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Professor Maralyn Foureur


Maralyn is currently Professor of Midwifery  in the Centre for Midwifery, Child and Family Health at UTS and Adjunct Professor of Midwifery at Victoria University of Wellington, New Zealand and the University of Southern Denmark. 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 a major focus on how the Birth Unit Design impacts on women and staff stress, communication, and ultimately birth outcomes.

She holds 3 NHMRC (CI and AI) and 1 ARC grant as a CI and supervises Doctoral (PhD and Professional Doctorate), Masters and Honours students studying aspects of improving maternity services including: a cohort study of pregnant women with Group B Streptococcus Infection; A case study of antenatal depression screening; a video-ethnographic study of the impact of Birth Unit Design on the behaviour and practices of midwives; the impact of Birth Unit Design on the experiences of supporters in childbirth;a case study of  midwifery students’ experiences of continuity of care models of education; a mixed methods study to evaluate the NSW Fetal welfare and Obstetric and Neonatal Training (FONT) program; a mixed methods study of the culture of the maternity unit; a discourse analysis of the concept of time and induction of labour; a critique of the Baby Friendly Hospital Initiative (BFHI). 

Maralyn co-leads the consortium called Birth After Caesarean Interventions (BACI) which is undertaking research to promote normal birth and increase the rate of vaginal birth after caesarean section. She undertakes a range of projects within the clinical setting of the Central Coast and Northern Sydney LHNs which includes establishing and evaluating an innovative model of care for obese pregnant women; establishing and evaluating models of midwifery continuity of care. She is also involved in teaching midwifery students and teaches in the Bachelor of Midwifery, Graduate Diploma of Midwifery and Master of Midwifery programs.

Maralyn also holds a Bachelor of Arts degree majoring in Psychology and Sociology (Flinders University, S. Aust.) and a Graduate Diploma in Clinical Epidemiology and Biostatistics (University of Newcastle, NSW). She is a Fellow of the Australian College of Midwives (ACM).

Maralyn is a member of the editorial panel of Women and Birth and regularly reviews articles for a number of other journals including Rural and Remote Health, BMC Pregnancy and Childbirth, Midwifery: An International Journal; Australian and New Zealand Journal of Obstetrics and Gynaecology

1994-1995 Lecturer: Faculty of Nursing & Midwifery, University of Newcastle, NSW
1996-1998 Senior Lecturer: Grad School Nursing, Midwifery & Health (GSNMH), Victoria University of Wellington (VUW), NZ
1998-2005 Clinical Professor Midwifery, GSNMH, VUW & Wellington Womens Hospital
2006 Professor of Midwifery GSNMH VUW
2006 (August) Assoc Professor Research Faculty of Nursing Midwifery and Health UTS
2006 Adjunct Professor of Midwifery GSNMH VUW Wellington New Zealand
2007 Clinical Professor of Midwifery Faculty of Nursing Midwifery and Health UTS and Northern Sydney Central Coast Area Health Service


Fellow - Australian College of Midwives
Member - Australian College of Midwives NSW
Member - New Zealand College of Midwives
Member Perinatal Society of Australia and New Zealand
Member Editorial Board: Women & Birth
Member Editorial Board: Journal of the New Zealand College of Midwives
Member editorial panel for MORE EBN, nursing +Best Evidence for Nursing Care, and Evidence-Based Nursing

Image of Maralyn Foureur
Professor, Faculty of Health
Member, Centre for Midwifery, Child and Family Health (CMCFH)
Course Coordinator, Faculty of Health
Core Member, Health Services and Practice Research Strength
BA, Epidemiology and Biostatistics, Doctor of Philosophy
Fellow, Australian College of Midwives
Member, Perinatal Society of Australia and New Zealand
+61 2 9514 4914

Research Interests

Birth environment
Strategies for keeping birth normal
Physiology of normal childbirth
History of midwifery

Additional research interests
Impact of internal and external birth environment on woman and infant health
Prenatal and perinatal influences on child and adult health

Transdisciplinary models of education, research and clinical practice

  • Mixed Methods Research
  • Qualitative, interpretive designs

Can supervise: Yes

Registered at Level 1

Research areas
Action Research
Case Study
Critical Research Approaches
Delphi Technique
Feminist Research Narrative
Discourse or Historical Analysis
Randomised Controlled Trials
Survey Methods

Midwifery - undergraduate and postgraduate
Research in midwifery, nursing and health services - postgraduate

Book Chapters

Fahy, K., Parrat, J., Foureur, M. 2011, 'Birth Territory: A Theory for Midwifery Practice' in Rosamund Bryar and Marlene Sinclair (eds), Theory for Midwifery Practice, Second Edition, Palgrave MacMillan, Oxford, UK, pp. 215-240.
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This new edition of a highly regarded classic midwifery text encourages critical thinking about the art and science of midwifery. Promoting the idea that thinking directly affects practice, it offers a clear explanation of the concepts, theories and models that shape effective evidence-informed care for women.
Foureur, M. 2008, 'Creating Birth Space to Enable Undisturbed Birth' in Fahy, K., Foureur, M., Hastie, C (eds), Birth Territory and Midwifery Guardianship, Elsevier, Oxford, UK, pp. 57-78.
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Lepori, B., Foureur, M. & Hastie, C. 2008, 'Mindbodyspirit Architecture: Creating birth space' in Fahy, K., Foureur, M., Hastie, C (eds), Birth Territory and Midwifery Guardianship, Elsevier, Oxford, UK, pp. 95-112.
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Co-authored with Lepori, B and Hastie C. Examines the research evidence for the impact of the physical and emotional environment on the physiology of women in labour and birth. Proposes new principles for the design of birth spaces and sets a new research agenda.
Foureur, M. & Sandall, J. 2008, 'The challenges of evaluating midwifery continuity of care' in Homer, Brodie and Leap (eds), Midwifery Continuity of Care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australa, pp. 165-180.
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In this chaprer) we describe some of the challenges associated with evaluating midwifery continuity of care. The notion of 'midwifery care as a complex intervention' is explored as this informs (he way it is evaluated. Midwifery models of care are complex as they consist of a package ofinrerventions. In evaluations we have often tried to reduce the cornplexity, which may actually leave out the things that arc most important. Murray Enkin, one of the original editors of Effective Care in Pregnancy and Childbirth (Chalmers et al. 1989), highlighted this understanding by saying "TI,e things that count cannot be counted'. This was a version of a famous quotation by Alben Einstein: 'Everything that can be counted does not necessarily count; and, everything that counts) cannot necessarily be counted'. 'lhis chapter deals with these issues and the importance of maintaining the complexity in evaluations by using a framework developed by the Medical Research Council of the United Kingdom as a way of thinking through and planning an evaluation. 'This chapter also includes a briefcritique of the evidence around midwifery continuity of care presented in Chapter 2.
Wood, P.J., Foureur, M. 2007, 'A clean front passage: dirt, douches and disinfectants at St Helens Hospital, Wellington, New Zealand, 1907-1922' in Kirkham, M (eds), Exploring the dirty side of women's health, Routledge, Great Britain, pp. 30-44.
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This chapter was an invited publication in an international, refereed book. It is based on historical research using the archives of the St Helens Hospital Wellington 1907-1922. It is one of several publications and presentations arising from the archival database which we set up in 2000. This chapter explores the relationship between puerpural sepsis at the beginning of the 20th century and notions of dirt carried within the bodies of childbearing women. St Helens Hospitals were renowned for their cleanliness and attention to aspepsis. They had the lowest rate of puerpural sepsis in New Zealand. This chapter contributes to my research platform which explores the impact of the birth environment on birth outcomes -from a number of perspectives.
Foureur, M. 2005, 'Next Steps: Public Health in Midwifery Practice' in O'Luanaigh P and Carlson C (eds), Midwifery and Public Health: Future Directions and New Opportunities, Elsevier, Churchill Livingstone, London, UK, pp. 221-237.
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The preceding chapters have provided insights into how the health agenda of governments in many developed countries has changed . The past focus on preventative health care and individual education for appropriate lifestyle choices has been recognised as limited and largely ineffectual in addressing the poor health of certain population groups. Governments have now embraced a broader understanding of the complex interactions and contributi on to health outcomes of not only individual behaviour but also socio-economic inequalities. This has led to a new public health agenda that seeks to engage communities , in concert with a range of health providers including midwives, to improve the health status of those who are currently disadvantaged.
Foureur, M. & Wood, P. 2005, 'Exploring the Maternity Archive of the St Helens Hospital Wellington New Zealand' in Mortimer B and McGann S (eds), New Directions in the History of Nursing, Routledge, Oxford, pp. 1907-1922.
This chapter, is an international publication, provides further evidence of my research platform in exploring the contributions of the complex nature of the birth environment to birth outcomes - this time from an historical perspective based on the maternity archives of the first St Helen's Hospital in New Zealand. This was an invited chapter following the presentation of the research which it is based to the conference celebrating the launch of the UK centre for the History of Nursing in Edingburgh in 2000. The ongoing research on which this chapter is based discovered that the reportedly low maternal mortality rates attributed to midwifery practices at the St Helen's Hospitals were due to the almost total absence of puerpural spesi. Maternal mortality from other causes was however the same as in the rest of the country. This chapter also provides further evidence of the international standing, and of the collaborative nature of my research, this time with a nurse historian.
Foureur, M. & Hunter, M. 2005, 'The Place of Birth' in Pairman, Pincombe, Thorogood, Tracy, Churchill Livingstone (eds), MIdwifery Preparation for Practice, Elsevier, London, UK, pp. 1-25.
This chapter provides further evidence of my research platform and international standing. The chapter continues to explore the complex nature of the birth environment. It focuses on the place of birth and how this contributes to birth outcomes. The chapter was invited to be submitted following a conference presentation of the research on which it is based at the 7th ICM (International Conference of Midwives) Asia Pacific Regional Conference in Honk Kong, 27-28 November 2003.where I was the keynote speaker. This chapter was published as one of two sample chapters in the book to coincide with the international Confederation of Midwives Congress in Brisbane in July 2005 and will be included in the book of the same name to be published in 2006.
Wood, P.J., Foureur, M. 2005, 'Exploring the maternity archive of the St Helens Hospital, Wellington, New Zealand 1907-1922: an historian and a midwifer collaborate' in MOrtimer, B., McGann, S. (eds), New Directions in the History of Nursing: International perspectives, Routledge, London, UK, pp. 179-193.
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An analysis of the maternity archive of the first publicly funded maternity hospital in New Zealand which opened at the turn of the 20th century. This was a midwifery led hospital with one consultant medical practitioner. The hospital was renowned for its high standards of cleanliness. The analysis critiques the understanding that most maternal deaths at the time were due to puerpural sepsis. At this hospital puerpural sepsis was a rare event and maternal deaths were due to a range of other causes.


Foureur, M., Fahy, K. & Hastie, C. 2008, Birth Territory and Midwifery Guardianship, 1, Butterworth Heinemann Elsevier, Edinburgh, UK.
Midwives and other healthcare providers are grappling with the issue of rising intervention rates in childbirth and trying to identify ways to reverse the trend. It is increasingly accepted that intervention in childbirth has long-term consequences for women and their children. Birth Territory provides practical, evidence-based ideas for restructuring the birth territory to facilitate normal birth.
Fisher, K., Foureur, M. & Hawley, J. 2004, Maternity Services and Gynaecology Report 2003, Capital and Coast DHB, Wellington, New Zealand.
Analysis of the maternity service and gynaecology service processes and outcomes of a large regional maternity and womens health service in wellington, New Zealand. Recommendations for policy and practice made. Co-authored with Keith Fisher and Jackie Hawley
Fisher, K., Foureur, M. & Hawley, J. 2003, Maternity Report 1997-2002, Capital and Coast DHB, Wellington, New Zealand.
Analysis of the maternity outcomes database of a large regional maternity hospital in New Zealand with recommendations for practice change and new policy directions. Co-authored with Keith Fisher and Jackie Hawley

Conference Papers

Foureur, M. 2010, 'Changing the Birth Environment to Facilitate Optimal Birth Experiences for Women', Nepean Midwifery Conference, Sebel Resort, Windsor, February 2010.
This paper explored the current research understanding of the physiology of stress in childbirth and how this impacts outcomes in labour and birth for women and babies. It proposed innovative strategies for focussed attention on aspects of the birth environment that are amendable to change and how optimal birth environments could lead to reduced intervention in childbirth.
Foureur, M. 2010, 'Epigenetics and the Birth Environment', Royal Hospital for Women "Celebrating Midwifery Excellence" Conference, Royal Hospital for Women, Randwick, Sydney NSW, March 2010.
This keynote addressed presented new research understanding of the influence of the birth environment -from preconception, through conception, pregnancy, labour, birth and the early postnatal period, on the human epigenome
Foureur, M. 2010, 'How the Birth Environment impacts the Human Epigenome', Canterbury Hospital Inaugural Midwifery Conference "From small beginnings, big things grow", Canterbury Hospital, Canterbury, Sydney, NSW, May 2010.
Presented animal and human research findings that describe the impact of stressful birth environments on short term birth outcomes and long term health behaviours of infants - and in particular focussed on changes to the epigenome
Foureur, M., Homer, C.S., Leap, N., Forbes, I. & Davis, D.L. 2009, 'Development and Testing of the Birth unit design spatial evaluation tool (BUDSET) to assess optimality of birth environments', Darwin Convention Centre, Darwin, Northern Territory, April 2009 in 13th Annual Congress PSANZ, ed Oberklaid, F; Beasley, S; Isaacs, D., Journal of Paediatrics and Child Health, Carlton South Victoria 3053 Australia, pp. A31-A31.
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', International Conference on e-Health Networking, Applications and Services, Biopolis, Singapore, July 2008 in 2008 10th IEEE International Conference on e-Health Networking, Applications and Services, ed IEEE, IEEE, Piscataway, NJ, 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, February 2008.
Foureur, M. 2007, 'Establishing the principles for creating positive birth space (part 1)', Midwives Riding the Wave of Innovation and Evidence based Practice, Legends Hotel Surfers Paradise Queensland, July 2007.
Foureur, M. 2007, 'Enacting the principles for creating positive birth space (part 2)', Midwives Riding the Wave of Innovation and Evidence Based Practice, Legends Hotel Surfers Paradise Queensland, July 2007.
Foureur, M. 2007, 'Creating Positive Birth Space', Supporting Normal Birth Seminar for the Otway Division of General Practice, Corangamite Managed Clinical Network, Terang, Victoria, April 2007.
Foureur, M. 2007, 'The Psychosocial Impact of EFM', A critical evaluation of the value of electronic fetal monitoring., Hunter New England Health Service, John Hunter Hospital, Newcastle, NSW, February 2007.

Journal Articles

Homer, C.S., Thornton, T., Scarf, V.L., Ellwood, D.A., Oats, J., Foureur, M., Sibbritt, D., McLachlan, H.L., Forster, D. & Dahlen, H.G. 2014, 'Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data', BMC Pregnancy Childbirth, vol. 14, no. 206, pp. 1-12.
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.
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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Atchan, M.A., Davis, D., Foureur, M. 2014, 'Applying a Knowledge Translation Model to the uptake of the Baby Friendly Health Initiative in the Australian health care system', Women and Birth, vol. 27, no. 2, pp. 79-85.
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.
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.
Maude, R., Skinner, J.P., Foureur, M. 2014, 'Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women', BMC Pregnancy and Childbirth, vol. 14, no. 184, pp. 1-13.
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, no. 206, pp. 1-12.
Dahlen, H., Downe, S., Powell Kennedy, H., Foureur, M. 2014, 'Is society being reshaped on a microbiological and epigenetic level by the way women give birth?', Midwifery, vol. on-line.
Invited commentary for special issue of the journal
Dahlen, H., Kennedy Powell, H., Anderson, C.M., Bell, A., Clark, A., Foureur, M., Ohm, J.E., Shearman, A., Taylor, J.Y., Wright, M.L. & Downe, S. 2013, 'The EPIIC Hypothesis: Intrapartum Effects on the Neonatal Epigenome and Consequent Health Outcomes', Medical Hypotheses, vol. 80, no. 5, pp. 656-662.
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There are many published studies about the epigenetic effects of the prenatal and infant periods on health outcomes. However, there is very little knowledge regarding the effects of the intrapartum period (labor and birth) on health and epigenetic remodeling.
Mollart, L.J., Skinner, V., Newing, c., Foureur, M. 2013, 'Factors That May Influence Midwives Work-related Stress And Burnout', Women and Birth, vol. 26, no. 1, pp. 26-32.
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Research question To determine the incidence and level of work-related stress and burnout in midwives and contributing and protective demographic factors that may influence those levels. Participants and method All registered midwives (152) working in two public hospital maternity units within the same health service district in NSW completed the Maslach Burnout Inventory Human Services Survey and a demographic survey including care model, shift work, lifestyle data and exercise level. Findings There was a response rate of 36.8% with 56 (56/152) midwives completing the surveys. Almost two thirds (60.7%) of midwives in this sample experienced moderate to high levels of emotional exhaustion, a third (30.3%) scoring low personal accomplishment and a third (30.3%) experiencing depersonalization related to burnout. Significant differences were found among groups of midwives according to years in the profession, shifts worked, how many women with multiple psychosocial issues were included in the midwife's workload and the midwife's uptake of physical exercise. Those midwives who had spent longer in the profession and exercised scored low burnout levels.
Homer, C.S., Besley, K.J., Bell, J.E., 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, no. 140, pp. 1-6.
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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.
Dixon, L., Skinner, J.P., Foureur, M. 2013, 'Women's perspectives of the stages and phases of labour', Midwifery, vol. 29, no. 2013, pp. 10-17.
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Background: within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as stages and phases. The aim of this research was to determine whether the discourse of labour as stages and phases resonated with women who had experienced spontaneous labour and birth.
Monk, A.R., Tracy, S.K., Foureur, M. & Tracy, M.B. 2013, 'Evaluating midwifery units (EMU): Lessons from the pilot study', Midwifery, vol. 29, no. 8, pp. 845-851.
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Objective this paper describes the pilot study that was undertaken to test the feasibility of the recruitment plan designed to recruit women who booked to give birth in two freestanding midwifery units in NSW, Australia. The pilot preceded the full prospective cohort study, Evaluating Midwifery Units (EMU), which aimed to examine the antenatal, birth and postnatal outcomes of women planning to give birth in freestanding midwifery units compared to those booked to give birth in tertiary level maternity units in Australia and New Zealand. Design a prospective cohort study with two mutually-exclusive cohorts. Setting two freestanding midwifery units in NSW and their corresponding tertiary referral hospitals. Participants a total of 146 women with few identified risk factors recruited between 13 September 2009 and 31 March 2010 whose planned place of birth was either a freestanding midwifery unit or tertiary maternity unit. Measurements and findings the pilot study identified the feasibility of relying on the booking midwife to recruit eligible women from several antenatal booking clinics to the study. Low rates of eligible women were invited resulting in a lower than expected consent rate. In addition, although mostly only low-risk women were invited to participate, some women requiring medical consultation at the time of booking were inadvertently recruited into the study. The results of this pilot study led us to revise the study protocol to find ways of including the outcomes of all women without identified risk factors who booked at either the freestanding midwifery units or the tertiary referral hospital in that area. This paper describes the revisions that were made to the study plan.
Catling, C., Coddington, R.L., 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.
Stenglin, M.K., Foureur, M. 2013, 'Designing out the fear cascade to increase the likelihood of normal birth', Midwifery, vol. 29, no. 8, pp. 819-825.
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Increasing normal birth by lowering the rate of birth by caesarean section(CS) has become high on the list of health priorities for professional and government bodies in much of the developed world(Maternity Care Working Party, 2007; Society of Obstetricians and Gynaecologists of Canada (SOGC) etal.,2008; Commonwealth of Australia, 2009; American College of Nurse-Midwives etal.,2012).
Monk, A.R., Tracy, S.K., Foureur, M. & Barclay, L. 2013, 'Australian primary maternity units: past, present and future', Women and Birth, vol. 26, no. 3, pp. 213-218.
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Primary maternity units are commonly those run by midwives who provide care to women with low risk pregnancies with no obstetric, anaesthetic, laboratory or paediatric support available on-site. In some other countries, primary level maternity units play an important role in offering equitable and accessible maternity care to women with low-risk pregnancies, particularly in rural and remote areas. However there are very few primary maternity units in Australia, largely due to the fact that over the past 200 years, the concept of safety has become inherently linked with the immediate on-site availability of specialist medical support.
Atchan, M.A., Davis, D., Foureur, M. 2013, 'The impact of the Baby Friendly Health Initiative in the Australian health care system a critical narrative review of the evidence', Breastfeeding Review, vol. 21, no. 2, pp. 15-22.
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Studies.have.identified.that.the.practices.of.maternity.facilities.and.health.professionals.are.crucial.to.women+s.experience.of. support.and.breastfeeding.`success+..The.Baby.Friendly.Hospital Initiative.(BFHI).was.launched.globally.in.1991.to.protect,. promote.and.support.breastfeeding..While.a.direct.causal.effect.has.not.been.established.and.critics.suggest.the.rhetoric. conflicts.with.women+s.lived.experiences.as.new.mothers,.a.positive.association.between.the.Initiative.and.breastfeeding. prevalence.is.apparent..Internationally,.impact.studies.have.demonstrated.that.where.the.Initiative.is.well.integrated,.there. is.an.increase.in.rates.of.breastfeeding.initiation.and,.to.a.lesser.extent,.duration..In.consideration.of.the.known.health.risks. associated.with.the.use.of.artificial.baby.milks.this.would.suggest.that.BFHI.implementation.and.accreditation.should.be.a. desirable.strategy.for.committed.health.facilities..However,.a.variation.in.both.BFHI.uptake.and.breastfeeding.prevalence. between.nations.has.been.reported..This.narrative.review.critically.discusses.a.variety.of.issues.relevant.to.the.uptake. and.support.of.breastfeeding.and.the.BFHI,.utilising.Australia.as.a.case.study..Whilst.it.enjoys.`in.principle+.policy.support,. Australia.also.suffers.from.a.lack.of.uniformity.in.uptake.and.perception.of.the.benefits.of.BFHI.at.all.levels.of.the.health. system..Australian.and.international.studies.have.identified.similar.enablers.and.barriers.to.implementation.
Foureur, M., Besley, K.J., Burton, G., Yu, N. & Crisp, J.M. 2013, 'Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress', Contemporary Nurse, vol. 45, no. 1, pp. 114-125.
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Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress
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.
Hammond, A.D., Foureur, M., Homer, C.S., Davis, D.L. & 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.
Dixon, L., Skinner, J.P., Foureur, M. 2013, 'The emotional and hormonal pathways of labour and birth: integrating mind, body and behaviour', New Zealand College of Midwives Journal, vol. 48, no. 1, pp. 15-23.
Background: Women have described normal labour and birth in terms of their emotions. Major advances in knowledge have occurred within the sciences resulting in an understanding of emotions as prime directors of human behaviour which is orchestrated by neurohormones. Method: This paper focusses on key aspects of contemporary knowledge of childbirth physiology, neuroscience and behaviour. It integrates this understanding with women+s descriptions of their emotions during labour. Findings: Neurohormones associated with labour and birth are designed to trigger a transformation in the body and behaviour and create an environment which supports both the mother and the baby. Hormones and emotions are intertwined and interconnected. Labour hormones are linked to the woman+s emotions and behaviour during labour and birth as well as the physical signs of labour. An interactive model is presented which explains labour in terms of both the physical effects and the emotional affects that women have described as part of their labour experience. The hypothesis for this model is that the hormones that initiate and sustain labour also cause the instinctual emotions that women feel, and the behaviour they exhibit, during spontaneous labour and birth.
Kassab, M., Roydhouse, J., Fowler, C.M., Foureur, M. 2012, 'The Effectiveness of Glucose in Reducing Needle-Related Procedural Pain in Infants', Journal of Pediatric Nursing, vol. 27, no. 1, pp. 3-17.
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This systematic review examined the effectiveness of glucose in relieving needle-associated pain in infants. Meta-analysis was not undertaken, and there was variation in dose, administration method, concentration, and outcome measurement. Glucose was more effective than placebo in relieving infant pain as measured by behavioral outcomes, but there were mixed findings for physiological outcomes. Based on these findings, 25%-50% glucose appears effective for infant pain management.
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.
Kassab, M., Sheehy, A.D., King, M.T., Fowler, C.M., Foureur, M. 2012, 'A double-blind randomised controlled trial of 25% oral glucose for pain relief in 2-month old infants undergoing immunisation', International Journal of Nursing Studies, vol. 49, no. 3, pp. 249-256.
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This article reports a double-blind RCT to determine the effectiveness of 25% oral glucose solution in reducing immunisation pain in 2-month old infants.
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.
Davis, D.L., Foureur, M., Clements, V.J., Brodie, P.M. & Herbison, P. 2012, 'The self reported confidence of newly graduated midwives before and after their first year of practice in Sydney, Australia', Women and Birth, vol. 25, pp. e1-e10.
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Graduates from a new, 3-year Bachelor of Midwifery program joined those educated through the 1 year, postgraduate route (for those already qualified as nurses) for the first time in New South Wales (NSW) Australia in 2007. Many hospitals offer transition support programs for new graduates during their first year of practice though there is little evidence available to inform these programs. To establish the new midwife's confidence in working to the 14 National Competency Standards for the Midwife 1 and the International Confederation of Midwives (ICM) Definition of a Midwife and to explore whether the new midwife's confidence changed over the new graduate year. In particular the study set out to determine whether there were any differences in the confidence of new graduates from undergraduate or postgraduate programs. Pre and post survey with comparisons longitudinally and within undergraduate and postgraduate cohorts. Three Area Health Services in Sydney and surrounding areas, Australia. A convenience sample of all new graduate midwives employed in the three Area Health Services in the early months of 2008. New graduate midwives rated their level of confidence (1-10) in working to the 14 National Competency Standards for the Midwife and the ICM Definition of a Midwife during their first weeks of employment and after the completion of their first year of practice. Midwives prepared through the undergraduate and postgraduate routes commenced their first year of practice with similar levels of confidence. The confidence of these midwives increased modestly over the first year of practice. Those from postgraduate programs were significantly more confident than those from undergraduate programs on four competencies after the first year of practice. Participant's self reported confidence in working to the ICM Definition of a Midwife was low.
Lennox, S., Foureur, M. 2012, 'Developmental mentoring: New graduates' confidence grows when their needs shape the relationship', New Zealand College of Midwives Journal, vol. 46, no. June2012, pp. 26-31.
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This paper describes a research project that explored group mentoring with four new graduate midwives and four experienced midwives.
Homer, C.S., Foureur, M., Allende, T., Pekin, F., Caplice, S. & Catling, 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. Online, pp. e509-e515.
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The Malabar Community Midwifery Link Service was developed to meet the needs of women from Aboriginal and Torres Strait Island in suburban Sydney, Australia. This paper reports the evaluation from the perspective of the Aboriginal and Torres Strait Islander women who accessed the service.
Lennox, S., Jutel, A., Foureur, M. 2012, 'The Concerns of Competent Novices during a Mentoring Year', Nursing Research and Practice, vol. Epub, pp. 1-9.
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In an innovative group mentoring approach, four experienced midwives mentored four new graduates during their first year of practice.
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.
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, vol. 2012, pp. 1-59.
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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
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 1998+2006. Participants women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria. Measurements data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400 g birth weight in the state.
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.
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.
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.
Hartz, D., Foureur, M. & Tracy, S.K. 2011, 'Australian caseload midwifery: The exception or the rule', Women and Birth, vol. 25, pp. 39-46.
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Summary The aim of this paper is to review the clinical outcomes of descriptive and comparative cohort studies of the Australian caseload midwifery models of care that emerged during the late 1990s and early 2000s. These models report uniformly a decrease in caesarean section operation rates when compared to local, state and national rates, irrespective of the obstetric risk of the women cared for. These outcomes are in contrast to the findings of the randomised controlled trials and comparative cohort studies of caseload midwifery conducted, predominantly in the United Kingdom, in the mid to late 1990s. The Australian studies show that caseload midwifery is a model of care that is associated with lowered rates of caesarean section operations, and other obstetric intervention rates. The absence of definitive evidence of the effect of caseload midwifery, derived from published descriptive and comparative cohort studies, underlines the need for a sufficiently powered randomised controlled trial of caseload midwifery. The randomised controlled trial of caseload midwifery being undertaken in two major teaching hospitals in Australia will provide definitive answers relating to the effect of the caseload midwifery model of care for women of all risk in the Australian context.
Patterson, J., Foureur, M. & Skinner, J.P. 2011, 'Patterns of transfer in labour and birth in rural New Zealand', Rural and Remote Health, vol. 11, no. 1710, pp. 1-15.
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For many women, and particularly rural women, birthing locally and within their own community is important for personal, social and/or cultural reasons. If concerns about the woman or her baby mean transfer to a secondary or tertiary facility is necessary, this can be disruptive and stressful, especially if road transfer is complicated by terrain, weather or distance, as is often the case in rural New Zealand. The objective of this study was to explore the number of and reason for transfers during labour and birth for well women, close to full term, from primary rural maternity facilities to specialist care in rural New Zealand. Methods: This retrospective survey of 45 rural maternity units in the North and South Islands of New Zealand was conducted over a 2 year period ending on 30 June 2006. The participants were the 4678 women who began labour in a rural facility during this time period. Results: The survey response rate was 66.6%. The data revealed that 16.6% of women who commenced labour in a rural unit were transferred in labour or within 6 hours of birth; 3% of babies born in rural units were transferred after birth and up to 7 days post-birth. The primary reason for maternal transfer was slow progress in labour (49.67%). Of the 123 babies transferred, this was most often due to respiratory problems (43%). Key features of the rural context (times and distances to be travelled, geological and climatic characteristics, types of transport systems and availability of local assistance) influenced the timeliness of the decision to transfer. Conclusions: Within New Zealand++s regionalised perinatal system, midwives make cautious decisions about transfer, taking into account the local rural local circumstances, and also the topography as it impacts on transport.
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
Foureur, M. 2011, 'The decision not to initiate breastfeeding-women's reasons, attitudes and influencing factors-a review of the literature', Breastfeeding Review, vol. 19, no. 2, pp. 9-17.
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Breastfeeding is the biological feeding norm for human babies. Encouraging breastfeeding is a primary health promotion strategy, with studies demonstrating the risks of artificial baby milks. each year approximately 10% of the women who give birth in New South Wales decide not to initiate breastfeeding, and the demographic characteristics of this group of women have previously been identified. This paper reviews the literature to explore the factors that influence women's decisions about breastfeeding, and their reasons for not initiating breastfeeding. The review revealed there are relatively few studies that explore the experiences of women who decide not to initiate breastfeeding, especially in the Australian context.
Kassab, M., Fowler, C.M., Foureur, M. 2011, 'Managing immunisation pain in infants', Australian Journal of Child and Family Health Nursing, vol. 8, no. 3, pp. 4-9.
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There exists an ethical imperative to ensure the wellbeing of infants undergoing painful procedures, even procedures of short duration. The use of suitable, non-pharmacological pain-relieving measures such as sweet-tasting solutions (for example, sucrose of glucose) should be considered.
Skinner, J.P., Foureur, M. 2010, 'Consultation, referral and collaboration between midwives and obstetricians: lessons from New Zealand.', Journal of Midwifery and Women's Health, vol. 55, no. 1, pp. 28-37.
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There has been substantial growth in the provision of midwifery-led models of care, yet little is known about the obstetric consultation and referral practices of these midwives or the quality of the collaboration between midwives and obstetricians. This study aimed to describe these processes as they are practised in New Zealand, where midwifery-led maternity care is the dominant model. A total population postal survey was conducted that included 649 New Zealand midwives who provided midwifery-led care in 2001. There was a 56.5% response rate, describing care for 4251 women. Within this cohort, there was a 35% consultation rate and 43% of these women had their lead carer role transferred to an obstetrician. However, the midwives continued to provide care in collaboration with obstetricians for 74% of transferred women. Seventy-two percent of midwives felt that they were well supported by the obstetricians to continue care. Midwifery-led care is reasonable for the general population of childbearing women, and a 35% consultation rate can be seen as a benchmark for this population. Midwives can, when well supported, provide continuity of care for women who experience complexity during pregnancy and/or birth. Collaboration with obstetricians is possible, but there needs to be further work to describe what successful collaboration is and how it might be fostered.
Homer, C.S., Catling, C., Sinclair, D., Ahmad, 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.
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
Cooke, H.M., Foureur, M., Kinnear, A., Bisits, A. & Giles, W.B. 2010, 'The Development And Initiation Of The NSW Department Of Health Interprofessional Fetal Welfare Obstetric Emergency Neonatal Resuscitation Training Project', Australian and New Zealand Journal of Obstetrics ..., vol. 50, no. 4, pp. 334-339.
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Background: The Fetal Welfare Obstetric emergency Neonatal resuscitation Training (FONT) project was initiated on a background of rising notifications of adverse events in NSW maternity units, the significant proportion of which were related to fetal wel
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
Dixon, L., Foureur, M. 2010, 'The vaginal examination during labour. Is it of benefit or harm?', New Zealand College of Midwives Journal, vol. 42, no. May 2010, pp. 21-26.
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Giving birth is an important life event and care practices that occur during labour and birth can have a lasting influence on the mother and the family (Beech & Phipps, 2004). The use of regular, routine vaginal examination to assess the progress of labour is one such care practice. There are two ways of viewing the vaginal examination during labour. The first regards the vaginal examination as a physically invasive intervention which can have adverse psychological consequences (Kitzinger, 2005). The second sees vaginal examination as an essential clinical assessment tool that provides the most exact measure of labour progress (Enkin et al., 2000). This paper explores thes two viewpoints in more detail and discusses the benefits versus the harms of undertaking a vaginal examination during labour. Midwives use a variety of skills and observations to assess labour progress.
Maude, R., Lawson, J., Foureur, M. 2010, 'Auscultation - The Action of Listening', New Zealand College of Midwives Journal, vol. 43, no. 1, pp. 13-18.
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The article focuses on the historical development of auscultation and listening to fetal heart beats. It mentions that auscultation defines as the action of listening to the sounds inside the body. It says that the use stethoscope in midwifery practice was introduced in 1819 wherein listening to fetal heart sounds helps determine the well-being of the fetus. It adds that intermittent auscultation was recommended for fetal heart monitoring by the professional evidence-based guideline
Kassab, M., Foster, J.P., Foureur, M. & Fowler, C.M. 2010, 'Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age', The Cochrane Database of Systematic Reviews, vol. 3, pp. 1-11.
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To determine the effectiveness of sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age compared to no treatment, placebo, other sweet-tasting solutions, or pharmacological or other non-pharmacological pain-relieving methods.
Harding, D., Foureur, M. 2009, 'New Zealand and Canadian Midwives' Use of Complementary and Alternative Medicine (CAM)', New Zealand College of Midwives Journal, vol. 40, no. 1, pp. 7-12.
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Complementary and alternative medicine (CAM) is widely used by women and midwives in maternity care despite the lack of strong evidence for safety or efficacy. The purpose of this research was to investigate how midwives in primary midwifery care practice in two countries use CAM.
Mollart, L., Ewing, C., Foureur, M. 2009, 'Midwives' emotional wellbeing: Impact of conducting Structured Antenatal Psychosocial Assessments (SAPSA)', Women and Birth, vol. 22, no. 3, pp. 82-88.
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Research problem To investigate the impact of conducting structured antenatal psychosocial assessments (SAPSA) on midwives+ emotional wellbeing. The SAPSA includes screening and assessment tools for domestic violence, childhood trauma, drug and alcohol use, depression, and vulnerability factors. Participants and methods Registered midwives who had conducted the SAPSA with women during the first hospital booking visit at two hospitals in NSW. Data was collected by means of focus group interviews. Results Four sub-themes were identified that directly impacted upon the midwives+ emotional wellbeing: cumulative complex disclosures, frustration and stress, lack of support for midwives and unhealthy coping strategies. Discussion and conclusions There was a cumulative emotional effect with some midwives utilising unhealthy strategies to cope with feelings of frustration, inadequacy and vicarious trauma. Establishment of structured referral pathways for women and supportive systems for midwives is essential prior to implementing the SAPSA.
Duke, J., McBride-Henry, K., Walsh, K., Foureur, M. 2009, 'The expectations of two New Zealand health services of the role of clinical chairs in Nursing and Midwifery.', Contemporary Nurse, vol. 31, no. 2, pp. 129-141.
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Clinical Professoriate positions within nursing or midwifery in New Zealand are a relatively recent development. One New Zealand University worked collaboratively to establish two joint clinical Professorial appointments with different District Health Boards. Each position had unique mandates around research platforms, and differing operational responsibilities. This paper reports on the qualitative component of a larger study that aimed to examine the research culture, and the role of Clinical Chairs, within the two District Health Boards. This Phase of the research involved semi-structured interviews with senior staff from the DHB to explore their experiences of working with the Clinical Professor. Themes that emerged revolved around expectations of the role during its development, and the subsequent perceived outcomes. The need for objective measures of the roles' impact on clinical outcomes emerged as a key impression from the participants. Future research that focuses on measurements of outcomes attributable to the roles will ensure their sustainability over time.
Maude, R., Foureur, M. 2009, 'Intrapartum fetal heart rate monitoring: using audit methodology to identify areas for research and practice improvement', New Zealand College of Midwives Journal, vol. 40, no. 1, pp. 24-30.
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The purpose of the study was to explore the fetal heart rate monitoring practices of midwives and doctors to determine compliance with an evidence-based guideline for fetal heart rate monitoring endorsed by one New Zealand (NZ) District Health Board (DHB). A retrospective audit of 193 randomly selected medical records was undertaken over six months (July-December 2006). The audit revealed deficiencies in choice of fetal heart rate monitoring modality, monitoring technique, documentation, communication and use of a standardised approach and language for interpreting cardiotocograph (CTG) traces especially the description and categorisation of the four main fetal heart rate features. Multidisciplinary education and a standardised template for reporting CTG+s were key recommendations.
Wilton, D.C., Foureur, M. 2009, 'A survey of folic acid use in primigravid women', Women and Birth, vol. 23, no. 2, pp. 67-73.
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A convenience sample of 320 consecutive primigravid women attending the antenatal clinic of a large Sydney tertiary referral hospital were invited to take part in a survey of folic acid use in pregnancy. The aim of the survey was to determine the number of primigravid women who commenced taking folic acid supplementation at least 1 month prior to conception. In addition the survey sought information on women's source of knowledge about the need for folic acid in pregnancy and whether their pregnancy was planned or unplanned. 295 women qualified to be included in the survey. While 88.1% of women took folic acid at some time prior to and/or during the first trimester, only 23.4% were found to have taken folic acid at least 1 month prior to conception. Of women with a planned birth only 34.5% commenced folic acid prior to conception. This survey adds further weight to the decision of the Australian Government to mandate for fortification of bread-making flour with folic acid, due to commence in September 2009. However, even with folic acid fortified food, health professionals need to continue to advise women to take supplements prior to conception and for at least 12 weeks into their pregnancy to prevent neural tube defects.
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.
McBride-Henry, K., Foureur, M. 2008, 'Organisational culture, medication administration and the role of nurses.', Practice Development in Healthcare, vol. 5, no. 4, pp. 208-222.
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Medication administration is a critical aspect of nursing practice, and has significant implications for the safety of the patients we care for. This research study was designed to identify ways of enhancing patient safety during the administration of medications within the New Zealand context. We employed a multi-method approach that included a survey using the Safety Climate Survey tool, focus groups and three clinical practice development groups. The outcomes of this study indicate that practice development initiatives, such as the ones outlined in this project, can have a positive effect on nurses' perceptions of organisational safety, which in turn has been demonstrated to have a positive impact on patient safety (Pronovost et al., 2003).
Lennox, S., Skinner, J., Foureur, M. 2008, 'Mentorship, preceptorship and clinical supervision: three key processes for supporting midwives', New Zealand College of Midwives Journal, vol. 39, no. October, pp. 7-12.
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New Zealand midwives are increasingly seeking and receiving professional support in clinical practice. This support is gaining acceptance within the profession and is now underpinned by government funding. There are a variety of ways in which support can be provided and this review of the literature describes three main approaches: mentoring, preceptorship and clinical supervision. These three key processes may be undertaken by all midwives whether new to practice or new to New Zealand and also by those who wish ongoing support and development.
Foureur, M. 2008, 'Der ideale Kreibsaal?', Deutsche Hebammen-Zeitschrift: Fachblatt fuer ..., vol. 6, pp. 10-12.
Foureur, M., Bush, R., Duke, J. & Walton, C. 2007, 'Poetry, A Reflective Practice tool for Nurses and Midwives.', Practice Development in Healthcare, vol. 6, no. 4, pp. 203-212.
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This article describes the practice of a poet-in-residence in a tertiary hospital in New Zealand, a country with a unique bicultural foundation. During her residency, the poet worked with hospital staff to gain insight into how nurses and midwives contribute to health outcomes. As well as creating 12 poems which make the work of nurses and midwives more visible, the poet provided poetry readings in two clinical areas and conducted a reflective practice exercise using the co-creation of poetry, with a group of newly graduated nurses. This residency demonstrated the importance of connecting the world of science and technology with the world of lived experience and how poetry can help nurses and midwives to express the complexity of human care practice
Walsh, K., Duke, J., Foureur, M. & MacDonald, L. 2007, 'Designing an effective evaluation plan: a tool for understanding and planning evaluations for complex nursing contexts', Contemporary Nurse, vol. 25, no. 1-2, pp. 136-145.
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With the increasing emphasis on the development of nursing, evidence based practice, practice development and new and extended nursing roles, nurses are faced with the challenge of developing effective evaluation practices in an increasingly complex health care environment. This complexity has seen a number of evaluation methodologies and methods used in health care and nurses in clinical settings may find it difficult to know what approach or approaches best apply to their context. Given that evaluation of nursing innovations and interventions can have political, practical and fiscal consequences it is important that nurses have a broad understanding of evaluation, why it is important, the various types of evaluation methods and methodologies as well as some way of working through this complexity in order to develop evaluation plans and practices that best meet their needs. This paper explores a number of common types of evaluation methodologies and aims to assist nurses to better understand the 'why' and the 'how' of evaluation. In addition the paper describes the development of an evaluation tool which aims to assist nurses to develop effective evaluation plans that will best meet their evaluation needs.
Maude, R., Foureur, M. 2007, 'It's beyond water: Stories of women's experience of using water for labour and birth', Women and Birth, vol. 20, no. 1, pp. 17-24.
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Qualitative descriptive study of women's experiences of using water for labour and birth based on analysis of in depth interviews. Revealed women use water immersion during labour and birth for many reasons other than for pain relief therefore studies using the RCT method to investigate the effectiveness of water for pain relief in labour have asked the wrong question of women. Provides a new research agenda and adds to the knowledge of this aspect of clinical practice. Co-authored with Robyn Maude who was my student undertaking a Masters research programme.
McBride-Henry, K., Foureur, M. 2007, 'A Secondary Care Nursing Perspective On Medication Administration Safety', Journal Of Advanced Nursing, vol. 60, no. 1, pp. 58-66.
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Title. A secondary care nursing perspective on medication administration safety Aim. This paper is a report of a study to explore how nurses in a secondary care environment understand medication administration safety and the factors that contribute to, o
McBride-Henry, K., Foureur, M. 2006, 'Medication Administration Errors: Understanding the Issues.', Australian Journal of Advanced Nursing, vol. 23, no. 3, pp. 33-41.
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Objective: This paper surveys current literature related to medication administration errors, the role of nurses in such errors, and current initiatives that are underway within New Zealand to address this aspect of patient safety. Setting: The literature review focused on research that primarily addresses the issues related to medications that arise in tertiary care facilities.
Barton, J., Don, M., Foureur, M. 2004, 'Nurses and midwives pain knowledge improves under the influence of an acute pain service', Acute Pain, vol. 6, no. 2, pp. 47-51.
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A recent survey of nurses and midwives pain knowledge and attitudes demonstrated that those working regularly with an acute pain service were more knowledgeable about analgesics, non-drug pain management and addiction issues. An acute pain service was shown to have a positive influence on pain management practice. A 29-item pain knowledge and attitudes questionnaire which also included questions relating to the impact of an acute pain service was distributed to 600 nurses and midwives. A response rate of 48% (286 valid responses) was achieved. Nurses and midwives who were unaware of an acute pain service in their organisation had significantly lower scores on knowledge about pain management, particularly in relation to the analgesia choices made. This data indicates that an acute pain service has an important influence within health care organisations and can be utilised to lead advancement in pain management practice.
Levine, M., edelstein, J., Foureur, M. 2003, 'The Relationship between Pregnancy Planning and Breastfeeding Duration', New Zealand College of Midwives Journal, vol. 29, no. 1, pp. 20-22.
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This exploratory study, using a convenience sample of 102 primiparous women in New Zealand, examined the relationship between pregnancy planning and duration of breastfeeding. These women, who had chosen to exclusively breastfeed their infants, responded to a two-part survey: Part I self administered on the day of discharge from hospital; Part II completed during a telephone interview at 6 weeks postpartum. Results: No relationship was found between planning of pregnancy and duration of exclusive breastfeeding. At 6 weeks postpartum, 66 (65%) were exclusively breastfeeding and 34 (35%) were not. Women who had completed 12th grade were significantly more likely to exclusively breastfeed at 6 weeks postpartum than women who had not completed high school (X2= 5.38, p = 0.02).
Jull, A., Foureur, M. 2003, 'Letter to the editor', Nursing Praxis in New Zealand, vol. 19, no. 2, pp. 53-55.
A letter critiquing an article in a previous issue of the journal that described case control studies. The letter pointed out errors in the article and proposed that research without adequate controls provides less than robust evidence of effectiveness of practice interventions and should be presented with its limitations clearly articulated.
Shepherd, L., Foureur, M. 2001, 'Introduction of night-lights to reduce falls on an Assessment, Treatment and Rehabilitation Unit', Australasian Journal of Rehabilitation Nursing, vol. 1, pp. 2-3.
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Foureur, M. 1999, 'The role of the Clinical Professor in Nursing and Midwifery', Nursing Praxis in New Zealand, vol. 14, no. 3.
Guest editorial describing the role of joint clinical chairs - Nursing or Midwifery Professorial appointments which are funded by District Health Boards and located within Universities. The aim of such positions in to undertake research and practice development to improve nursing and midwifery practice and health outcomes. The competing requirements of DHB and university create challenges that need to be managed by the incumbents. Often the service delivery component takes precedent over the research publication requirements of the university.

Major Reviews

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', Centre for Midwifery Child and family Health, University of Technology Sydney, http://www.nmh.uts.edu.au/cmcfh/research/birth-after-caesarean-intervent..., pp. 1-94.

Other research activity

Raymond, J.E., Foureur, M. & Davis, D. 2014, 'Gestational weight change in women attending a group antenatal program aimed at addressing obesity in pregnancy in New South Wales, Australia', Journal of Midwifery and Women's Health, Elsevier Inc, New York, USA.
Dixon, L., Skinner, J.P., Foureur, M. 2014, 'The emotional journey of labour- women's perspectives of the experience of labour moving towards birth', Midwifery, Elsevier, London.
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Background: there has been minimal exploration o fwomen's emotional flow during labour and towards birth. his research aimed to capture woman's remembered experiences of this process.


Fisher, K., Foureur, M. & Hawley, J. 2005, 'Maternity and Gynaecology Report 2004', Capital and Coast DHB, Wellington, New Zealand, pp. 3-98.
Analysis of Maternity and Gynaecology Service processes and outcomes. Recommendations for practice and policy changes made. Co-authored with Keith Fisher and Jackie Hawley.
Farquhar, C., Lethaby, A., Guilliland, K., Cole, S., Foureur, M., Buist, R., Banks, M., Waller, N. & Yates, A. 2004, 'Care of Women with Breech or Previous Caesarean Birth- Evidence-based Best Practice Guideline', Evidence Based Practice Guideline, New Zealand Guidelines Group, Wellington, New Zealand, pp. 1-106.
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Member of the NZ Guidelines Group to develop a Ministry of Health Commissioned Guideline. This was a multidisciplinary group who worked for two years reviewing the evidence and preparing a summary and then developing the guideline. The guideline is available from infor@nzgg.org.nz or www.nzgg.org.nz

Northern Sydney Local Health District

Central Coast Local Health District