turnover show inconsistent findings, which can be attributed to differences in study design, metrics used to calculate turnover and variations in definitions for turnover. This paper will report the rates and costs of nurse turnover across three States in Australia.
Dawson, A., Turkmani, S., Fray, S., Nanayakkara, S., Varol, N. & Homer, C. 2015, 'Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience', Midwifery, vol. 31, no. 1, pp. 229-238.
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Objective to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care. Design an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014. Findings 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial. Key conclusions professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice. Implications for practice improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation.
Vallely, L.M., Homiehombo, P., Kelly-Hanku, A., Vallely, A., Homer, C.S.E. & Whittaker, A. 2015, 'Childbirth in a rural highlands community in Papua New Guinea: A descriptive study', MIDWIFERY, vol. 31, no. 3, pp. 380-387.
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Duffield, C.M., Roche, M.A., Dimitrelis, S., Homer, C. & Buchan, J. 2015, 'Instability in patient and nurse characteristics, unit complexity and patient and system outcomes.', Journal of Advanced Nursing, vol. 71, no. 6, pp. 1288-1298.
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AIMS: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. BACKGROUND: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. DESIGN: Descriptive. METHODS: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. RESULTS: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). CONCLUSION: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity.
Renfrew, M.J., Homer, C.S., Van Lerberghe, W. & Hoope-Bender, P.T. 2015, 'Improving midwifery care worldwide--authors' reply.', Lancet (London, England), vol. 385, no. 9962, p. 27.
Cummins, A.M., Denney-Wilson, E. & Homer, C.S.E. 2015, 'The experiences of new graduate midwives working in midwifery continuity of care models in Australia', Midwifery, vol. 31, no. 4, pp. 438-444.
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Catling, C., Medley, N., Foureur, M., Ryan, C., Leap, N., Teate, A. & Homer, C.S.E. 2015, 'Group versus conventional antenatal care for women', Cochrane Database of Systematic Reviews.
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Everitt, L., Fenwick, J. & Homer, C.S.E. 2015, 'Midwives experiences of removal of a newborn baby in New South Wales, Australia: Being in the 'head' and 'heart' space', Women and Birth, vol. 28, no. 2, pp. 95-100.
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Dawson, A.J., Turkmani, S., Varol, N., Nanayakkara, S., Sullivan, E. & Homer, C.S. 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia.', Women and Birth, vol. 28, no. 3, pp. 207-214.
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Female genital mutilation (FGM) has serious health consequences, including adverse obstetric outcomes and significant physical, sexual and psychosocial complications for girls and women. Migration to Australia of women with FGM from high-prevalence countries requires relevant expertise to provide women and girls with FGM with specialised health care. Midwives, as the primary providers of women during pregnancy and childbirth, are critical to the provision of this high quality care.To provide insight into midwives' views of, and experiences working with, women affected by FGM.A descriptive qualitative study was undertaken using focus group discussions with midwives from four purposively selected antenatal clinics and birthing units in three hospitals in urban New South Wales. The transcripts were analysed thematically.Midwives demonstrated knowledge and recalled skills in caring for women with FGM. However, many lacked confidence in these areas. Participants expressed fear and a lack of experience caring for women with FGM. Midwives described practice issues, including the development of rapport with women, working with interpreters, misunderstandings about the culture of women, inexperience with associated clinical procedures and a lack of knowledge about FGM types and data collection.Midwives require education, training and supportive supervision to improve their skills and confidence when caring for women with FGM. Community outreach through improved antenatal and postnatal home visitation can improve the continuity of care provided to women with FGM.
Homer, C.S.E., Watts, N.P., Petrovska, K., Sjostedt, C.M. & Bisits, A. 2015, 'Women's experiences of planning a vaginal breech birth in Australia', BMC Pregnancy and Childbirth, vol. 15, pp. 89-89.
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Dawson, A., Homer, C.S., Turkmani, S., Black, K. & Varol, N. 2015, 'A systematic review of doctors' experiences and needs to support the care of women with female genital mutilation.', International Journal of Gynecology and Obstetrics, vol. 131, no. 1, pp. 35-40.
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BACKGROUND: Female genital mutilation (FGM) involves partial or complete removal of the external female genitalia or other injury for non-therapeutic reasons. Little is known about the knowledge and skills of doctors who care for affected women and their practice in relation to FGM. OBJECTIVES: To examine the FGM experiences and educational needs of doctors. SEARCH STRATEGY: A structured search of five bibliographic databases was undertaken to identify peer-reviewed research literature published in English between 2004 and 2014 using the keywords "female genital mutilation," "medical," "doctors," "education," and "training." SELECTION CRITERIA: Observational, quasi-experimental, and non-experimental descriptive studies were suitable for inclusion. DATA COLLECTION AND ANALYSIS: A narrative synthesis of the study findings was undertaken and themes were identified. MAIN RESULTS: Ten papers were included in the review, three of which were from low-income countries. The analysis identified three themes: knowledge and attitudes, FGM-related medical practices, and education and training. CONCLUSIONS: There is a need for improved education and training to build knowledge and skills, and to change attitudes concerning the medicalization of FGM and reinfibulation.
Lopes, S.C., Titulaer, P., Bokosi, M., Homer, C.S.E. & ten Hoope-Bender, P. 2015, 'The involvement of midwives associations in policy and planning about the midwifery workforce: A global survey', Midwifery, vol. 31, no. 11, pp. 1096-1103.
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Sword, W., Heaman, M., Biro, M.A., Homer, C.S., Yelland, J., Akhtar-Danesh, N. & Bradford-Janke, A. 2015, 'Quality of prenatal care questionnaire: Psychometric testing in an Australia population', BMC Pregnancy and Childbirth, vol. 10, pp. 214-214.
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Background The quality of antenatal care is recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. However, research has been hindered by the lack of a theoretically-grounded and psychometrically sound instrument to assess the quality of antenatal care. In response to this need, the 46-item Quality of Prenatal Care Questionnaire (QPCQ) was developed and tested in a Canadian context. The objective of this study was to validate the QPCQ and to establish its internal consistency reliability in an Australian population. Methods Study participants were recruited from two public maternity services in two Australian states: Monash Health, Victoria and Wollongong Hospital, New South Wales. Women were eligible to participate if they had given birth to a single live infant, were 18 years or older, had at least three antenatal visits during the pregnancy, and could speak, read and write English. Study questionnaires were completed in hospital. A confirmatory factor analysis (CFA) was conducted. Construct validity, including convergent validity, was further assessed against existing questionnaires: the Patient Expectations and Satisfaction with Prenatal Care (PESPC) and the Prenatal Interpersonal Processes of Care (PIPC). Internal consistency reliability of the QPCQ and each of its six subscales was assessed using Cronbach's alpha. Results Two hundred and ninety-nine women participated in the study. CFA verified and confirmed the six factors (subscales) of the QPCQ. A hypothesis-testing approach and an assessment of convergent validity further supported construct validity of the instrument. The QPCQ had acceptable internal consistency reliability (Cronbach's alpha=0.97), as did each of the six factors (Cronbach's alpha=0.74 to 0.95). Conclusions The QPCQ is a valid and reliable self-report measure of antenatal care quality. This instrument fills a scientific gap and can be used in research to examine relationships between...
Rumsey, M. & Homer, C.S.E. 2015, 'Global health and nursing and midwifery leadership', JOURNAL OF NURSING MANAGEMENT, vol. 23, no. 8, pp. 963-964.
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Sullivan, E.A., Dickinson, J.E., Vaughan, G.A., Peek, M.J., Ellwood, D., Homer, C.S.E., Knight, M., McLintock, C., Wang, A., Pollock, W., Pulver, L.J., Li, Z., Javid, N., Denney-Wilson, E. & Callaway, L. 2015, 'Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study', BMC Pregnancy and Childbirth, vol. 15, pp. 322-322.
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McDonnell, N., Knight, M., Peek, M.J., Ellwood, D., Homer, C.S., McLintock, C., Vaughan, G., Pollock, W., Li, Z., Javid, N. & Sullivan, E. 2015, 'Amniotic fluid embolism: an Australian-New Zealand population-based study.', BMC Pregnancy and Childbirth, vol. 15, pp. 352-352.
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Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes.A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation).Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100000 women giving birth (95 % CI 3.5 to 7.2 per 100000). Two (6 %) events occurred at home whilst 46 % (n=15) occurred in the birth suite and 46 % (n=15) in the operating theatre (location not reported in one case). Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Eight women (24 %) conceived using assisted reproduction technology. Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % (n=6) had a hysterectomy and 85 % (n=28) received a transfusion of blood or blood products. Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Five woman died (case fatality rate 15 %) giving an estimated maternal morta...
Moores, A., Catling, C., West, F., Neill, A., Rumsey, M., Kilio Samor, M. & Homer, C.S.E. 2015, 'What motivates midwifery students to study midwifery in Papua New Guinea?', Pacific Journal of Reproductive Health, vol. 1, no. 2, pp. 60-67.
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Introduction: Midwives in Papua New Guinea have a vital role to play in addressing the high maternal and neonatal mortality rate. Attracting applicants in sufficient numbers and quality to study midwifery has been challenging in some countries. Aim: The aim of this study was to explore the motivation of students to study midwifery in Papua New Guinea. Findings from this study will assist in midwifery workforce recruitment and retention. Methods: Between 2012-2014, midwifery students (n=298) from the four midwifery schools in Papua New Guinea were surveyed and interviewed on their perceptions regarding their midwifery studies. One part of the data collection process asked the students to describe their motivation to become a midwife with the question: Why did you choose to study midwifery? A content and thematic analysis was undertaken. Results: 194 (65% response rate) students provided between 1-3 different responses to the question, making a total of 246 responses. Three main themes emerged which were recognising a public need; recognising professional needs; and, building upon experience. Discussion: Forty-one percent (n=101) of midwifery students in Papua New Guinea studied midwifery because they wanted to help lower the high maternal mortality in the country. This is a unique finding reflecting the reality of maternal and child health in Papua New Guinea and is of great contrast to the motivations of midwifery students in similarly low to middle income countries in the region and globally.
Catling, C., Watts, N., Petrovska, K., Sjostedt, C., Bisits, A. & Homer, C.S.E. 2015, ''Normal' vaginal breech birth: The clinicians' perspective', WOMEN AND BIRTH, vol. 28, no. 1, pp. S43-S43.
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Everitt, L., Homer, C.S. & Fenwick, J. 2015, 'Working with vulnerable pregnant women who are at risk of having their babies removed by the Child Protection Agency in NSW Australia', Child Abuse Review.
Vallely, L.M., Homiehombo, P., Walep, E., Moses, M., Tom, M., Nataraye, E., Kelly-Hanku, A., Vallely, A., Ninnes, C., Mola, G., Morgan, C., Kaldor, J.M., Wand, H., Whittaker, A. & Homer, C.S. 2015, 'Feasibility and acceptability of clean birth kits containing self-administered misoprostol for prevention of postpartum haemorrhage in rural Papua New Guinea', International Journal of Gynecology and Obstetrics.
Pascal, M. & Homer, C.S. 2015, 'Models of postnatal care for low-income countries: A review of the literature', International journal of childbirth.
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Renfrew, M.J., Homer, C.S.E., Van Lerberghe, W. & ten Hoope-Bender, P. 2015, 'Bettina Utz, Abdul Halim Reply', LANCET, vol. 385, no. 9962, pp. 27-27.
Roberts, L., Homer, C.S.E. & Davis, G.K. 2015, 'Does hypertension in pregnancy impact the woman's mental health?', WOMEN AND BIRTH, vol. 28, no. 1, pp. S52-S52.
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Dawson, A., Turkmani, S., Varol, N., Sullivan, E. & Homer, C.S.E. 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia', WOMEN AND BIRTH, vol. 28, no. 1, pp. S30-S30.
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Moores, A., West, F., Puawe, P., Buasi, N. & Homer, C.S.E. 2015, 'Developing 'super' midwives - Motivation to become a midwife in Papua New Guinea', WOMEN AND BIRTH, vol. 28, no. 1, pp. S24-S24.
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Harte, D., Homer, C.S., Sheehan, A., Leap, N. & Foureur, M. 2015, 'Using video in childbirth research: ethical approval challenges', Nursing Ethics, pp. 1-13.
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Farrokh-Eslamlou, H., Aghlmand, S., Eslami, M. & Homer, C.S. 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, vol. 40, no. 2, pp. 89-95.
We investigated whether use of the World Health Organizations (WHOs) 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.
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. 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.
Davidson, P.M., Newton, P.J., Ferguson, C., Daly, J., Elliott, D., Homer, C.S., Duffield, C.M. & Jackson, D.E. 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.
Psalia, K., Kruske, S., Fowler, C.M., Homer, C.S. & 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 Childbirth, vol. 14, pp. 151-151.
Cummins, A.M., Catling, C., Hogan, R. & Homer, C.S. 2014, 'Addressing culture shock in 1st year midwifery students: maximising the initial clinical experience', Women and Birth, vol. Online.
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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.
Dawson, A., Stasa, H., Roche, M.A., Homer, C.S. & Duffield, C.M. 2014, 'Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies', BMC Nursing, vol. 13, pp. 11-11.
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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.
Schmied, V., Fowler, C.M., Rossiter, C., Homer, C.S., Kruske, S. & CHoRUS team 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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Objective. Australia has a system of universal child and family health (CFH) nursing services providing primary health services from birth to school entry. Herein, we report on the findings of the first national survey of CFH nurses, including the ages and circumstances of children and families seen by CFH nurses and the nature and frequency of the services provided by these nurses across Australia.
Homer, C.S., Scarf, V.L., 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.
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.
Homer, C.S., Thornton, T., Scarf, V.L., Ellwood, D., Oats, J., Foureur, M., Sibbritt, D., McLachlan, H.L., Forster, D. & Dahlen, H. 2014, 'Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data', BMC Pregnancy and Childbirth, vol. 14, pp. 206-206.
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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.
Homer, C.S., Friberg, I.K., Dias, M.A., ten Hoope-Bender, P., Sandall, J., Speciale, A.M. & Bartlett, L. 2014, 'The projected effect of scaling up midwifery', The Lancet, vol. 384, no. 9948, pp. 1164-1157.
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This is paper 2 in the Lancet Series on Midwifery, published online June 2014.
Catling, C., Dahlen, H. & Homer, C.S. 2014, 'The influences on women who chose publicly-funded homebirth in Australia', Midwifery, vol. 30, no. 7, pp. 892-898.
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Sibbritt, D., Catling, C., Adams, J., Shaw, A. & Homer, C.S. 2014, 'The self-prescibed use of aromatherapy oils by pregnant women', Women and Birth, vol. 27, no. 1, pp. 41-45.
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Hammond, A.D., Foureur, M. & Homer, C.S. 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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Hammond, A.D., Homer, C.S. & Foureur, M. 2014, 'Messages from Space: An exploration of the relationship between hospital birth environments and midwifery practice', Health Environments Research & Design Journal, vol. 7, no. 4, pp. 81-95.
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ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., Homer, C.S., Kennedy, H., Matthews, Z., McFadden, A., Renfrew, M. & Lerberghe, W. 2014, 'Improvement of maternal and newborn health through midwifery', The Lancet, vol. 384, no. 9949, pp. 1226-1235.
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This is the fi nal paper in a Series in which we provide evidence (analyses of systematic reviews, case studies, analysis, and modelling of deaths averted) for the contribution of midwifery to the survival, health, and wellbeing of childbearing women and newborn infants.
Harte, J.D., Leap, N., Fenwick, J., Homer, C.S. & 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.
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Dawson, A., Brodie, P.M., Copeland, F.H., Rumsey, M. & Homer, C.S. 2014, 'Collaborative approaches towards building midwifery capacity in low income countries: A reviewof experiences', Midwifery, vol. 30, no. 4, pp. 391-402.
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Research paper
Duffield, C.M., Roche, M.A., Homer, C.S., Buchan, J. & Dimitrelis, S. 2014, 'A comparative review of nurse turnover rates and costs across countries', Journal of Advanced Nursing, vol. 70, no. 12, pp. 2703-2712.
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Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. A significant proportion of turnover costs are attributed to temporary replacement, highlighting the importance of nurse retention.
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, pp. 318-318.
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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.
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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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, p. 1098.
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Shaban, I., Mohammad, K. & Homer, C.S. 2014, 'Development and Validation of Women's Satisfaction With Hospital-Based Intrapartum Care Scale in Jordan', Journal of Transcultural Nursing.
Mohammad, K.I., Shaban, I.A., Homer, C.S. & Creedy, D. 2014, 'Women's Satisfaction with hospital-based intrapartum care: A Jordanian Study', International Journal of Nursing and Midwifery, vol. 6, no. 3, pp. 32-39.
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Ith, P., Dawson, A., Homer, C.S. & Whelan, A.K. 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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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.
Halliday, L.E., Peek, M.J., Ellwood, D.A., Homer, C.S., Knight, M., McLintock, C., Jackson-Pulver, L. & Sullivan, E. 2013, 'The Australasian Maternity Outcomes Surveillance System: An evaluation of stakeholder engagement, usefulness, simplicity, acceptability, data quality and stability', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 2, pp. 152-157.
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Background: The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts active, prospective surveillance of severe maternal conditions in Australia and New Zealand (ANZ). AMOSS captures greater than 96% of all births, and utilises an online, active case-based negative reporting system.
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 womenâs 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. & Homer, C.S. 2013, ''Mother birth or childbirth'? A prospective analysis of vaginal birth after caesarean blogs', Midwifery, vol. 29, no. 2, pp. 167-173.
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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.
Ith, P., Dawson, A. & Homer, C.S. 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.
Gray, J.E., Leap, N., Sheehy, A.D. & Homer, C.S. 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.
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, C., Coddington, B., Foureur, M. & Homer, C.S. 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.
Tracy, S.K., Hartz, D., Tracy, M., Allen, J., Forti, A., Hall, B., White, J., Lainchbury, A., Stapleton, H., Beckmann, M., Bisits, A., Homer, C.S., Foureur, M., Welsh, A. & Kildea, S.V. 2013, 'Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial', The Lancet, vol. 382, no. 9906, pp. 1723-1732.
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Background Women at low risk of pregnancy complications benefit from continuity of midwifery care, but no trial evidence exists for women with identified risk factors. We aimed to assess the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors.
Dawson, A. & 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 nursing practice', Journal Of Clinical Nursing, vol. 22, no. 23-24, pp. 3597-3609.
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Aims and objectives. The aim of this review was 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.
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.
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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.D., Foureur, M., Homer, C.S. & 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.
Sibbritt, D., Catling, C., Scarf, V.L. & Homer, C.S. 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 Womens Health (ALSWH). Participants were the younger (3136 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.
Raymond, J., Homer, C.S., Smith, R.M. & 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.
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.
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 and Childbirth, vol. 13, pp. 105-105.
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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.D., Davis, D.L. & Homer, C.S. 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.
Homer, C.S., Besley, K.J., Bell, J., Davis, D.L., 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 Childbirth, vol. 13, pp. 140-140.
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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.
Vallely, L.M., Homiehombo, P., Kelly, A., Vallely, A., Homer, C.S. & 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
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, pp. e31-e36.
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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 REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 199, no. 11, pp. 743-743.
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Homer, C.S. 2013, 'Home-like environments for labour and birth: benefits for women and babies.', Evidence-based medicine, vol. 18, no. 4, p. e32.
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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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 Lancetâs 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 todayâs 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.L., Fry, M., Brodie, P.M. & Homer, C.S. 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.
Homer, C.S., Ryan, C.L., Leap, N., Foureur, M., Teate, A. & Catling, C. 2012, 'Group versus conventional antenatal care for women (Review)', The Cochrane Database of Systematic Reviews.
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The primary and secondary outcomes were pre-determined as described. The included trials measured a number of outcomes that were non-pre-speci?ed. As these were important for the populations studied in the trials, these were included post hoc. For example, the Ickovics 2007a trial targeted young women and the outcomes included sexual and behavioural outcomes including HIV risk behaviour and STDs. The Kennedy 2011 trial included family healthcare readiness. In addition, inadequate antenatal care was included as a non-pre-speci?ed outcome as it was used as a measure of quality of care
Smith, R.M., Gray, J.E., Raymond, J.E., Catling, C. & Homer, C.S. 2012, 'Simulated Learning Activities: Improving Midwifery Students' Understanding of Reflective Practice', Clinical Simulation in Nursing, vol. 8, no. 9, pp. 451-457.
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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. Students reported improved levels of satisfaction, greater earning, 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. 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.
Catling, C., Foureur, M. & Homer, C.S. 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.
Dahlen, H.G. & Homer, C.S. 2012, 'Web-Based News Reports On Midwives Compared With Obstetricians: A Prospective Analysis', Birth: issues in perinatal care, 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
Fenwick, J.H., Hammond, A.D., Raymond, J.J., Smith, R.A., Gray, J., Foureur, M., Homer, C.S. & 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.
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.
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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.S. 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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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.
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.S. 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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Aim: to identify the current barriers to developing midwifery as a primary health-care strategy in Jordan and to explore the strategies to overcome these barriers. Design: an exploratory design using an action research approach was undertaken. Workshop discussion groups and reflection were used to collect the data. A thematic approach was taken for the analysis. Participants: data were collected from a convenience sample of 64midwives and educatorswho attended workshops. Findings: the professional identity and image for midwifery has been confused within a medically dominated health system and has not been seen as a primary health strategy. Midwives are not able to practice to the full role and scope of the midwife. Implications for practice: key issues identified need to be addressed before midwifery can be part of a primary health-care strategy in Jordan.
Vaughan, G., Pollock, W., Peek, M., Knight, M., Ellwood, D., Homer, C.S., Pulver, L.J., McLintock, C., Ho, M.T. & Sullivan, E. 2012, 'Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 52, no. 2, pp. 195-203.
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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.
Gray, J.E., Leap, N., Sheehy, A.D. & Homer, C.S. 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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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. 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. 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. 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. 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. Despite these challenges, there were significant learning opportunities. Future work and research needs to ensure than an integrated approach is taken to enhance learning.
Homer, C.S., Griffiths, M., Brodie, P.M., Kildea, S., Curtin, A.M. & Ellwood, D. 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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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.
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.
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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. & Catling, 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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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. 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. There is no strong evidence that a DDI of 30 min or less is associated with improved outcomes for babies or mothers. Some evidence suggests that a DDI of greater than 30 min but less than 75 min confers benefit, but these findings were confounded by the indications for the emergency CS. Urgent CS should occur as soon as possible, but there is insufficient evidence to support a definite time frame, such as 30 min. 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.
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.
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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.M., Brodie, P.M. & Homer, C.S. 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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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.
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.
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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.', The Cochrane database of systematic reviews, vol. 11, p. CD007622.
BACKGROUND: 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. OBJECTIVES: 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. SEARCH METHODS: 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. SELECTION CRITERIA: 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. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and evaluated trial quality. Two authors extracted data. Data were checked for accuracy. MAIN RESULTS: 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 trial...
Pierce, H., Homer, C.S., Dahlen, H.G. & King, J. 2012, 'Pregnancy-related lumbopelvic pain: listening to Australian women.', Nursing research and practice, vol. 2012.
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UNLABELLED: 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. SAMPLE POPULATION: 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 Outcome Measures. 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.
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, pp. e509-e515.
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Roth, H., Homer, C. & Fenwick, J. 2012, '"Bouncing back'': How Australia's leading women's magazines portray the postpartum 'body'', Women and Birth, vol. 25, no. 3, pp. 128-134.
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Homer, C., Armari, E. & Fowler, C. 2012, 'Bed-sharing with infants in a time of SIDS awareness', Neonatal, Paediatric and Child Health Nursing, vol. 15, no. 2, pp. 3-7.
Objective Risks associated with maternal-infant bed-sharing are widely documented and promoted. This study aims to examine sleep patterns and strategies including bed-sharing. Methods 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. Results 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. Conclusions Maternal-infant bed-sharing continues to be an infant sleep strategy used by mothers, despite the risks involved. Implications 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.
Homer, C.S., Johnston, R.A. & Foureur, M. 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 19982006. 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.
Sullivan, K.J., Lock, L. & Homer, C.S. 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.
Catling, C., Johnston, R.A., Ryan, C.L., Foureur, M. & Homer, C.S. 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.
Homer, C.S., Kurinczuk, 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. 480-487.
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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
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.
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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. 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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Antenatal education programmes have been implemented in many settings around the world. There is, however, uncertainty about their effectiveness. Many studies have failed to show a benefi t for women in terms of birth outcomes. A systematic review in The Cochrane Database of Systematic Reviews included nine trials (2,284 women). The findings were inconclusive with inconsistent results and small sample sizes. The authors of the Cochrane Review stated that the 'effects of general antenatal education for childbirth or parenthood, or both, remain largely unknown'. Few large well-conducted randomised controlled trials have been undertaken which make the study by Maimburg and colleagues particularly exciting.
Catling, C., Dahlen, H. & Homer, C.S. 2011, 'Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study', Women and Birth, vol. 24, no. 3, pp. 122-128.
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Background: 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. Womens confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored. Aim: The aim of the study was to explore the reasons why multiparous women feel confident to have a homebirth within a publicly-funded model of care in Australia. Methods: Ten multiparous English-speaking women who chose to have a homebirth with the St George Hospital Homebirth Program were interviewed in the postnatal period using semistructured, open-ended questions. Interviews were transcribed, then a thematic analysis was undertaken. Results: Women, having already experienced a normal birth, demonstrated a strong confidence in their ability to give birth at home and described a confidence in their bodies, their midwives, and the health system. Women weighed up the risks of homebirth through information they gathered and integration with their previous experience of birth, their family support and self-confidence. Discussion: Women choosing publicly-funded homebirth display strong confidence in both themselves to give birth at home, and their belief in the health systems ability to cope with any complications that may arise.
Catling, C., Johnston, R.A., Ryan, C.L., Foureur, M. & Homer, C.S. 2011, 'Non-Clinical Interventions that increase the uptake or 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 nonclinical 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.
Foureur, M., Leap, N., Davis, D.L., Forbes, I. & Homer, C.S. 2011, 'Testing the birth unit design spatial evaluation tool (BUDSET) in Australia: a Pilot Study', Health Environments Research & Design Journal, vol. 4, no. 2, pp. 36-60.
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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.
Adams, J., Lui, C., Sibbritt, D., Broom, A., Wardle, J. & Homer, C.S. 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.
Hammond, A.D., Gray, J.E., Smith, R.M., Fenwick, J.H. & 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 preregistration 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.
Homer, C.S., Biggs, J.B., Vaughan, G. & Sullivan, E. 2011, 'Mapping Maternity Services In Australia: Location, Classification And Services', Australian Health Review, vol. 35, no. 2, pp. 222-229.
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Abstract 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.
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.D., Foureur, M., Catling, C. & Homer, C.S. 2011, 'Examining the Content Validity of the Birthing Unit Design Spatial Evaluation Tool Within a Woman-Centered Framework', Journal Of Midwifery & Womens Health, vol. 56, no. 5, pp. 494-502.
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Introduction: 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 audi
Catling, C., McDonnell, N., Moores, A. & Homer, C.S. 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.
Teate, A., Leap, N., Rising, S. & Homer, C.S. 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.
Davidson, P.M., Homer, C.S., Duffield, C.M. & 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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The long awaited and much anticipated results of Australia's first national university system wide research evaluation exercise were delivered in February this year. The Excellence in Research Assessment (ERA) examined `research quality within Australia's higher education institutions using a combination of indicators and expert review by committees comprising experienced, internationally-recognised experts' (Australian Research Council, 2011). In the discipline review for nursing some twenty three universities were assessed. Midwifery was included in the Nursing category as the Field of Research (FoR) code (the way the groups were clustered together) for nursing includes midwifery. The results for nursing and midwifery were impressive and they demonstrated that nine of the twenty three research programs in this category that were assessed were world class or above world class. In fact, nursing and midwifery in the FoR code 1110 was noted to be a `particularly strong performer' (Australian Research Council, 2011). This demonstrates that nurses and midwives in Australia are engaged in high quality research which is influencing practice and policy and making a difference to the health care of Australians. In addition, the research of many nurses and midwives was also considered in other categories including public health, health services and clinical medicine. This shows that our disciplines are well represented across the health field and the commitment to interdisciplinary practice to solve complex health care problems.
Schmied, V., Donovan, J., Kruske, S., Kemp, L., Homer, C.S. & Fowler, C.M. 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.
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Nurses and midwives play a key role in providing universal maternal, child and family health services in Australia. However, the Australian federation of states and territories has resulted in policy frameworks that differ across jurisdictions and services that are fragmented across disciplines and sectors. This paper reports the findings of a study that reviewed and synthesised current Australian service policy or frameworks for maternity and child health services in order to identify the degree of commonality across jurisdictions and the compatibility with international research on child development. Key maternity and child health service policy documents in each jurisdiction were sourced. The fi ndings indicate that current policies were in line with international research and policy directions, emphasising prevention and early intervention, continuity of care, collaboration and integrated services. The congruence of policies suggests the time is right to consider the introduction of a national approach to universal maternal, child health services.
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.
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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., Homer, C.S., 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 (98138 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 reemergence 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.
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.', Evidence-based nursing, vol. 14, no. 1, pp. 16-17.
Catling-Paull, C., Dahlen, H. & Homer, C.S.E. 2011, 'Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study (vol 24, pg 122, 2011)', WOMEN AND BIRTH, vol. 24, no. 4, pp. 180-180.
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Sibbritt, D., Homer, C.S.E. & Adams, J. 2011, 'The self-prescribed use of aromatherapy oils by pregnant women: Cause for concern?', WOMEN AND BIRTH, vol. 24, pp. S24-S24.
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Bonnette, S., Broom, A. & Homer, C.S.E. 2011, 'Choosing freebirth in NSW: An exploration of expectations and experience', WOMEN AND BIRTH, vol. 24, pp. S10-S10.
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O'Sullivan, E.A., Peek, M., Knight, M., Ellwood, D., Homer, C.S.E., Pulver, L.J., Vaughan, G.A. & Callaway, L. 2011, 'Extreme morbid obesity in pregnancy: Risk management and resources', WOMEN AND BIRTH, vol. 24, pp. S25-S25.
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Catling-Paull, C., Homer, C.S.E., Foureur, M., Azzopardi, C., Cameron, D., Clarke, J., Elmes, R., Kitschke, J., Koay, A., Lennon, K., McMurtrie, J., Pratt, J., Skewes, R. & White, J. 2011, 'Introducing ... the National Publicly Funded Homebirth Consortium', WOMEN AND BIRTH, vol. 24, pp. S36-S37.
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Davis, D. & Homer, C.S.E. 2011, 'Meta-WHAT! Cochrane reviews and other research stuff for dummies [workshop]', WOMEN AND BIRTH, vol. 24, pp. S19-S19.
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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.M. & Homer, C.S. 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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Aim. This paper explores the impact of models of integrated services for pregnant women, children and families and the nature of collaboration between midwives, child and family health nurses and general practitioners. Background. Increasingly, maternity and child health services are establishing integrated service models to meet the needs of pregnant women, children and families particularly those vulnerable to poor outcomes. Little is known about the nature of collaboration between professionals or the impact of service integration across universal health services. Design. Discursive paper. Methods. A literature search was conducted using a range of databases and combinations of relevant keywords to identify papers reporting the process, and/or outcomes of collaboration and integrated models of care. Results. There is limited literature describing models of collaboration or reporting outcomes. Several whole-of-government and community-based integrated service models have been trialled with varying success. Effective communication mechanisms and professional relationships and boundaries are key concerns. Liaison positions, multidisciplinary teams and service co-location have been adopted to communicate information, facilitate transition of care from one service or professional to another and to build working relationships. Conclusions. Currently, collaboration between universal health services predominantly reflects initiatives to move services from the level of coexistence to models of cooperation and coordination.
Allen, S., Chiarella, M. & Homer, C.S. 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 understa
Foureur, M., Davis, D.L., Fenwick, J.H., Leap, N., Iedema, R.A., Forbes, I. & Homer, C.S. 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 an
Homer, C.S., Kurinczuk, 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 cl
Foureur, M., Leap, N., Davis, D.L., Forbes, I. & Homer, C.S. 2010, 'Developing The Birth Unit Design Spatial Evaluation Tool (Budset) In Australia: A Qualitative Study', Health Environments Research & Design Journal, vol. 3, no. 4, pp. 43-57.
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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 a
Dahlen, H.G., Barclay, L. & Homer, C.S. 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,
Dahlen, H.G., Barclay, L. & 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 groun
Dahlen, H.G., Barclay, L. & 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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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 genereated from in-depth interviews with women in thire own homes. Setting: Sydney, Australia.
Foureur, M., Ryan, C.S., Nicholl, M. & Homer, C.S. 2010, 'Inconsistent Evidence: Analysis Of Six National Guidelines For Vaginal Birth After Cesarean Section', Birth: issues in perinatal care, vol. 37, no. 1, pp. 3-10.
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Background: 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
Dahlen, H.G. & Homer, C.S. 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 0.41.2), at 6 weeks (60% vs. 61%, OR 1, 95% CI 0.71.4) or 12 weeks postpartum (51% vs. 56%, OR 0.8, 95% CI 0.61.2). They were, however, significantly more likely to be partially breastfeeding on discharge from hospital (10% vs. 2%, OR 5.3, 95% CI 2.312.4), at 6 weeks (22% vs. 11%, OR 1.9, 95% CI 1.23.2) and 12 weeks postpartum (17% vs. 8%, OR 2.2, 95% CI 1.23.9).
Dahlen, H.G., Homer, C.S., Tracy, S.K. & Bisits, A. 2010, 'Planned home and hospital births in South Australia, 1991-2006: differences in outcomes', 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.M., Leap, N. & Homer, C.S. 2010, 'Advanced midwifery practice or advancing midwifery practice?', Women and 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 20092010 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.
Sullivan, E., Ellwood, D., Peek, M., Knight, M., Jackson Pulver, L.R., Homer, C.S., Elliott, E., McLintock, C., Thompson, J., Zurynski, Y., Ho, T., McDonnell, N. & Pollock, W. 2010, 'Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study', British Medical Journal, vol. 340:c1279, no. NA, pp. 1-6.
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Objective To describe the epidemiology of 2009 A/H1N1 influenza in critically ill pregnant women. Design Population based cohort study. Setting All intensive care units in Australia and New Zealand. Participants All women with 2009 H1N1 influenza who were pregnant or recently post partum and admitted to an intensive care unit in Australia or New Zealand between 1 June and 31 August 2009. Main outcome measures Maternal and neonatal mortality and morbidity.
Homer, C.S., Catling, C., Sinclair, D., Faizah, N., Balasubramanian Appiah, V., Foureur, M., Hoang, D.B. & Lawrence, E.M. 2010, 'Developing an interactive electronic maternity record', Birtish Journal of Midwifery, vol. 18, no. 6, pp. 384-389.
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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.
van Teijlingen, E., Homer, C. & Sandall, J. 2010, 'Special issue of Midwifery on 'The maternity work force': Call for papers', MIDWIFERY, vol. 26, no. 3, pp. 257-257.
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McMurtrie, J., Catling-Paull, C., Teate, A., Caplice, S., Chapman, M. & Homer, C. 2010, 'The St. George Homebirth Program: an evaluation of the first 100 booked women (vol 49, pg 631, 2009)', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 50, no. 1, pp. 100-100.
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Homer, C.S., Passant, L., Brodie, P.M., Kildea, S.V., 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.
Homer, C.S., Hanna, E. & McMichael, A.J. 2009, 'Climate change threatens the achievement of the millennium development goal for maternal health', Midwifery, vol. 25,, pp. 606-612.
Homer, C.S., Henry, K., Schmied, V., Kemp, L., Leap, N. & Briggs, C.J. 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.
Schmied, V., Cooke, M., Gutwein, R., Steinlein, E. & Homer, C.S. 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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Aim and objective. This study aimed to design, implement and evaluate strategies to improve the quality and content of hospital-based postnatal care. Background. Following birth, women report physical health problems, difficulties with breastfeeding, a lack of parenting self-efficacy and there is high occurrence of postnatal distress and depression. Despite these significant needs, women are frequently dissatisfied with the advice and support they receive from hospital-based postnatal care. Design. A pre/post test design compared the effect of multifaceted strategies on perceptions of quality and content of postnatal care, knowledge and experience of postnatal problems, parenting self-efficacy and breastfeeding outcomes. The key strategy, `one-to-one time, focused on providing women an uninterrupted period of time each day when a midwife would be available to discuss womens concerns about their health and that of their baby. Method. A convenience sample of 146 women at baseline and 148 women postintervention completed a postal self-report questionnaire between 24 weeks postpartum. Results. There were no significant differences between baseline and postintervention groups in perceived quality of care, breastfeeding outcomes and maternal self-efficacy. Women experiencing health issues, including insufficient milk supply, backache, abnormal bleeding and urinary incontinence, were more likely to report that they received good or excellent care and advice in the postintervention group. Strategies to increase rest appeared effective with women less likely to report excessive tiredness postintervention.
Homer, C.S., Clements, V.J., 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.
Foureur, M., Brodie, P.M. & Homer, C.S. 2009, 'Midwife-centred versus Woman-centered Care: A developmental phase?', Women and Birth, vol. 22, no. 2, pp. 47-49.
As three of the early leaders and researchers in the field of midwifery continuity of care in Australia, we have been instrumental in addressing reforms to the fragmented model of maternity service delivery. These services have seen each childbearing woman in our public health system enduring up to 20 different care providers in one pregnancy experience.1 The last 20 years of research has included randomised controlled trials, case control studies and large population based epidemiological investigations. These studies have convincingly shown that midwifery continuity of care, provided in any location, is highly satisfying for women, leads to reduced interventions and is no less safe in terms of maternal and perinatal mortality when compared to the fragmented models that emerged last century.2 Many health services have now changed their models of care-delivery to incorporate new systems that are focused on improving the experience for each woman by enabling continuity of care from a known midwife. The key characteristic of these new models is that they have a specific focus on woman-centered or relationship-based care.
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., Sibbritt, D., Broom, A., Wardle, J., Homer, C.S. & Beck, S. 2009, 'Women's Use of Complementary and Alternative Medicine During Pregnancy: : A Critical Review Of The Literature', Birth: issues in perinatal care, 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.
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., 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, pp. 39-48.
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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.
Homer, C., Ryan, C., Leap, N., Foureur, M. & Teate, A. 2009, 'Group versus conventional antenatal care for pregnant women', Cochrane Database of Systematic Reviews, no. 1.
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Khresheh, R., Homer, C. & Barclay, L. 2009, 'A comparison of labour and birth outcomes in Jordan with WHO guidelines: a descriptive study using a new birth record', MIDWIFERY, vol. 25, no. 6, pp. E11-E18.
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Schmied, V., Cooke, M., Gutwein, R., Steinlein, E. & Homer, C.S. 2008, 'Time to listen:Strategies to improve hospital-based postnatal care', Women and Birth, vol. 21, no. 3, pp. 99-105.
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Summary Background In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care. Aim To design and implement strategies to improve hospital-based postnatal care at a Sydney metropolitan hospital. Method This was an Action Research study. In Phase One, midwives considered the literature and participated in group discussions and interviews to determine their perceptions of postnatal care and the factors that facilitate or hinder the provision of quality care. In Phase Two, midwives participated in 12 working group meetings to design strategies to improve care. Results Several important principles of postnatal care were described, including building a relationship with women, meeting their individual needs, being flexible in approach and providing continuity of care. `Listening to women, `being there, and `normalising experiences and expectations were believed to be critical to achieving these principles. A key strategy `One to One Time was designed to provide women with an uninterrupted period of time each day with a midwife who was available to listen to their needs and concerns and discuss issues related to their health and that of their baby. Conclusion Midwives designed and implemented strategies that they believed would improve in-hospital 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.
Dahlen, H.G., Barclay, L. & Homer, C.S. 2008, 'Preparing for the first birth: Mothers' experiences at home and in hospital in Australia', Journal of Perinatal Education, vol. 17, no. 4, pp. 21-32.
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The aim of this research was to explore the experiences of a group of first-time mothers who had given birth at home or in hospital in Australia. Data were generated from in-depth interviews with 19 women and analyzed using a grounded theory approach. One of the categories to emerge from the analysis, ``Preparing for Birth, is discussed in this article. Preparing for Birth consisted of two subcategories, ``Finding a Childbirth Setting and ``Setting Up Birth Expectations, which were mediated by beliefs, convenience, finances, reputation, imagination, education and knowledge, birth stories, and previous life experiences. Overall, the women who had planned home births felt more prepared for birth and were better supported by their midwives compared with women who had planned hospital births.
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. 2008, 'What are the views of midwives in relation to perineal repair?', Women and Birth, vol. 21, no. 1, pp. 27-36.
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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.
Daly, J., Ged Kearney, G. & Homer, C. 2008, 'Reflections on the Australia 2020 summit long-term national health strategy', COLLEGIAN, vol. 15, no. 4, pp. 123-124.
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Dahlen, H.G., Ryan, M., Homer, C.S. & 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
Roberts, L., Homer, C.S., Davis, G.K. & Miller, T. 2007, 'Misoprostol to induce labour A review of its use in a NSW hospital', Australian & New Zealand Journal Of Obstetrics & 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 misopr
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 div
Buckland, S.S. & Homer, C.S. 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 5L 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.
Dahlen, H., Homer, C.S., Cooke, M., Upton, A., 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 control trial', Birth: issues in perinatal care, vol. 34, no. 4, pp. 282-290.
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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-totreat 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
Homer, C.S., Passant, L., Kildea, S.V., 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.
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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Moss, J.R., Crowther, C.A., Hiller, J.E., Willson, K.J. & Robinson, J.S. 2007, 'Costs and consequences of treatment for mild gestational diabetes mellitus - evaluation from the ACHOIS randomised trial.', BMC pregnancy and childbirth, vol. 7, p. 27.
BACKGROUND: Recommended best practice is that economic evaluation of health care interventions should be integral with randomised clinical trials. We performed a cost-consequence analysis of treating women with mild gestational diabetes mellitus by dietary advice, blood glucose monitoring and insulin therapy as needed compared with routine pregnancy care, using patient-level data from a multi-centre randomised clinical trial. METHODS: Women with a singleton pregnancy who had mild gestational diabetes diagnosed by an oral glucose-tolerance test between 24 and 34 weeks' gestation and their infants were included. Clinical outcomes and outpatient costs derived from all women and infants in the trial. Inpatient costs derived from women and infants attending the hospital contributing the largest number of enrolments (26.1%), and charges to women and their families derived from a subsample of participants from that hospital (in 2002 Australian dollars). Occasions of service and health outcomes were adjusted for maternal age, ethnicity and parity. Analysis of variance was used with bootstrapping to confirm results. Primary clinical outcomes were serious perinatal complications; admission to neonatal nursery; jaundice requiring phototherapy; induction of labour and caesarean delivery. Economic outcome measures were outpatient and inpatient costs, and charges to women and their families. RESULTS: For every 100 women with a singleton pregnancy and positive oral glucose tolerance test who were offered treatment for mild gestational diabetes mellitus in addition to routine obstetric care, $53,985 additional direct costs were incurred at the obstetric hospital, $6,521 additional charges were incurred by women and their families, 9.7 additional women experienced induction of labour, and 8.6 more babies were admitted to a neonatal nursery. However, 2.2 fewer babies experienced serious perinatal complication and 1.0 fewer babies experienced perinatal death. The incremental cost ...
Homer, C. 2007, 'Women and birth.', Women and birth : journal of the Australian College of Midwives, vol. 20, no. 2, pp. 39-40.
Homer, C.S. 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
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.
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Mackenzie, C., Davis, G., Brown, M., Homer, C., Holt, J., McHugh, L. & Mangos, G. 2006, 'Predicting transformation from gestational hypertension to preeclampsia using 24 hour ambulatory blood pressure monitoring (ABPM).', HYPERTENSION IN PREGNANCY, vol. 25, pp. 165-165.
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.
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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.
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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, p. 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.
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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. 2003, 'The clinical utility of routine urinalysis in pregnancy.', The Medical journal of Australia, vol. 178, no. 10, p. 524.
Homer, C.S., Davis, G.K., Cooke, M. & Barclay, L. 2002, 'Womens 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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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, vol. 10, no. 2, pp. 27-32.
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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.
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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., 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.
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Davis, G.K., Homer, C.S. & Brown, M.A. 2002, 'Hypertension in Pregnancy: Do consensus statements makes a difference?', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 42, no. 4, pp. 369-373.
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Homer, C.S. 2002, 'Private Health Insurance Uptake and the Impact on Normal Birth and Costs: A hypothetical model', Australian Health Review, vol. 25, no. 2, pp. 32-37.
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Homer, C.S. 2002, 'Using the Zelen Design in Randomised Controlled Trials: Debates and controversies', Journal of Advanced Nursing, vol. 38, no. 2, pp. 200-207.
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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.
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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, vol. 24, no. 1, pp. 85-89.
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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
Karnatanis, E., Alcock, D., Phelan, L.K., Homer, C.S. & Davis, G.K. 2001, 'Introducing external cephalic version to clinical practice', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 41, no. 4, pp. 395-397.
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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., Davis, G.K., Brodie, P.M., Sheehan, A., Barclay, L., Wills, J. & Chapman, M. 2001, 'Collaboration in Maternity Care: A randomised controlled trial comparing community-based continuity of care with standard hospital care', British Journal of Obsterics and Gynaecology, vol. 108, no. 1, pp. 16-22.
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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. & Brodie, P.M. 2000, 'What do Women feel about Community-based antenatal care?', Australian & New Zealand Journal of Public Health, vol. 24, no. 6, pp. 590-595.
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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., Davis, G., Petocz, P., Barclay, L., Matha, D. & Chapman, M. 2000, 'Birth centre or labour ward? A comparison of the clinical outcomes of low-risk women in a NSW hospital.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 18, no. 1, pp. 8-12.
A number of birth centres were established in New South Wales as a result of the Shearman Report (NSW Health Department 1989). 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. The study showed that there was no significant difference in the caesarean section rate between the groups (3.5% in the birth centre and 4.3% in the labour ward). We suggest that the site of birthing does not affect clinical outcomes for low-risk women at this hospital. These results are relevant to contemporary clinical practice as they question the basis upon which birth centres have been popularised, that is, the medicalisation of birth in conventional labour wards increases intervention rates.
Homer, C.S., 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 & New Zealand Journal Of Obstetrics & Gynaecology, vol. 39, no. 1, pp. 54-57.
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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
Homer, C., Brock, M. & Matha, D. 1999, 'Commentary: Early labour assessment improved several intrapartum outcomes', Evidence-Based Nursing, vol. 2, no. 1, p. 9.
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Barclay, K.M., Chamberlain, M., Homer, C.S. & Barclay, L. 1998, 'Early Discharge And Risk For Postnatal Depression', Medical Journal Of Australia, vol. 168, no. 8, pp. 419-420.
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Reports

Rumsey, M. & Homer, C. WHO CC UTS 2014, Building Faculty Capacity: Short Course for Teaching and Assessment Skills for Nurses, Midwives and Community Health Workers, pp. 1-12, Sydney, Australia.
Rumsey, M., Neill, A., Homer, C. & Karan, P. WHO CC UTS 2014, UTS World Health Organization Collaborating Centre for Nursing, Midwifery & Health Development - Phase 1: final report - PNG maternal and child health initiative (MCHI), pp. 1-58, Sydney, Australia.
Thiessen, J., Rumsey, M. & Homer, C. WHO CC UTS 2014, Reproductive Health Training Unit Monitoring and Evaluation Report 2013.
Rumsey, M., Neill, A., Homer, C. & Copeland, F. World Health Organization – Western Pacific Region 2013, WHO/AusAID Collaboration in PNG for the project, 'Capacity building in Midwifery Education and Practice in PNG - Final Status Report, pp. 1-138, Boroko, Papua New Guinea.
Rumsey, M., Copeland, F. & Homer, C. WHO CC UTS 2012, Papua New Guinea Maternal and Child Health Initiative: Monitoring and Evaluation Report, pp. 1-41, Sydney, Australia.
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.
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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.
Catling, C., Johnston, R., Ryan, C., foureur & Homer Interventions for increasing the rates of uptake or success of vaginal birth after caesarean section A Technical Report.