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Associate Professor Deborah Davis

Biography

Deborah has been working in health care for over 25 years. In this time she has held positions focusing on clinical practice, management, education, practice development, leadership and research. Her current role is Associate Professor of Midwifery Practice Development and Research with University of Technology, Sydney and South Eastern Sydney Illawarra Area Health Service. This chair was established to improve maternity care through the strengthening of midwifery practice, the development of contemporary maternity service models and engagement with research.

Deborah has worked across midwifery research, education and practice in both New Zealand and Australia. She was a Principal Lecturer, Researcher and Postgraduate Program Coordinator at Otago Polytechnic in New Zealand for 12 years where she facilitated learning in the Bachelor of Midwifery and Postgraduate Midwifery programs; working with a team to develop New Zealand’s first Master of Midwifery program. In 2008 Deborah was awarded the Excellence in Research Award, at this institution.

Associate Professor Davis completed her PhD in Midwifery at UTS, her thesis examining the discursive construction of case-loading midwifery in New Zealand. With a focus on the obstetric hospital setting her thesis described the way that space/place is implicated in constructing our understanding of women’s bodies and childbirth and thus, plays an active role in shaping midwifery practice. Space/place and its impact on the labouring woman, her supporters and caregivers, continue to be of particular interest to Deborah.

Professional

Associate Professor Davis is a member of the Australian College of Midwives, playing an active role in its activities, and the International Confederation of Midwives Research Advisory Network. She has contributed to National (NZ), State and Commonwealth government policies through membership on Technical Advisory Groups, Expert Advisory Groups, various Working Parties and consultations. Deborah regularly reviews scholarly work for journals such as "midwifery", "women and birth" and organisations including the New Zealand College of Midwives and the International Confederation of Midwives.

Adjunct Professor, Faculty of Health
PhD
Member, NSW Midwives Association
 

Research Interests

Associate Professor Davis has several main research interests. These focus on; midwifery education, the impact of space/place on the experiences of women, their supporters and midwifery practice and practices/services that promote physiological birth and/or enhance the experiences of childbearing women.

She is the lead investigator on a large National New Zealand study that compares the outcomes of low risk women in the care of midwifery lead maternity carers, giving birth in a variety of settings including home, birthing units and hospitals. Working with the SLENZ (Second Life Education New Zealand) team, Deborah developed the first educational Birth Center in the virtual word of Second Life. This was designed using the Birth Unit Design principles developed by researchers at the University of Technology, Sydney. This Virtual Birth Center provides an opportunity for lay “residents” of Second Life and student midwives to learn about the importance of the design of birthing environments. Student midwives are also able to role play in this environment to develop their skills in midwifery practice and decision making.

Research approaches
Theoretical approaches: poststructural, Foucauldian, feminist, post-positivist
Methodologies/Methods: discourse analysis, interpretive, descriptive, cross sectional, cohort studies
Data collection methods: in-depth interview, focus groups, survey, database

Can supervise: Yes

Midwifery: undergraduate and postgraduate
Specific subject expertise; sociology of health, research methods, evidence informed practice, midwifery led care

Chapters

Davis, D.L. 2005, 'Choice in the midwifery market' in Wickham, S. (ed), Midwifery Best Practice 3, Elsevier, London, UK, pp. 3-7.
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Conferences

Davis, D.L. 2010, 'Second life: The development of a virtual birth centre', Celebrating excellence in Midwifery, Royal Hospital for Women, Randwick.
Davis, D.L. 2010, 'The impact of place on childbirth outcomes in New Zealand', 14th Annual Congress of the Perinatal Society of Australia and New Zealand, Wellington, New Zealand.
Background: In NZ the majority of childbearing women are cared for by midwives who access a variety of birth settings. Over 84% of all births in NZ occur in tertiary or secondary hospitals where midwives report that they struggle to promote normal birth. Method: All low risk women giving birth in 2006-2007 were identified in the Midwifery Maternity Provider Organisation database (n=16,200). Outcomes were compared for those women planning to birth (at onset of labour); at home, in primary, secondary and tertiary level facilities. Results: Outcomes varied significantly between birth settings. The risk of emergency CS was higher for women planning to birth in tertiary (RR 6.12, 95% CI 4.88-7.68) or secondary settings (RR 2.99, 95% CI 2.39-3.75) compared to those planning to birth in a primary facility. Babies born to women planning to birth secondary and tertiary hospitals also had a higher risk of admission to NICU (RR 1.44, 95% CI 1.08-1.91 and RR 1.88, 95% CI 1.39-2.53). Conclusions: For low risk women in the care of midwives, planned place of birth has a significant influence on childbirth outcomes.
Davis, D.L., Herbison, P., Baddock, S., Pairman, S., Hunter, M., Benn, C., Wilson, D., Anderson, J. & Dixon, L. 2010, 'The impact of place on childbirth outcomes in New Zealand', 3rd Biennial Conference: Breathing New Life into Maternity Care, Alice Springs, Australia.
Stewart, S. & Davis, D.L. 2009, 'Using second life to teach students about normal birth', Australian College of Midwives 16th National Conference, Adelaide, Australia.
Davis, D.L. & Stewart, S. 2009, 'Promoting normal birth in the virtual space of Second Life', Normal Labour and Birth: 4th Research Conference, Grange-over-Sands, United Kingdom.
Davis, D.L., Pairman, S., McIntosh, C., Hickey, R. & Patterson, J. 2008, 'Preparing direct entry midwifery students for autonomous, woman centred practice (Symposia)', International Confederation of Midwives 28th Triennial Congress. Midwifery: A worldwide commitment to women and the newborn, Glasgow, Scotland.
Davis, D.L. 2008, 'Midwives making space for childbirth', International Confederation of Midwives 28th Triennial Congress. Midwifery: A worldwide commitment to women and the newborn., Glasgow, Scotland.
Davis, D.L. 2008, 'With your feet on the ground and your eyes on the horizon', NSW Midwives Association State Conference: Midwives Business: Peeling Back the Layers, Coffs Harbour, Australia.
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

Foureur, M., Turkmani, S., Clack, D.C., Davis, D.L., Mollart, L., Leiser, B. & Homer, C.S.E. 2017, 'Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians.', Women and birth : journal of the Australian College of Midwives, vol. 30, no. 3017, pp. 3-8.
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One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section.Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC).To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women.A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted.The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted.Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.
Atchan, M., Davis, D. & Foureur, M. 2016, 'A methodological review of qualitative case study methodology in midwifery research', Journal of Advanced Nursing, vol. 72, no. 10, pp. 2259-2271.
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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, vol. 29, no. 5, pp. 407-415.
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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.
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.
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.
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.
Clements, V.J., Fenwick, J.H. & Davis, D.L. 2012, 'Core Elements Of Transition Support Programs: The Experiences Of Newly Qualified Australian Midwives', Sexual and Reproductive HealthCare, vol. 3, no. 4, pp. 155-162.
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Aim: This article reports on newly qualified midwives' experiences of the core elements of their transition support program: clinical rotations, supernumerary time, study days and midwife-to-midwife support. Background: There is limited knowledge and und
Davis, D.L., Raymond, J., Clements, V., Adams, C., Mollart, L., Teate, A. & Foureur, M. 2012, 'Addressing obesity in pregnancy: The designand feasibility of an innovative intervention in NSW, Australia', Women and Birth, vol. 25, no. 4, pp. 174-180.
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Objective: Obesity amongst women of child bearing age is increasing at an unprecedented, rate throughout the Western world. This paper describes the design of an innovative, collaborative, antenatal intervention that aims to assist women to manage their weight during pregnancy and, presents aspects of the programme evaluation.
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.
Davis, D.L., Baddock, S., Pairman, S., Hunter, M., Benn, C., Wilson, D., Dixon, L. & Herbison, P. 2011, 'Planned Place Of Birth In New Zealand: Does It Affect Mode Of Birth And Intervention Rates Among Low-Risk Women?', Birth: issues in perinatal care, vol. 38, no. 2, pp. 111-119.
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Background: Midwives providing care as lead maternity caregivers in New Zealand provide continuity of care to women who may give birth in a variety of settings, including home, primary units, and secondary and tertiary level hospitals. The purpose of thi
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
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
Davis, D.L. & Walker, K. 2010, 'The Corporeal, The Social And Space/Place: Exploring Intersections From A Midwifery Perspective In New Zealand', Gender Place And Culture, vol. 17, no. 3, pp. 377-391.
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This article explores the interrelations between the corporeal, the social and the spatial as they operate to shape the discursive and material realities of childbirth in the obstetric hospital setting. It draws on interviews conducted with midwives thro
Davis, D.L. & Walker, K. 2010, 'Re-discovering the material body through an exploration of theories of embodiment', Midwifery, vol. 26, no. 4, pp. 457-462.
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The body is of central concern to midwifery yet, as a profession, we have largely failed to grapple with the corpus of feminist and other literature that deals with the body. This article provides an overview of the ways in which the body has been theorised, from the essential and biological through to postmodern theories of the body. We draw attention to the limitations of some of these approaches, suggesting that Elizabeth Groszs schema of the Mo¨ bius strip (representing the inter-relationships between the inside and outside, culture and nature) provides a useful framework for thinking about the body; one that avoids a biological materialism that disregards the effect of culture, and a cultural determinism that neglects the corporeal body. Recognising the multiplicity and fluidity of womens experiences of pregnancy, their body and childbearing emancipates us from the limitations imposed by the masculinist Western philosophical traditions that we have inherited.
Patterson, J. & Davis, D.L. 2007, 'New Zealand Midwives and Tertiary Study', New Zealand College of Midwives Journal, vol. 36, pp. 13-19.
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To elicit factors influencing practising midwives with regard to tertiary study, a national survey was distributed attracting 386 responses from midwives working in a variety of settings. Many midwives engaged in tertiary study, cited personal interest and practice development as motivational factors, with midwifery practice topics providing the most interest. However midwives' time restrictions, the cost of papers and lack of financial or other incentives inhibited study. Midwives preferred face-to-face delivery with other midwives rather than mixed classes, followed by distance delivery with paper-based materials. Mixed modes of face-to-face and distance, or Internet based delivery, were not favoured by the midwives. These factors should be considered when designing tertiary programmes for practising midwives, incorporating adequate information, interaction and communication.
Davis, D.L. & McIntosh, C. 2005, 'Partnership in education: the involvement of service users in one midwifery programme in New Zealand', Nurse Education in Practice, vol. 5, pp. 274-280.
Davis, D.L. 2005, 'Evidence based health care: Raising issues from a midwifery perspective', New Zealand College of Midwives Journal, vol. 32, no. 1, pp. 274-280.
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Davis, D.L. 2003, 'Spoilt for choice: consuming maternity care', Birtish Journal of Midwifery, vol. 11, no. 9, pp. 574-578.
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Medical care throughout the 19th and 20th centuries was characterized by a paternalistic approach to care. From the mid-20th century we began to see a shift in the way health was conceptualized and approached. Individuals demanded more control over their experiences, encouraging individual choice and responsibility. The emergence of the discourses of individual choice and responsibility has had a significant impact on midwifery practice. This article focuses on some of the consequences of these discourses, suggesting that it has submerged some other important professional imperatives such as promoting normal birth. It is suggested that midwives will need to take a more active approach. This article explores this issue within the context of midwifery practice in New Zealand. While some points of history and details of the maternity system or practice may be specific to New Zealand, the discourses explored and implications for practice are relevant to many other Western countries and their midwives.