Doctor Amy Monk is a registered midwife, lecturer and researcher in the areas of midwifery, perinatal health, primary health care and maternity service provision. Amy was awarded a PhD in midwifery in 2015, and her thesis was based upon a prospective cohort study examining the safety of different maternity units in Australia.
Amy is passionate about improving the equity and accessibility of maternity care and was the lead author on Australia’s first national report on perinatal mortality in Australia, which will be released in 2016 by the Australian Institute of Health and Welfare.
Member of the Australian College of Midwives
University Medal, the University of Sydney 2003
CMCFH International Travel Consortia Funding to present at the 31st International Confederation of Midwives Triennial Congress in Toronto in 2017
Can supervise: YES
- Place of birth
- Maternity service provision
- Risk evaluation
- Midwifery (undergraduate and postgraduate)
- Health sciences (undergraduate)
Braye, K, Ferguson, J, Davis, D, Catling, C, Monk, A & Foureur, M 2018, 'Effectiveness of intrapartum antibiotic prophylaxis for early-onset group B Streptococcal infection: An integrative review.', Women and Birth, vol. 31, no. 4, pp. 244-253.View/Download from: UTS OPUS or Publisher's site
In some countries, up to 30% of women are exposed to intrapartum antibiotic prophylaxis for prevention of early-onset group B Streptococcal infection. Intrapartum antibiotic prophylaxis aims to reduce the risk of neonatal morbidity and mortality from this infection. The intervention may adversely affect non-pathogenic bacteria which are passed to the newborn during birth and are considered important in optimising health. Since many women are offered intrapartum antibiotic prophylaxis, effectiveness and implications of this intervention need to be established. This review considers clinical trials and observational studies analysing the effectiveness of intrapartum antibiotic prophylaxis.An integrative literature review was conducted. One systematic review, three clinical trials and five observational studies were identified for appraisal.Randomised controlled trials found intrapartum antibiotic prophylaxis effective but all retrieved randomised clinical trials had significant methodological flaws. High quality observational studies reported high rates of effectiveness but revealed less than optimal adherence to screening and administration of the prophylaxis. Scant consideration was given to short term risks, and long-term consequences were not addressed.Studies found intrapartum antibiotic prophylaxis to be effective. However, evidence was not robust and screening and prophylaxis have limitations. Emerging evidence links intrapartum antibiotic prophylaxis to adverse short and longer-term neonatal outcomes.Our review found high quality evidence of the effectiveness of intrapartum antibiotic prophylaxis was limited. Lack of consideration of potential risks of the intervention was evident. Women should be enabled to make informed decisions about GBS management. More research needs to be done in this area.
Monk, AR, Grigg, CP, Foureur, M, Tracy, M & Tracy, SK 2017, 'Freestanding midwifery units: Maternal and neonatal outcomes following transfer.', Midwifery, vol. 46, pp. 24-28.View/Download from: UTS OPUS or Publisher's site
the viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, require transfer.to compare the maternal and neonatal birth outcomes of women who planned, to give birth at freestanding midwifery units and subsequently, transferred to a tertiary maternity unit to the maternal and neonatal, outcomes of a low-risk cohort of women who planned to give birth in, tertiary maternity unit.a descriptive study compared two groups of women with low-risk singleton, pregnancies who were less than 28 weeks pregnant at booking: women who, planned to give birth at a freestanding midwifery unit (n=494) who, transferred to a tertiary maternity unit during the antenatal, intrapartum or postnatal periods (n=260) and women who planned to give, birth at a tertiary maternity unit (n=3157). Primary outcomes were mode, of birth, Apgar score of less than 7 at 5minutes and admission to, special care nursery or neonatal intensive care.the proportion of women who experienced a caesarean section was lower, among the freestanding midwifery unit women who transferred during the, intrapartum/postnatal period compared to women in the tertiary maternity, unit group (16.1% versus 24.8% respectively). Other outcomes were, comparable between the cohorts. Rates of primary outcomes in relation to, stage of transfer varied when stratified by parity.these descriptive results support the provision of care in freestanding, midwifery units as an alternative to tertiary maternity units for women, with low risk pregnancies at the time of booking. A larger study, powered, to determine statistical significance of any differences in outcomes, is, required.
Grigg, CP, Tracy, SK, Tracy, M, Daellenbach, R, Kensington, M, Monk, A & Schmied, V 2017, 'Evaluating Maternity Units: a prospective cohort study of freestanding midwife-led primary maternity units in New Zealand-clinical outcomes.', BMJ Open, vol. 7, no. 8, pp. e016288-e016288.View/Download from: UTS OPUS or Publisher's site
To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in a freestanding primary level midwife-led maternity unit (PMU) or tertiary level obstetric-led maternity hospital (TMH) in Canterbury, Aotearoa/New Zealand.Prospective cohort study.407 women who intended to give birth in a PMU and 285 women who intended to give birth at the TMH in 2010-2011. All of the women planning a TMH birth were 'low risk', and 29 of the PMU cohort had identified risk factors.Mode of birth, Apgar score of less than 7 at 5 min and neonatal unit admission.labour onset, analgesia, blood loss, third stage of labour management, perineal trauma, non-pharmacological pain relief, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality.Women who planned a PMU birth were significantly more likely to have a spontaneous vaginal birth (77.9%vs62.3%, adjusted OR (AOR) 1.61, 95% CI 1.08 to 2.39), and significantly less likely to have an instrumental assisted vaginal birth (10.3%vs20.4%, AOR 0.59, 95% CI 0.37 to 0.93). The emergency and elective caesarean section rates were not significantly different (emergency: PMU 11.6% vs TMH 17.5%, AOR 0.88, 95% CI 0.55 to 1.40; elective: PMU 0.7% vs TMH 2.1%, AOR 0.34, 95% CI 0.08 to 1.41). There were no significant differences between the cohorts in rates of 5 min Apgar score of <7 (2.0%vs2.1%, AOR 0.82, 95% CI 0.27 to 2.52) and neonatal unit admission (5.9%vs4.9%, AOR 1.44, 95% CI 0.70 to 2.96). Planning to give birth in a primary unit was associated with similar or reduced odds of intrapartum interventions and similar odds of all measured neonatal well-being indicators.The results of this study support freestanding midwife-led primary-level maternity units as physically safe places for well women to plan to give birth, with these women having higher rates of spontaneous vaginal births and lower rates of interventions and their associated morbidities than...
Grigg, CP, Tracy, SK, Schmied, V, Monk, A & Tracy, MB 2015, 'Women's experiences of transfer from primary maternity unit to tertiary hospital in New Zealand: part of the prospective cohort Evaluating Maternity Units study', BMC PREGNANCY AND CHILDBIRTH, vol. 15.View/Download from: Publisher's site
Grigg, CP, Tracy, SK, Tracy, M, Schmied, V & Monk, A 2015, 'Transfer from primary maternity unit to tertiary hospital in New Zealand - timing, frequency, reasons, urgency and outcomes: Part of the Evaluating Maternity Units study', MIDWIFERY, vol. 31, no. 9, pp. 879-887.View/Download from: Publisher's site
Monk, A, Tracy, M, Foureur, M, Grigg, C & Tracy, S 2014, 'Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia', BMJ Open, vol. 4, no. 10, pp. 1-11.View/Download from: UTS OPUS or Publisher's site
Objective To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia.
Design Prospective cohort study.
Participants 494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28+0 weeks gestation at the time of booking.
Primary and secondary outcome measures Primary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality.
Results Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being.
Conclusions The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking.
Monk, AR, Tracy, SK, Foureur, M & Barclay, L 2013, 'Australian primary maternity units: past, present and future', Women and Birth, vol. 26, no. 3, pp. 213-218.View/Download from: UTS OPUS or Publisher's site
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.
Monk, AR, Tracy, SK, Foureur, M & Tracy, MB 2013, 'Evaluating midwifery units (EMU): Lessons from the pilot study', Midwifery, vol. 29, no. 8, pp. 845-851.View/Download from: UTS OPUS or Publisher's site
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.