Caroline is currently the Director of the Centre for Midwifery, Child and Family Health in the Faculty of Health at UTS and is registered as a midwife in Australia. She has led research into the development and implementation of innovative models of midwifery care and the development of midwifery practice and education. Her other research includes the translation of research into clinical practice particularly in maternity care, clinical risk management strategies and the development of educational strategies to prepare midwives for practice..
She holds NHMRC and ARC-linkage grants as a CI and supervises PhD, Masters and Honours students studying aspects of improving maternity services including midwifery continuity of care, workforce development, models of care, place of birth, cost of maternity care, female genital mutilation and vasa previa. She co-leads the consortium called BACI – Birth After Caesarean Interventions which is undertaking in research to promote normal birth and increase the rate of vaginal birth after caesarean section.
She is also involved in teaching midwifery students, both clinically and through UTS and teaches in the Bachelor of Midwifery, Graduate Diploma of Midwifery and Master of Midwifery (Research) programs. In 2010, she was part of the midwifery teaching team that was awarded a highly commended outcome for the UTS Learning and Teaching Awards for 2009. In 2016, she led the midwifery team in their Team Teaching Award in the UTS Learning and Teaching Awards.
Caroline also holds a Masters of Science in Medicine (Clinical Epidemiology) from the University of Sydney. She is the national President of the Australian College of Midwives.
Current working group/committees
NHMRC Research Committee (2009-2011)
Commonwealth Department of Health and Ageing Co-Chair, National Expert Advisory Executive for the Development of Antenatal Guidelines. (2008-current))
NSW Health Department, Maternal and Perinatal Health Priority Taskforce (2007-current)
Can supervise: YES
Group antenatal care
Birth after caesarean section
Maternal mortality and morbidity
Birth Unit Design
Models of midwifery care
Clinical risk management in maternity care
Women's experiences of maternity care
Midwifery workforce issues
Global maternal and child health
Current research projects
See the Centre for Midwifery, Child and Family Health's research projects.
Midwifery - undergraduate / postgraduate
Higher degrees supervision
International development in maternal and newborn health
Written by a team of international experts in their field, this book highlights lessons learned to help develop new ways of planning, implementing, evaluating and sustaining midwifery continuity of care for the benefit of women, babies and ...
The Illustrated Dictionary of Midwifery is an adaptation of the popular UK dictionary, of the same name, for Australian and New Zealand student and practicing midwives. This highly illustrated dictionary contains approximately 4,000 midwifery terms and abbreviations. The Australian authors have further developed the dictionaryâs women-centred care approach and updated the evidence throughout.
Coates, D, Makris, A, Catling, C, Henry, A, Scarf, V, Watts, N, Fox, D, Thirukumar, P, Wong, V, Russell, H & Homer, C 2020, 'A systematic scoping review of clinical indications for induction of labour.', PloS one, vol. 15, no. 1.View/Download from: Publisher's site
BACKGROUND:The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS:A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS:68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive eviden...
Jittitaworn, W, Fox, D, Catling, C & Homer, CSE 2020, 'Recognising the challenges of providing care for Thai pregnant adolescents: Healthcare professionals' views.', Women and Birth, vol. 33, no. 2, pp. e182-e190.View/Download from: Publisher's site
BACKGROUND:In Thailand, maternal complications and poor neonatal outcomes are common in pregnant adolescents. There are attempts to improve outcomes for this group through specialised antenatal clinics, however, neither the way in which these clinics are provided nor the attitudes of healthcare professionals to pregnant adolescents are known. The aim of this study was to understand the experiences of healthcare professionals in caring for pregnant adolescent women in Thailand. METHODS:A qualitative descriptive design was used. Semi-structured interviews were conducted with 21 healthcare professionals involved in caring for pregnant adolescents across three public hospitals in Bangkok, Thailand. All interviews were analysed thematically. RESULTS:The core concept 'recognising the challenges of providing care for young Thai pregnant women' explained the provision of care. This concept contained three main themes: 1) having an awareness of the political and societal contexts and environment of care; 2) being aware of attitudes and the need to develop psychosocial skills in caring for adolescent women; and 3) having different approaches to caring for pregnant adolescents. A lack of continuity of care was a significant barrier in terms of structure and process. Effective communication was important to provide quality care. CONCLUSION:Healthcare professionals recognised that there were barriers to providing effective care for adolescent women. These findings may inform healthcare professionals and policymakers in Thailand in relation to the systems of care required and addressing the needs of pregnant adolescents. This would enable Thailand to meet the goal in providing a positive pregnancy experience for all women.
Coddington, R, Catling, C & Homer, C 2020, 'Seeing birth in a new light: The transformational effect of exposure to homebirth for hospital-based midwives.', Midwifery, vol. 88.View/Download from: Publisher's site
OBJECTIVE:The aim of the study was to explore hospital-based midwives' experiences of providing publicly-funded homebirth services in Australia. DESIGN:A qualitative descriptive study using a constructivist grounded theory methodology was undertaken. SETTING:Five different states or territories of Australia where publicly-funded homebirth services were operating. PARTICIPANTS:Interviews were conducted with 21 midwives and midwifery managers from eight different public hospitals who had recent experience of working in, or with, publicly-funded homebirth models. FINDINGS:Witnessing undisturbed birth in the home setting transformed midwives' attitudes towards birth. Following exposure to homebirth, many midwives felt they were seeing undisturbed birth for the first time. This led them to question their current understanding of physiological birth and develop a new awareness of the powerful influence that the environment has on labouring women. This new understanding resulted in changes to their practice. KEY CONCLUSIONS:For midwives accustomed to working in hospital settings, exposure to homebirth deepened their understanding of physiological birth, resulting in a perspective transformation and subsequent shift in practice. IMPLICATIONS FOR PRACTICE:Exposure to homebirth may motivate midwives to alter their practice in both home and hospital settings in order to shift the power dynamic between women and caregivers and protect women from unnecessary disturbance during labour.
Coates, D, Homer, C, Wilson, A, Deady, L, Mason, E, Foureur, M & Henry, A 2020, 'Indications for, and timing of, planned caesarean section: A systematic analysis of clinical guidelines.', Women and Birth, vol. 33, no. 1, pp. 22-34.View/Download from: Publisher's site
BACKGROUND:There has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in relation to the timing and indications for planned caesarean section as well as recommendations around the process of decision-making. METHOD:A systematic search of national and international English-language guidelines published between 2008 and 2018 was undertaken. Guidelines were reviewed, assessed in terms of quality and extracted independently by two reviewers. FINDINGS:In total, 49 guidelines of varying quality were included. There was consistency between the guidelines in potential indications for caesarean section, although guidelines vary in terms of the level of detail. There was substantial variation in timing of birth, for example recommended timing of caesarean section for women with uncomplicated placenta praevia is between 36 and 39weeks depending on the guideline. Only 11 guidelines provided detailed guidance on shared decision-making. In general, national-level guidelines from Australia, and overseas, received higher quality ratings than regional guidelines. CONCLUSION:The majority of guidelines, regardless of their quality, provide very limited information to guide shared decision-making or the timing of planned caesarean section, two of the most vital aspects of guidance. National guidelines were generally of better quality than regional ones, suggesting these should be used as a template where possible and emphasis placed on improving national guidelines and minimising intra-country, regional, variability of guidelines.
Coates, D, Homer, C, Wilson, A, Deady, L, Mason, E, Foureur, M & Henry, A 2020, 'Induction of labour indications and timing: A systematic analysis of clinical guidelines.', Women and birth : journal of the Australian College of Midwives, vol. 33, no. 3, pp. 219-230.View/Download from: Publisher's site
BACKGROUND:There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may stem from variability in clinical guidelines. This review aimed to identify to what extent induction of labour guidelines provide consistent recommendations in relation to reasons for, and timing of, induction of labour and ascertain whether inconsistencies can be explained by variability guideline quality. METHOD:We conducted a systematic search of national and international English-language guidelines published between 2008 and 2018. General induction of labour guidelines and condition-specific guidelines containing induction of labour recommendations were searched. Guidelines were reviewed and extracted independently by two reviewers. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument. FINDINGS:Forty nine guidelines of varying quality were included. Indications where guidelines had mostly consistent advice included prolonged pregnancy (induction between 41 and 42 weeks), preterm premature rupture of membranes, and term preeclampsia (induction when preeclampsia diagnosed ≥37 weeks). Guidelines were also consistent in agreeing on decreased fetal movements and oligohydramnios as valid indications for induction, although timing recommendations were absent or inconsistent. Common indications where there was little consensus on validity and/or timing of induction included gestational diabetes, fetal macrosomia, elevated maternal body mass index, and twin pregnancy. CONCLUSION:Substantial variation in clinical practice guidelines for indications for induction exists. As guidelines rated of similar quality presented conflicting recommendations, guideline variability was not explained by guideline quality. Guideline variability may partly account for unexplained variation in induction of labour rates.
Rogers, HJ, Hogan, L, Coates, D, Homer, CSE & Henry, A 2020, 'Responding to the health needs of women from migrant and refugee backgrounds-Models of maternity and postpartum care in high-income countries: A systematic scoping review.', Health & social care in the community, vol. 28, no. 5, pp. 1343-1365.View/Download from: Publisher's site
Pregnant women from migrant and refugee backgrounds living in high-income countries (HIC) are at increased risk of adverse perinatal outcomes compared with women born in the host country. Women from migrant and refugee background have perinatal healthcare needs that are recognised internationally as a public health priority. The aim of this study was to identify, appraise and synthesise available evidence on the effectiveness of models of care in pregnancy or first 12 months postpartum for women from migrant and refugee backgrounds living in HIC. Care models were mapped in terms of (a) effectiveness at improving service access, (b) effectiveness at improving maternal and infant health outcomes, (c) acceptability and appropriateness from the perspective of women and (d) acceptability and appropriateness from the perspective of service providers. Using systematic scoping review methodology, qualitative, quantitative, and mixed methods research published in English 2008-2019 were included. The databases MEDLINE, Embase, Emcare, PubMed, Scopus, CINAHL, PsycINFO, Web of Science, Google Scholar, Cochrane Database of Systematic Reviews and Joanna Briggs Institute were searched between 27 February 2019 and updated 27 December 2019. Qualitative and quantitative data were analysed narratively. Seventeen studies, involving 1,499 women and 203 service providers, were included. A diverse range of interventions were identified, including bilingual/bicultural workers, group antenatal care and specialised clinics. All identified interventions were acceptable to women, and improved access, however, few provided evidence of improved perinatal outcomes. Gaps identified for future research include the use of qualitative and quantitative approaches to ascertain the experiences of women, their families, service providers and impact on perinatal outcomes. Synthesis of the included studies indicates the key elements of acceptable and accessible models, which were as follows: culturally ...
Andrews, CJ, Ellwood, D, Middleton, PF, Homer, CSE, Reinebrant, HE, Donnolley, N, Boyle, FM, Gordon, A, Nicholl, M, Morris, J, Gardener, G, Davies-Tuck, M, Wallace, EM & Flenady, VJ 2020, 'Survey of Australian maternity hospitals to inform development and implementation of a stillbirth prevention 'bundle of care'.', Women and Birth, vol. 33, no. 3, pp. 251-258.View/Download from: Publisher's site
BACKGROUND:'Bundles of care' are being implemented to improve key practice gaps in perinatal care. As part of our development of a stillbirth prevention bundle, we consulted with Australian maternity care providers. OBJECTIVE:To gain the insights of Australian maternity care providers to inform the development and implementation of a bundle of care for stillbirth prevention. METHODS:A 2018 on-line survey of hospitals providing maternity services included 55 questions incorporating multiple choice, Likert items and open text. A senior clinician at each site completed the survey. The survey asked questions about practices related to fetal growth restriction, decreased fetal movements, smoking cessation, intrapartum fetal monitoring, maternal sleep position and perinatal mortality audit. The objectives were to assess which elements of care were most valued; best practice frequency; and, barriers and enablers to implementation. RESULTS:227 hospitals were invited with 83 (37%) responding. All proposed elements were perceived as important. Hospitals were least likely to follow best practice recommendations "all the time" for smoking cessation support (<50%), risk assessment for fetal growth restriction (<40%) and advice on sleep position (<20%). Time constraints, absence of clear guidelines and lack of continuity of carer were recognised as barriers to implementation across care practices. CONCLUSIONS:Areas for practice improvement were evident. All elements of care were valued, with increasing awareness of safe sleeping position perceived as less important. There is strong support from maternity care providers across Australia for a bundle of care to reduce stillbirth.
Evans, J, Taylor, J, Browne, J, Ferguson, S, Atchan, M, Maher, P, Homer, CS & Davis, D 2020, 'The future in their hands: Graduating student midwives' plans, job satisfaction and the desire to work in midwifery continuity of care', Women and Birth, vol. 33, no. 1, pp. e59-e66.View/Download from: Publisher's site
© 2018 Australian College of Midwives Background: Midwife-led continuity of care models benefit women and the midwives who work in them. Australian graduate midwives are familiar with, and educated to provide, continuity of care to women although the opportunity to work exclusively in positions providing continuity of care on graduation is uncommon. Aim: To explore the immediate and aspirational employment plans and workforce choices, reasons for staying in midwifery and perceptions around factors likely to influence job satisfaction of midwives about to graduate from one Australian university during the years 2012–2016. Methods: This longitudinal study draws on survey responses from five cohorts of midwifery students in their final year of study. Findings: Ninety five out of 137 midwifery students responded to the survey. Almost nine out of ten respondents either aspired to work in a continuity of care model or recognised that they would gain job satisfaction by providing continuity of care to women. Factors leading to job satisfaction identified included making a difference to the women for whom they care, working in models of care which enabled them to provide women with 'the care I want to give', and having the ability to make autonomous midwifery decisions. Conclusion: Aligning early graduate work experiences with continuity of care models may have a positive impact on the confidence and professional development of graduate midwives, which in turn may lead to greater satisfaction and retention among a workforce already committed to supporting the maternity healthcare reform agenda.
Hobday, K, Zwi, AB, Homer, C, Kirkham, R, Hulme, J, Wate, PZ & Prata, N 2020, 'Misoprostol for the prevention of post-partum haemorrhage in Mozambique: an analysis of the interface between human rights, maternal health and development.', BMC international health and human rights, vol. 20, no. 1.View/Download from: Publisher's site
BACKGROUND:Mozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. Misoprostol can be administered by a traditional birth attendant or self-administered. The objective of this paper is to examine, through applying a human rights lens, the broader contextual, policy and institutional issues that have influenced and impacted the early implementation of misoprostol for the prevention of PPH. We explore the utility of rights-based framework to inform this particular program, with implications for sexual and reproductive health programs more broadly. METHODS:A human rights, health and development framework was used to analyse the early expansion phase of the scale-up of Mozambique's misoprostol program in two provinces. A policy document review was undertaken to contextualize the human rights, health and development setting in Mozambique. Qualitative primary data from a program evaluation of misoprostol for the prevention of PPH was then analysed using a human rights lens; these results are presented alongside three examples where rights are constrained. RESULTS:Structural and institutional challenges exacerbated gaps in the misoprostol program, and sexual and reproductive health more generally. While enshrined in the constitution and within health policy documents, human rights were not fully met and many individuals in the study were unaware of their rights. Lack of information about the purpose of misoprostol and how to access the medication contributed to power imbalances between the state, health care workers and beneficiaries. The accessibility of misoprostol was further limited due to dynamics of power and control. CONCLUSIONS:Applying a rights-based approach to the Moz...
Homer, C 2020, '2020 is the International Year of the Midwife: Announcing a special issue.', Women and birth : journal of the Australian College of Midwives, vol. 33, no. 1, pp. 1-2.View/Download from: Publisher's site
Homer, C, Wilson, A & Davis, D 2020, 'Editorial: Words matter; language matters.', Women and birth : journal of the Australian College of Midwives, vol. 33, no. 2, pp. 105-106.View/Download from: Publisher's site
Michel-Schuldt, M, McFadden, A, Renfrew, M & Homer, C 2020, 'The provision of midwife-led care in low-and middle-income countries: An integrative review', MIDWIFERY, vol. 84.View/Download from: Publisher's site
O'Connell, M, Crowther, S, Ravaldi, C & Homer, C 2020, 'Midwives in a pandemic: A call for solidarity and compassion', Women and Birth, vol. 33, no. 3, pp. 205-206.View/Download from: Publisher's site
Ravaldi, C, Wilson, A, Ricca, V, Homer, C & Vannacci, A 2020, 'Pregnant women voice their concerns and birth expectations during the COVID-19 pandemic in Italy', Women and Birth.View/Download from: Publisher's site
© 2020 The Authors Background: In March 2020, COVID-19 was declared to be a pandemic. While data suggests that COVID-19 is not associated with significant adverse health outcomes for pregnant women and newborns, the psychological impact on pregnant women is likely to be high. Aim: The aim was to explore the psychological impact of the COVID-19 pandemic on Italian pregnant women, especially regarding concerns and birth expectations. Methods: A cross-sectional online survey of pregnant women in Italy was conducted. Responses were analysed for all women and segregated into two groups depending on previous experience of pregnancy loss. Analysis of open text responses examined expectations and concerns before and after the onset of the pandemic. Findings: Two hundred pregnant women responded to the first wave of the survey. Most (n = 157, 78.5%) had other children and 100 (50.0%) had a previous history of perinatal loss. 'Joy' was the most prevalent emotion expressed before COVID-19 (126, 63.0% before vs 34, 17.0% after; p < 0.05); fear was the most prevalent after (15, 7.5% before vs 98, 49.0% after; p < 0.05). Positive constructs were prevalent before COVID-19, while negative ones were dominant after (p < 0.05). Across the country, women were concerned about COVID-19 and a history of psychological disorders was significantly associated with higher concerns (p < 0.05). A previous pregnancy loss did not influence women's concerns. Conclusions: Women's expectations and concerns regarding childbirth changed significantly as a result of the COVID-19 pandemic in Italy. Women with a history of psychological disorders need particular attention as they seem to experience higher levels of concern.
Wilson, AN & Homer, CSE 2020, 'Third- and fourth-degree tears: A review of the current evidence for prevention and management', Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 60, no. 2, pp. 175-182.View/Download from: Publisher's site
© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: Third- and fourth-degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third- and fourth-degree tears relative to countries of similar economic development. Aims: We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third- and fourth-degree perineal tears in Australian maternity centres. Materials and Methods: We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic. Results: Twenty-six systematic reviews were identified. The most common risk factors reported in the literature for third- and fourth-degree tears included primiparity, mother's ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births. Conclusions: Third- and fourth-degree perineal tears are associated with immediate and long-term implications for women and health systems. Evidence-based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do.
Wilson, AN, Ravaldi, C, Scoullar, MJL, Vogel, JP, Szabo, RA, Fisher, JRW & Homer, CSE 2020, 'Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic', Women and Birth.View/Download from: Publisher's site
© 2020 Australian College of Midwives The COVID-19 pandemic is impacting health systems worldwide. Maternity care providers must continue their core business in caring and supporting women, newborns and their families whilst also adapting to a rapidly changing health system environment. This article provides an overview of important considerations for supporting the emotional, mental and physical health needs of maternity care providers in the context of the unprecedented crisis that COVID-19 presents. Cooperation, planning ahead and adequate availability of PPE is critical. Thinking about the needs of maternity providers to prevent stress and burnout is essential. Emotional and psychological support needs to be available throughout the response. Prioritising food, rest and exercise are important. Healthcare workers are every country's most valuable resource and maternity providers need to be supported to provide the best quality care they can to women and newborns in exceptionally trying circumstances.
Scarf, V, Yu, S, Foureur, M, Viney, R, Dahlen, H, Lavis, L & Homer, C 2020, 'The cost of vaginal birth at home, in a birth centre or in a hospital setting in New South Wales: A micro-costing study', Women and Birth.View/Download from: Publisher's site
Geia, L, Baird, K, Bail, K, Barclay, L, Bennett, J, Best, O, Birks, M, Blackley, L, Blackman, R, Bonner, A, Bryant Ao, R, Buzzacott, C, Campbell, S, Catling, C, Chamberlain, C, Cox, L, Cross, W, Cruickshank, M, Cummins, A, Dahlen, H, Daly, J, Darbyshire, P, Davidson, P, Denny-Wilson, E, De Souza, R, Doyle, K, Drummond, A, Duff, J, Duffield, C, Dunning, T, East, L, Elliott, D, Elmir, R, Fergie, D, Ferguson, C, Fernandez, R, Flower Am, D, Foureur, M, Fowler, C, Fry, M, Gorman, E, Grant, J, Gray, J, Halcomb, E, Hart, B, Hartz, D, Hazelton, M, Heaton, L, Hickman, L, Homer, C, Hungerford, C, Hutton, A, Jackson Ao, D, Johnson, A, Kelly, M, Kitson, A, Knight, S, Levett-Jones, T, Lindsay, D, Lovett, R, Luck, L, Malloy, L, Manias, E, Mannix, J, Marriott Am, R, Martin, M, Massey, D, McCloughen, A, McGough, S, McGrath, L, Mills, J, Mitchell, B, Mohamed, J, Montayre, J, Moroney, T, Moyle, W, Moxham, L, Northam Am, H, Nowlan, S, O'Brien, T, Ogunsiji, O, Patterson, C, Pennington, K, Peters, K, Phillips, J, Power, T, Procter, N, Ramjan, L, Ramsay, N, Rasmussen, B, Rihari-Thomas, J, Rind, B, Robinson, M, Roche, M, Sainsbury, K, Salamonson, Y, Sherwood, J, Shields, L, Sim, J, Skinner, I, Smallwood, G, Smallwood, R, Stewart, L, Taylor, S, Usher Am, K, Virdun, C, Wannell, J, Ward, R, West, C, West, R, Wilkes, L, Williams, R, Wilson, R, Wynaden, D & Wynn, R 2020, 'A unified call to action from Australian Nursing and Midwifery leaders: ensuring that Black Lives Matter.', Contemporary nurse, pp. 1-20.View/Download from: Publisher's site
Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.
OBJECTIVES:to examine the factors that motivate women who have had a previous caesarean section to consider planning a vaginal birth. DESIGN:a qualitative descriptive study with thematic analysis, drawing on interviews with women participating in a two arm, un-blinded randomised controlled trial (RCT) of midwifery continuity of care for increasing the proportion of women planning VBAC. SETTING:A Maternity Unit attached to a district hospital in an outer metropolitan area of Sydney, Australia. PARTICIPANTS:a purposive sample of 18 women participating in an RCT who had experienced previous caesarean section and had no contraindications for vaginal birth. FINDINGS:These women were committed to natural birth and drew on their previous experience of caesarean section to highlight the downside of recovery post caesarean section. Decision making for these women was complex. During the decision-making process, women individualised the information provided to balance risk and chance within the context of their own circumstance. Supportive healthcare providers were important in motivating women towards vaginal birth and midwives were identified as being more supportive than obstetricians. CONCLUSIONS:Recovery post caesarean section is an important consideration that is under emphasised in the informed consent process. There is opportunity for midwives to contribute proactively in promoting vaginal birth for women who have experienced a previous caesarean section. IMPLICATIONS FOR PRACTICE:women should be assisted to make informed choices with balanced information that includes recovery from surgical birth. Models of care that include a significant role for midwives and strategies that proactively encourage vaginal birth for women after previous caesarean section are needed.
Turkmani, S, Homer, CSE & Dawson, AJ 2020, 'Understanding the Experiences and Needs of Migrant Women Affected by Female Genital Mutilation Using Maternity Services in Australia', INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, vol. 17, no. 5.View/Download from: Publisher's site
Pollock, W, Peek, MJ, Wang, A, Li, Z, Ellwood, D, Homer, CSE, Jackson Pulver, L, McLintock, C, Vaughan, G, Knight, M & Sullivan, EA 2020, 'Eclampsia in Australia and New Zealand: A prospective population-based study.', The Australian & New Zealand journal of obstetrics & gynaecology.View/Download from: Publisher's site
BACKGROUND:Eclampsia is a serious consequence of pre-eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia. AIM:To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ. MATERIALS AND METHODS:A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre-eclampsia. RESULTS:Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n = 9; 8.1%). Women with antepartum eclampsia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty-three (47.4%) women had pre-eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128; 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths. CONCLUSIONS:Eclampsia is an uncommon consequence of pre-eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk.
Cheah, SL, Scarf, VL, Rossiter, C, Thornton, C & Homer, CSE 2019, 'Creating the first national linked dataset on perinatal and maternal outcomes in Australia: Methods and challenges.', Journal of biomedical informatics, vol. 93.View/Download from: Publisher's site
BACKGROUND:Data linkage offers a powerful mechanism for examining healthcare outcomes across populations and can generate substantial robust datasets using routinely collected electronic data. However, it presents methodological challenges, especially in Australia where eight separate states and territories maintain health datasets. This study used linked data to investigate perinatal and maternal outcomes in relation to place of birth. It examined data from all eight jurisdictions regarding births planned in hospitals, birth centres and at home. Data linkage enabled the first Australia-wide dataset on birth outcomes. However, jurisdictional differences in data collection created challenges in obtaining comparable cohorts of women with similar low-risk pregnancies in all birth settings. The objective of this paper is to describe the techniques for managing previously linked data, and specifically for ensuring the resulting dataset contained only low-risk pregnancies. METHODS:This paper indicates the procedures for preparing and merging linked perinatal, inpatient and mortality data from different sources, providing technical guidance to address challenges arising in linked data study designs. RESULTS:We combined data from eight jurisdictions linking four collections of administrative healthcare and civil registration data. The merging process ensured that variables were consistent, compatible and relevant to study aims. To generate comparable cohorts for all three birth settings, we developed increasingly complex strategies to ensure that the dataset eliminated women with pregnancies at risk of complications during labour and birth. It was then possible to compare birth outcomes for comparable samples, enabling specific examination of the impact of birth setting on maternal and infant safety across Australia. CONCLUSIONS:Data linkage is a valuable resource to enhance knowledge about birth outcomes from different settings, notwithstanding methodological challenges...
Homer, CSE, Cheah, SL, Rossiter, C, Dahlen, HG, Ellwood, D, Foureur, MJ, Forster, DA, McLachlan, HL, Oats, JJN, Sibbritt, D, Thornton, C & Scarf, VL 2019, 'Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study.', BMJ open, vol. 9, no. 10.View/Download from: Publisher's site
OBJECTIVE:To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home. DESIGN:A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ2 tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance. SETTING:All eight Australian states and territories. PARTICIPANTS:Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home. MAIN OUTCOME MEASURES:Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death). RESULTS:Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth. CONCLUSIONS:This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths w...
Fernandez Turienzo, C, Roe, Y, Rayment-Jones, H, Kennedy, A, Forster, D, Homer, C, McLachlan, H & Sandall, J 2019, 'Implementation of midwifery continuity of care models for Indigenous women in Australia: Perspectives and reflections for the United Kingdom.', Midwifery, vol. 69, pp. 110-112.View/Download from: Publisher's site
Maternity models that provide midwifery continuity of care have been established to increase access to appropriate services for Indigenous Australian women. Understanding the development and implementation of continuity models for Indigenous women in Australia provides useful insights for the development and implementation of similar models in other contexts such as those for vulnerable and socially disadvantaged women living in the United Kingdom. To ensure better health outcomes for mothers and babies, it is crucial to promote culturally competent and safe public health models in which midwives work collaboratively with the multidisciplinary team.
Gao, L-L, Lu, H, Leap, N & Homer, C 2019, 'A review of midwifery in mainland China: Contemporary developments within historical, economic and sociopolitical contexts.', Women and Birth, vol. 32, no. 2, pp. e279-e283.View/Download from: Publisher's site
BACKGROUND:With the recent surging economic and social development in China, midwifery has undergone transformation. AIM:A narrative review of literature relating to midwifery in mainland China was undertaken to examine the characteristics of midwifery's potential development within relevant historical, economic and sociopolitical contexts. The aim was to assist future planning and the setting of strategic directions in policy in China. METHODS:Online bibliographic databases from 2000 to 2015 were searched including MEDLINE, WanFang Data and Chinese National Knowledge Infrastructure. A process of narrative synthesis was used to analyse the selected papers and major issues were identified. RESULTS:Twenty-one papers were included in the review. Two overarching issues were identified in relation to midwifery in mainland China: the history and status of midwifery education; and the practice and regulation of the midwifery profession. In recent decades, midwifery education, regulation and practice have occurred within systems that view midwifery as a specialisation of nursing. This means that there continues to be little opportunity for midwives to practise according to the international definition and scope of practice of the midwife. CONCLUSION:Midwifery in China must continue to develop in parallel with international trends. Investment in midwifery education alone will not suffice; it will have to operate within strong government policy regarding regulation, effective human resources management, visibility of the role of the midwife and development of the service delivery environment in which future midwives will work in China.
Dalinjong, PA, Wang, AY & Homer, CSE 2019, 'The free maternal health policy: Acceptability and satisfaction with quality of maternal health services during pregnancy in rural Northern Ghana', Journal of Health Sciences, vol. 9, no. 2, pp. 108-117.View/Download from: Publisher's site
© 2019 Philip Ayizem Dalinjong, et al. Introduction: Ghana introduced a maternal health policy in July 2008 to provide free of cost health services to women. However, the utilization of services does not depend on affordability alone but acceptability as well. Acceptability includes attitudes and behaviors of providers and satisfaction with the quality of care. The study explored women's views and perceptions about attitudes and behaviors of providers and satisfaction with the quality of services under the free maternal health policy in Ghana. In addition, the views and perceptions of providers were examined. Methods: A convergent parallel mixed methods study was conducted. The study was carried out in the Kassena-Nankana Municipality in Ghana. A structured questionnaire was distributed among women (n=406) who utilized health facilities during pregnancy. Further, focus group discussions (FGDs) with women (n=10) and in-depth interviews with midwives and nurses (n=25) were held. Quantitative data were analyzed using descriptive statistics, while the qualitative data were recorded, transcribed, read, and coded thematically. Results: Women perceived facilities to be clean, especially the smaller ones. Ninety-eight percent of women (n=313/320) perceived providers to be respectful or friendly, and this was mostly confirmed in the FGDs. More than two-thirds of the women (74%, n=300) were also very satisfied or satisfied with the quality of care due to the respect accorded them by providers. Equally, midwives and nurses were satisfied with the quality of care they provided. Nonetheless, providers believed that the unavailability of drugs and supplies, laboratory services, accommodation and transportation for emergencies reduced women's satisfaction with services and the quality of care they could provide. Conclusion: The services provided to women during pregnancy were acceptable under the free maternal health policy. There remain challenges in addressing a lack of infra...
Flenady, V, Ellwood, D, Bradford, B, Coory, M, Middleton, P, Gardener, G, Radestad, I, Homer, C, Davies-Tuck, M, Forster, D, Gordon, A, Groom, K, Crowther, C, Walker, S, Foord, C, Warland, J, Murphy, M, Said, J, Boyle, F, O'Donoghue, K, Cronin, R, Sexton, J, Weller, M & McCowan, L 2019, 'Beyond the headlines: Fetal movement awareness is an important stillbirth prevention strategy.', Women and birth : journal of the Australian College of Midwives, vol. 32, no. 1, pp. 1-2.View/Download from: Publisher's site
Hobday, K, Hulme, J, Prata, N, Wate, PZ, Belton, S & Homer, C 2019, 'Scaling Up Misoprostol to Prevent Postpartum Hemorrhage at Home Births in Mozambique: A Case Study Applying the ExpandNet/WHO Framework.', Global health, science and practice, vol. 7, no. 1, pp. 66-86.View/Download from: Publisher's site
BACKGROUND:Mozambique has a high maternal mortality ratio, and postpartum hemorrhage (PPH) is a leading cause of maternal deaths. In 2015, the Mozambican Ministry of Health (MOH) commenced a program to distribute misoprostol at the community level in selected districts as a strategy to reduce PPH. This case study uses the ExpandNet/World Health Organization (WHO) scale-up framework to examine the planning, management, and outcomes of the early expansion phase of the scale-up of misoprostol for the prevention of PPH in 2 provinces in Mozambique. METHODS:Qualitative semistructured interviews were conducted between February and October 2017 in 5 participating districts in 2 provinces. Participants included program stakeholders, health staff, community health workers (CHWs), and traditional birth attendants (TBAs). Interviews were analyzed using the ExpandNet/WHO framework alongside national policy and planning documents and notes from a 2017 national Ministry of Health maternal, newborn, and child health workshop. Outcomes were estimated using misoprostol coverage and access in 2017 for both provinces. RESULTS:The study revealed a number of barriers and facilitators to scale-up. Facilitators included a supportive political and legal environment; a clear, credible, and relevant innovation; early expansion into some Ministry of Health systems and a strong network of CHWs and TBAs. Barriers included a reduction in reach due to a shift from universal distribution to application of eligibility criteria; fear of misdirecting misoprostol for abortion or labor induction; limited communication and understanding of the national PPH prevention strategy; inadequate monitoring and evaluation; challenges with logistics systems; and the inability to engage remote TBAs. Lower coverage was found in Inhambane province than Nampula province, possibly due to NGO support and political champions. CONCLUSION:This study identified the need for a formal review of the misoprostol program to ...
Javid, N, Hyett, JA & Homer, CS 2019, 'Providing quality care for women with vasa praevia: Challenges and barriers faced by Australian midwives.', Midwifery, vol. 68, pp. 91-98.View/Download from: Publisher's site
OBJECTIVE:To explore the barriers to providing quality maternity care for women with vasa praevia as identified by Australian midwives. DESIGN:A qualitative descriptive study using semi-structured in-depth telephone interviews. SETTING:Australian maternity system. METHODS:Midwives were recruited from across Australia. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. PARTICIPANTS:Twenty midwives from five Australian states practising in 15 different public or private hospitals who had cared for at least one woman with vasa praevia during 2010-2016 were interviewed. More than half of the participants held senior positions. Twelve were involved in a neonatal death or 'near-miss' due to vasa praevia. FINDINGS:Two categories and five themes were identified in relation to barriers to the provision of quality care. Practitioner-level barriers included two themes: identifying lack of midwifery education and lack of knowledge. System-level barriers included lack of a local policy to guide practice, limited information for women, and paucity of research about vasa praevia. CONCLUSION:Midwives experienced a number of barriers in caring for women with vasa praevia. Offering more comprehensive pre-registration and continuing professional education to midwives, developing local protocols, and providing clear written information for women may improve the provision of quality care. IMPLICATIONS FOR PRACTICE:Midwives have a critical role in caring for and supporting women with vasa praevia. Improving midwives' knowledge with contemporary evidence and clinical guidelines could enable them to deliver safer maternity care and improve a women's journey through this potentially catastrophic condition.
Javid, N, Hyett, JA & Homer, CSE 2019, 'The experience of vasa praevia for Australian midwives: A qualitative study.', Women and Birth, vol. 32, no. 2, pp. 185-192.View/Download from: Publisher's site
Vasa praevia can cause stillbirth or early neonatal death if it is not diagnosed antenatally and managed appropriately. Experiencing undiagnosed vasa praevia during labour is challenging and traumatic for women and their care providers. Little is known about the experiences of midwives who care for these women.To investigate the experience of Australian midwives caring for women with undiagnosed vasa praevia during labour and birth.A qualitative descriptive study was conducted with midwives in Australia who had cared for at least one woman with vasa praevia during 2010-2016. Semi-structured in-depth telephone interviews were conducted and analysed using thematic analysis.Twelve of the 20 midwives interviewed were involved in a neonatal death and/or near-miss due to vasa praevia. There was one over-arching theme, which described the 'devastating and dreadful experience' for the midwives. This had two inter-related categories of feeling the personal impacts and addressing the professional processes. Feeling scared, shocked, and guilty described how the experience took its toll on the midwives personally. The professional processes included working in organised chaos; feeling for the parents; finding communication to be hard; and, doing their best to save the baby.Caring for women who experienced ruptured vasa praevia had a profound impact on the emotional and professional well-being of midwives even when the baby survived.Ruptured vasa praevia was recognised as a traumatic experience that warrants serious considerations from maternity care providers, managers and policy makers. Midwives should be supported and adequately prepared to cope with traumatic events.
Javid, N, Hyett, JA, Walker, SP, Sullivan, EA & Homer, CSE 2019, 'A survey of opinion and practice regarding prenatal diagnosis of vasa previa among obstetricians from Australia and New Zealand.', International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 144, pp. 252-259.View/Download from: Publisher's site
OBJECTIVES:To define current obstetric opinion and clinical practice regarding the prenatal diagnosis of vasa previa in Australia and New Zealand. METHODS:A population-based cross-sectional survey of Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted from April to May, 2016. Descriptive analysis was used to define factors influencing opinion and practice regarding definition of vasa previa, attributable risk factors, and the value of screening. RESULTS:Overall, 453 respondents were included in the study. Two-thirds (304/453; 67.1%) defined vasa previa as exposed fetal vessel(s) running over or within 2 cm of the internal os. A higher proportion of ultrasound specialists (30/65; 46.2%) preferred a broader definition as compared with generalists (115/388; 29.6%; P<0.001). Overall, Fellows were supportive (342/430; 79.5%) of both reporting ultrasound-based risk factors at the 20-week anomaly scan and targeted screening (298/430; 69.3%). Only 77/453 (17.0%) respondents recognized all five "known" risk factors for vasa previa. CONCLUSIONS:There was a lack of consensus regarding the definition and diagnosis process for vasa previa. There was also a knowledge gap in risk factors for vasa previa that would inform a targeted screening policy. Nevertheless, support for targeted screening was strong from obstetricians who responded. This article is protected by copyright. All rights reserved.
Meher, S, Cuthbert, A, Kirkham, JJ, Williamson, P, Abalos, E, Aflaifel, N, Bhutta, ZA, Bishop, A, Blum, J, Collins, P, Devane, D, Ducloy-Bouthors, A-S, Fawole, B, Gülmezoglu, AM, Gutteridge, K, Gyte, G, Homer, C, Mallaiah, S, Smith, JM, Weeks, AD & Alfirevic, Z 2019, 'Core outcome sets for prevention and treatment of postpartum haemorrhage: an international Delphi consensus study.', BJOG: An International Journal of Obstetrics and Gynaecology, vol. 126, no. 1, pp. 83-93.View/Download from: Publisher's site
To develop core outcome sets (COS) for studies evaluating interventions for (1) prevention and (2) treatment of postpartum haemorrhage (PPH), and recommendations on how to report the COS.A two-round Delphi survey and face-to-face meeting.Healthcare professionals and women's representatives.Outcomes were identified from systematic reviews of PPH studies and stakeholder consultation. Participants scored each outcome in the Delphi on a Likert scale between 1 (not important) and 9 (critically important). Results were discussed at the face-to-face meeting to agree the final COS. Consensus at the meeting was defined as ≥ 70% of participants scoring the outcome as critically important (7-9). Lectures, discussion and voting were used to agree how to report COS outcomes.Outcomes from systematic reviews and consultations.Both Delphi rounds were completed by 152/205 (74%) participants for prevention and 143/197 (73%) for treatment. For prevention of PPH, nine core outcomes were selected: blood loss, shock, maternal death, use of additional uterotonics, blood transfusion, transfer for higher level of care, women's sense of wellbeing, acceptability and satisfaction with the intervention, breastfeeding, and adverse effects. For treatment of PPH, 12 core outcomes were selected: blood loss, shock, coagulopathy, hysterectomy, organ dysfunction, maternal death, blood transfusion, use of additional haemostatic intervention, transfer for higher level of care, women's sense of wellbeing, acceptability and satisfaction with the intervention, breastfeeding, and adverse effects. Recommendations were developed on how to report these outcomes where possible.These COS will help standardise outcome reporting in PPH trials.Core outcome sets for PPH: nine core outcomes for PPH prevention and 12 core outcomes for PPH treatment.
Musgrave, LM, Homer, CSE, Kizirian, NV & Gordon, A 2019, 'Addressing preconception behaviour change through mobile phone apps: a protocol for a systematic review and meta-analysis.', Systematic reviews, vol. 8, no. 1.View/Download from: Publisher's site
BACKGROUND:Many of the adverse outcomes experienced by mothers and babies are directly related to the health of the woman prior to pregnancy. This preconception period is a unique window of opportunity when women are often more motivated to optimise health and change their lifestyle in preparation for pregnancy. Several risk factors in the preconception period can contribute to adverse perinatal outcomes. These risk factors can be divided into three broad areas: biomedical, social and environmental. Mobile phone applications as a behaviour change intervention have the potential to address these risks through supporting the provision of information, healthier lifestyles and informed decision-making. The aim of this systematic review is to assess the effectiveness of mobile phone applications in promoting behaviour change and improving long-term outcomes for mother and babies, in women of reproductive age. METHODS:This review will include trials that assess any mobile phone application (app) that assist women of reproductive age to optimise health behaviours. Randomised controlled trials, quasi-randomised controlled trials and cluster-randomised trials will be included. The search strategy will use both MeSH and keyword combinations to search databases including the WHO Global Health Library, CINHAL, The Cochrane Library, Embase and MEDLINE for relevant studies. Retrieved citations will be screened independently by two authors to assess eligibility. Studies will be selected only if the intervention was commenced prior to pregnancy. Comparisons will be made including mobile phone applications versus text messaging-based communications or paper-based, face-to-face or telephone conversations and standard care or no specific intervention. The Cochrane Handbook for Systematic Reviews of Interventions will be utilised to assess the quality of included randomised studies. Primary and secondary outcomes will be compared and analysed. Results of the review will be reported ...
Robbers, G, Vogel, JP, Mola, G, Bolgna, J & Homer, CSE 2019, 'Maternal and newborn health indicators in Papua New Guinea - 2008-2018.', Sexual and reproductive health matters, vol. 27, no. 1.View/Download from: Publisher's site
Papua New Guinea (PNG) is the most populous country in the Pacific with more than 9 million people. Difficult terrain, poor roads and limited infrastructure mean providing effective health care - especially in rural areas, where most people live - is challenging. Women and newborns in PNG experience high rates of preventable morbidity and mortality; however, reliable data are often limited or unavailable. The aim of this paper is to provide an overview of research on key maternal and neonatal health (MNH) indicators conducted approximately over the past 11 years in PNG comparing research findings to global MNH estimates of the indicators. There was considerable variation in mortality indicators (maternal mortality ratio, neonatal mortality rate and stillbirth) reported across studies in PNG. Mortality was generally higher in rural areas. Rates of sexually transmitted infections (STIs) in pregnancy were consistently high, while anaemia in pregnancy, preterm birth and low birth weight varied widely between studies and settings. Breastfeeding seems to have been under-researched. There was a lack of data available on other indicators such as the adolescent birth rate, postnatal care provided to women and newborns, intermittent preventative treatment to prevent malaria in pregnancy and treatment to prevent mother-to-child transmission of HIV. Studies demonstrate the high burden of preventable maternal and newborn morbidity and mortality across PNG. Efforts to improve MNH outcomes need to be escalated.
Roberts, L, Davis, GK & Homer, CSE 2019, 'Depression, Anxiety, and Post-traumatic Stress Disorder Following a Hypertensive Disorder of Pregnancy: A Narrative Literature Review', Frontiers in Cardiovascular Medicine, vol. 6.View/Download from: Publisher's site
Introduction: Pregnancy and childbirth can be a source of anxiety and worry for women. This is probably more so for women with a complicated pregnancy. Anxiety and worry may contribute to, or exacerbate, mental health disorders including depression and post-traumatic stress disorder (PTSD). Mental health is an integral part of health and well-being and poor mental health can be detrimental to the woman's welfare and her infant's behavior and cognitive development. It may be undetected, potentially leading to a burden on the woman, her family, the health system, and society. Women with complicated pregnancies, such as those with hypertensive disorders of pregnancy (HDP), may be at greater risk of poor mental health. The aim of this review was to examine whether there is an association between depression, anxiety, and PTSD in postpartum women with a history of HDP.
Methods: A narrative literature review was undertaken. Using the key search terms: preeclampsia, gestational hypertension, hypertensive disorders, pregnancy complications, depression, anxiety, and post-traumatic stress disorder; electronic databases were searched to determine what is known about depression, anxiety, and PTSD after HDP.
Results: In total, 17 publications were included. The relationship between HDP and depression, anxiety, and PTSD was variable between studies and inconsistent. Although some studies reported no significant association, there is a trend for increased prevalence and symptom severity of depression, anxiety, and PTSD following HDP. This trend was particularly evident following the more severe presentations of HDP. It was uncertain whether this association was due to the hypertensive disorder itself, the sequelae of the HDP, such as giving birth to a preterm baby, or it predated the pregnancy.
Conclusions: Women who experience HDP may be at increased risk of developing postpartum depression, anxiety, and PTSD. Awareness of, and screening for, these mental health disorders in...
Roth, H, LeMarquand, G, Henry, A & Homer, C 2019, 'Assessing Knowledge Gaps of Women and Healthcare Providers Concerning Cardiovascular Risk After Hypertensive Disorders of Pregnancy-A Scoping Review.', Frontiers in cardiovascular medicine, vol. 6.View/Download from: Publisher's site
Background: A history of a Hypertensive Disorder of Pregnancy (HDP) at least doubles a woman's risk of cardiovascular disease (CVD). The risk increases within 10 years after HDP and continues for life, making long-term health after HDP of major public health importance. Understanding knowledge gaps in health care professionals and women regarding cardiovascular health after HDP is an important component in addressing these risks. Objectives: The primary aim was to examine what women and healthcare providers (HCP) know about cardiovascular risks after HDP. The secondary aims were to identify enablers and barriers to knowledge and action on knowledge. Methods: A scoping review was conducted. This was a narrative synthesis, using PRISMA-ScR guidelines, of English-language full text articles that included assessment of knowledge of women, and/or HCP, on long term cardiovascular risk after HDP. The databases Embase, Medline, Scopus, ProQuest, Cochrane, and PsycInfo were searched from 01 January 2005 to 31 May 2019. Results: Twelve studies were included, six addressing women's knowledge, five addressing HCP knowledge, and one addressing both. The studies included 402 women and 1,215 HCP from seven countries. Regarding women's knowledge, six of seven studies found women had limited or no knowledge about the link between HDP and CVD. Where women were aware of the link, the majority had sourced their own information, rather than obtaining it through their HCP. In five of six studies, HCP also mostly had limited knowledge about HDP-CVD links. Primary enablers for HCP acquisition of knowledge and counseling were the availability and knowledge of guidelines. Where comparisons between HCP groups were made, obstetricians had greater knowledge than family physicians, internal medical specialists, or midwives. Conclusion: There was a low level of knowledge amongst HCP and women about increased CVD risk after HDP. Where women had higher levels of knowledge, the information was of...
Vallely, AJ, Pomat, WS, Homer, C, Guy, R, Luchters, S, Mola, GDL, Kariwiga, G, Vallely, LM, Wiseman, V, Morgan, C, Wand, H, Rogerson, SJ, Tabrizi, SN, Whiley, DM, Low, N, Peeling, R, Siba, P, Riddell, M, Laman, M, Bolnga, J, Robinson, LJ, Morewaya, J, Badman, SG, Batura, N, Kelly-Hanku, A, Toliman, PJ, Peter, W, Babona, D, Peach, E, Garland, SM & Kaldor, JM 2019, 'Point-of-care testing and treatment of sexually transmitted infections to improve birth outcomes in high-burden, low-income settings: Study protocol for a cluster randomized crossover trial (the wantaim trial, papua new guinea) [version 2; peer review: 1 approved, 1 approved with reservations]', Wellcome Open Research, vol. 4.View/Download from: Publisher's site
© 2019 Vallely AJ et al. Background: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and bacterial vaginosis have been associated with preterm birth and low birth weight, and are highly prevalent among pregnant women in many low-and middle-income settings. There is conflicting evidence on the potential benefits of screening and treating these infections in pregnancy. Newly available diagnostic technologies make it possible, for the first time, to conduct definitive field trials to fill this knowledge gap. The primary aim of this study is to evaluate whether antenatal point-of-care testing and immediate treatment of these curable sexually transmitted and genital infections (STIs) leads to reduction in preterm birth and low birth weight. Methods: The Women and New born Trial of Antenatal Interventions and Management (WANTAIM) is a cluster-randomised crossover trial in Papua New Guinea to compare point-of-care STI testing and immediate treatment with standard antenatal care (which includes the WHO-endorsed STI 'syndromic' management strategy based on clinical features alone without laboratory confirmation). The unit of randomisation is a primary health care facility and its catchment communities. The primary outcome is a composite measure of two events: the proportion of women and their new borns in each trial arm, who experience either preterm birth (delivery <37 completed weeks of gestation as determined by ultrasound) and/or low birth weight (<2500 g measured within 72 hours of birth). The trial will also evaluate neonatal outcomes, as well as the cost-effectiveness, acceptability and health system requirements of this strategy, compared with standard care. Conclusions: WANTAIM is the first randomised trial to evaluate the effectiveness, cost-effectiveness, acceptability and health system requirements of point-of-care STI testing and treatment to improve birth outcomes in high-burden settings. If the intervention is proven to have an impact, t...
Vallely, LM, Emori, R, Gouda, H, Phuanukoonnon, S, Homer, C & Vallely, AJ 2019, 'Women's knowledge of maternal danger signs during pregnancy: Findings from a cross-sectional survey in Papua New Guinea.', Midwifery, vol. 72, pp. 7-13.View/Download from: Publisher's site
OBJECTIVE:To explore knowledge of pregnancy related danger signs among women attending antenatal clinics in Papua New Guinea. DESIGN:Cross-sectional survey undertaken as part of a wider integrated health and demographic survey. SETTING:Three sites in Papua New Guinea: Hiri District (Central Province), Karkar (Madang Province) and Asaro (Eastern Highlands Province). PARTICIPANTS:482 women aged 15-44 years. FINDINGS:Almost all (95.2%; 459/482) women attended for antenatal care at least once; 68.2% attended four or more times. Among women who attended the antenatal clinic, 53.6% (246/459) reported receiving information about danger signs in pregnancy from a health worker. Of these 60.2% (148/246) could recall at least one danger sign. In addition, 16.4% (35/213) of women who did not receive information from the antenatal clinic reported pregnancy related danger signs. Among the 183 women who reported danger signs, 47.5% (87/183) reported fever; 39.3% (72/183) reported vaginal bleeding and 36.6% (67/183) reported swelling of the face, legs and arms. Women who reported receiving information at the antenatal clinic were significantly more likely know any danger signs, compared with women who did not receive information at the antenatal clinic (OR 7.68 (95%CI: 4.93, 11.96); p = <0.001). Knowledge of danger signs was significantly associated with secondary school education, compared with none or only primary education (OR 3.08 (95% CI: 2.06, 4.61); p = <0.001). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:Every antenatal clinic visit should be used opportunistically to provide women with information about key danger signs during pregnancy and childbirth. Recognising maternal danger signs, together with the importance of seeking early transfer to the health facility and the importance of attending for a health facility birth are critical to improving outcomes for mothers and babies especially in low income settings such as Papua New Guinea.
Zeki, R, Li, Z, Wang, AY, Homer, CSE, Oats, JJN, Marshall, D & Sullivan, EA 2019, 'Obstetric anal sphincter injuries among women with gestational diabetes and women without gestational diabetes: A NSW population-based cohort study', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 59, no. 5, pp. 662-669.View/Download from: Publisher's site
Scarf, VL, Viney, R, Yu, S, Foureur, M, Rossiter, C, Dahlen, H, Thornton, C, Cheah, SL & Homer, CSE 2019, 'Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012', BMC Pregnancy and Childbirth, vol. 19, no. 1.View/Download from: Publisher's site
Sheehy, A, Smith, RM, Gray, JE & Homer, CSE 2019, 'Midwifery pre-registration education and mid-career workforce participation and experiences.', Women and birth : journal of the Australian College of Midwives, vol. 32, no. 2, pp. e182-e188.View/Download from: Publisher's site
Midwives in Australia are educated through a range of routes providing flexible ways to become a midwife. Little is known about whether the route to registration impacts on mid-career experiences, in particular, whether the pathway (post-nursing pathway compared with 'direct-entry') makes any difference.The aim of this study was to explore the midwifery workforce experiences and participation in graduates six to seven years after completing either a post-nursing Graduate Diploma in Midwifery (GradDip) or an undergraduate degree, the Bachelor of Midwifery (BMid), from one university in New South Wales, Australia.Data were collected from mid-career midwives having graduated from one NSW university from 2007-2008 using a survey. The survey included validated workforce participation instruments - the Maslach Burnout Inventory (MBI), the Practice Environment Scale-Nursing Work Index (PES-NWI) and the Perceptions of Empowerment in Midwifery Scale (PEMS).There were 75 respondents: 40% (n=30) Bachelor of Midwifery and 60% (n=45) GradDip graduates. The age range was 27-56 years old (mean age=36 years) Bachelor of Midwifery graduates being on average 7.6 years older than Graduate Diploma in Midwifery graduates (40 vs 33 years; p<0.01). Almost 80% (59), were currently working in midwifery. Nine of the 12 not working in midwifery (75%) planned to return. There were no differences in workforce participation measures between the two educational pathways. Working in a continuity of care model was protective in regards to remaining in the profession.Most mid-career graduates were still working in midwifery. There were no differences between graduates from the two pathways in relation to burnout, practice experiences or perceptions of empowerment.
Rossiter, C, Fowler, C, Hesson, A, Kruske, S, Homer, CSE & Schmied, V 2019, 'Australian parents' use of universal child and family health services: A consumer survey.', Health and Social Care in the Community, vol. 27, no. 2, pp. 472-482.View/Download from: Publisher's site
This study aimed to explore Australian parents' use of universally available well-child health services. It used an online survey of 719 parents of children aged from birth to 5 years in all states and territories to examine patterns of service use and consumer preferences. In Australia, several health professional groups provide advice to pregnant women, infants, children, and parents, offering health promotion, developmental screening, parenting support, and referral to specialist health services if required. The survey examined parents' use of different child and family health providers, and their preferences for support with several common parenting issues. The study indicated that families with young children obtain primary healthcare from a range of service providers, often more than one, depending on children's ages and needs. Parents frequently visit general practitioners for immunisation and medical concerns. They attend dedicated child and family health nurses for parenting advice and well-child checks and prefer them as an information source for many health issues. However, a substantial proportion of parents (44.1%) do not currently visit a child and family health nurse, often because they not only do not perceive a need but also sometimes because these services are unknown, inaccessible, or considered unsuitable. They may seek advice from less qualified sources. There is potential for increased collaboration between child and family health providers to ensure effective resource use and consistency of parenting information and advice. Nursing services may need to address accessibility and appropriateness of care.
Rossiter, C, Fowler, C, Hesson, A, Kruske, S, Homer, CSE, Kemp, L & Schmied, V 2019, 'Australian parents' experiences with universal child and family health services', Collegian, vol. 26, pp. 321-328.View/Download from: Publisher's site
© 2018 Australian College of Nursing Ltd Background: Australian governments provide free services to promote maternal and child health, and to support parenting for families with children up to age five. Services are principally provided by dedicated child and family health nurses, but also by general practitioners, practice nurses, pharmacy nurses and midwives. Aim: This study aimed to examine the experiences of families with young children across Australia in accessing and receiving health care for well children, parenting support and advice from a range of providers. Methods: The study used quantitative and qualitative data from an online survey of 719 parents and carers with children aged up to five years. Findings: On quantitative scales, most respondents rated healthcare providers favourably for accessibility, credibility and their approach to families. However, qualitative responses revealed widely varying reactions to child and family health provision. Parents described both positive and negative experiences, highlighting elements of practice that are critical to consumer engagement. Discussion: Parents require health care and support that are accessible, consistent, affordable, encouraging, trustworthy, evidence-based and non-judgemental. Parents feel more confidence in the information and care provided by health professionals who are well-informed, resourceful and who respect their knowledge and beliefs. Conclusion: The findings demonstrate ways in which child and family health providers can engage and effectively support families with young children.
Turkmani, S, Homer, CSE & Dawson, A 2019, 'Maternity care experiences and health needs of migrant women from female genital mutilation-practicing countries in high-income contexts: A systematic review and meta-synthesis.', Birth, vol. 46, pp. 3-14.View/Download from: Publisher's site
Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for nontherapeutic indications. Due to changing patterns of migration, clinicians in high-income countries are seeing more women from countries where the practice is prevalent. This review aims to understand the sociocultural and health needs of these women and identify opportunities to improve the quality of maternity care for women with FGM.We undertook a systematic review and meta-synthesis of peer-reviewed primary qualitative research to explore the experience and needs of migrant women with FGM receiving maternity care. A structured search of nine databases was undertaken, screened papers appraised, and a thematic analysis undertaken on data extracted from the findings and discussion sections of included papers.Sixteen peer-reviewed studies were included in the systematic review. Four major themes were revealed: Living with fear, stigma, and anxiety; Feelings of vulnerability, distrust, and discrimination; Dealing with past and present ways of life after resettlement; and Seeking support and involvement in health care.The findings suggest that future actions for improving maternity care quality should be focused on woman-centered practice, demonstrating cultural safety and developing mutual trust between a woman and her care providers. Meaningful consultation with women affected by FGM in high-income settings requires cultural sensitivity and acknowledgment of their specific circumstances. This can be achieved by engaging women affected by FGM in service design to provide quality care and ensure woman-focused policy is developed and implemented.
Fox, D, Sheehan, A & Homer, C 2018, 'Birthplace in Australia: Processes and interactions during the intrapartum transfer of women from planned homebirth to hospital', MIDWIFERY, vol. 57, pp. 18-25.View/Download from: Publisher's site
Fox, D, Sheehan, A & Homer, CS 2018, 'Birthplace in Australia: Antenatal preparation for the possibility of transfer from planned home birth.', Midwifery, vol. 66, pp. 134-140.View/Download from: Publisher's site
The aim of the study was to explore how women and midwives prepare, during the antenatal period, for the possibility of intrapartum transfer from planned home birth.A Constructivist Grounded Theory approach was taken in order to focus upon the social interactions and processes that emerged.Urban and regional areas in four states of south eastern Australia.Thirty-one semi-structured interviews were conducted with women and midwives.There were three sub-categories relating to preparation for the possibility of transfer. These were 'Building the midwife-woman partnership', 'Fostering professional connections' and 'Reducing uncertainty'. The reciprocal trust inherent in the midwife-woman partnership helped women feel safe in relation to the possibility of intrapartum transfer to hospital. Midwives who had positive transfer experiences spoke about their commitment to fostering professional connections with hospitals and health professionals as a part of building the capacity for collaboration if, and when, a transfer occurred. Reducing uncertainty involved preparation that included not only providing information and emotional support to the woman around the possibility of transfer, but also arranging for her to book in to a back-up hospital.
Scarf, VL, Rossiter, C, Vedam, S, Dahlen, HG, Ellwood, D, Forster, D, Foureur, MJ, McLachlan, H, Oats, J, Sibbritt, D, Thornton, C & Homer, CSE 2018, 'Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis.', Midwifery, vol. 62, pp. 240-255.View/Download from: Publisher's site
BACKGROUND:The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal. Few have attempted to synthesise findings. OBJECTIVE:To compare maternal and perinatal outcomes from different places of birth via a systematic review of high-quality research, and meta-analysis of appropriate data (Prospero registration CRD42016042291). DESIGN:Reviewers searched CINAHL, Embase, Maternity and Infant Care, Medline and PsycINFO databases to identify studies comparing selected outcomes by place of birth among women with low-risk pregnancies in high-income countries. They critically appraised identified studies using an instrument specific to birth place research and then combined outcome data via meta-analysis, using RevMan software. FINDINGS:Twenty-eight articles met inclusion criteria, yielding comparative data on perinatal mortality, mode of birth, maternal morbidity and/or NICU admissions. Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:High-quality evidence ...
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Sevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking different questions: A call to action for research to improve the quality of care for every woman, every child', WOMEN AND BIRTH, vol. 31, no. 4, pp. 242-243.View/Download from: Publisher's site
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Stevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking different questions: A call to action for research to improve the quality of care for every woman, every child', MIDWIFERY, vol. 65, pp. 16-+.View/Download from: Publisher's site
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Stevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking Different Questions: A Call to Action for Research to Improve the Quality of Care for Every Woman, Every Child.', Journal of Midwifery and Women's Health, vol. 63, no. 5, pp. 516-517.View/Download from: Publisher's site
Kennedy, HP, Cheyney, M, Dahlen, HG, Downe, S, Foureur, MJ, Homer, CSE, Jefford, E, McFadden, A, Michel-Schuldt, M, Sandall, J, Soltani, H, Speciale, AM, Stevens, J, Vedam, S & Renfrew, MJ 2018, 'Asking different questions: A call to action for research to improve the quality of care for every woman, every child.', Birth (Berkeley, Calif.), vol. 45, no. 3, pp. 222-231.View/Download from: Publisher's site
Despite decades of considerable economic investment in improving the health of families and newborns world-wide, aspirations for maternal and newborn health have yet to be attained in many regions. The global turn toward recognizing the importance of positive experiences of pregnancy, intrapartum and postnatal care, and care in the first weeks of life, while continuing to work to minimize adverse outcomes, signals a critical change in the maternal and newborn health care conversation and research prioritization. This paper presents "different research questions" drawing on evidence presented in the 2014 Lancet Series on Midwifery and a research prioritization study conducted with the World Health Organization. The results indicated that future research investment in maternal and newborn health should be on "right care," which is quality care that is tailored to individuals, weighs benefits and harms, is person-centered, works across the whole continuum of care, advances equity, and is informed by evidence, including cost-effectiveness. Three inter-related research themes were identified: examination and implementation of models of care that enhance both well-being and safety; investigating and optimizing physiological, psychological, and social processes in pregnancy, childbirth, and the postnatal period; and development and validation of outcome measures that capture short and longer term well-being. New, transformative research approaches should account for the underlying social and political-economic mechanisms that enhance or constrain the well-being of women, newborns, families, and societies. Investment in research capacity and capability building across all settings is critical, but especially in those countries that bear the greatest burden of poor outcomes. We believe this call to action for investment in the three research priorities identified in this paper has the potential to achieve these benefits and to realize the ambitions of Sustainable Developm...
Sandall, J, Tribe, RM, Avery, L, Mola, G, Visser, GH, Homer, CS, Gibbons, D, Kelly, NM, Kennedy, HP, Kidanto, H, Taylor, P & Temmerman, M 2018, 'Short-term and long-term effects of caesarean section on the health of women and children.', Lancet (London, England), vol. 392, no. 10155, pp. 1349-1357.View/Download from: Publisher's site
A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose-response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.
Beeson, JG, Homer, CSE, Morgan, C & Menendez, C 2018, 'Multiple morbidities in pregnancy: Time for research, innovation, and action', PLOS MEDICINE, vol. 15, no. 9.View/Download from: Publisher's site
Dalinjong, PA, Wang, AY & Homer, CSE 2018, 'Are health facilities well equipped to provide basic quality childbirth services under the free maternal health policy? Findings from rural Northern Ghana', BMC Health Services Research, vol. 18, no. 1.View/Download from: Publisher's site
© 2018 The Author(s). Background: Basic inputs and infrastructure including drugs, supplies, equipment, water and electricity are required for the provision of quality care. In the era of the free maternal health policy in Ghana, it is unclear if such basic inputs are readily accessible in health facilities. The study aimed to assess the availability of basic inputs including drugs, supplies, equipment and emergency transport in health facilities. Women and health providers' views on privacy and satisfaction with quality of care were also assessed. Methods: The study used a convergent parallel mixed methods in one rural municipality in Ghana, Kassena-Nankana. A survey among facilities (n = 14) was done. Another survey was carried out among women who gave birth in health facilities only (n = 353). A qualitative component involved focus group discussions (FGDs) with women (n = 10) and in-depth interviews (IDIs) with midwives and nurses (n = 25). Data were analysed using descriptive statistics for the quantitative study, while the qualitative data were recorded, transcribed, read and coded using themes. Results: The survey showed that only two (14%) out of fourteen facilities had clean water, and five (36%) had electricity. Emergency transport for referrals was available in only one (7%) facility. Basic drugs, supplies, equipment and infrastructure especially physical space were inadequate. Rooms used for childbirth in some facilities were small and used for multiple purposes. Eighty-nine percent (n = 314) of women reported lack of privacy during childbirth and this was confirmed in the IDIs. Despite this, 77% of women (n = 272) were very satisfied or satisfied with quality of care for childbirth which was supported in the FGDs. Reasons for women's satisfaction included the availability of midwives to provide childbirth services and to have follow-up homes visits. Some midwives were seen to be patient and empathetic. Providers were not satisfied due to health system...
Dalinjong, PA, Wang, AY & Homer, CSE 2018, 'The implementation of the free maternal health policy in rural Northern Ghana: Synthesised results and lessons learnt', BMC Research Notes, vol. 11, no. 1.View/Download from: Publisher's site
© 2018 The Author(s). Objective: A free maternal health policy was implemented under Ghana's National Health Insurance Scheme to promote the use of maternal health services. Under the policy, women are entitled to free services throughout pregnancy and at childbirth. A mixed methods study involving women, providers and insurance managers was carried out in the Kassena-Nankana municipality of Ghana. It explored the affordability, availability, acceptability and quality of services. In this manuscript, we present synthesised results categorised as facilitators and barriers to access as well as lessons learnt (implications). Results: Reasonable waiting times, cleanliness of facilities as well as good interpersonal relationships with providers were the facilitators to access. Barriers included out of pocket payments, lack of, or inadequate supply of drugs and commodities, equipment, water, electricity and emergency transport. Four lessons (implications) were identified. Firstly, out of pocket payments persisted. Secondly, the health system was not strengthened before implementing the free maternal health policy. Thirdly, lower level facilities were poorly resourced. Finally, the lack of essential inputs and infrastructure affected quality of care and therefore, access to care. It is suggested that the Government of Ghana, the Health Insurance Scheme and other stakeholders improve the provision of resources to facilities.
Hobday, K, Hulme, J, Belton, S, Homer, CS & Prata, N 2018, 'Community-based misoprostol for the prevention of post-partum haemorrhage: A narrative review of the evidence base, challenges and scale-up.', Global Public Health, vol. 13, no. 8, pp. 1081-1097.View/Download from: Publisher's site
Achieving Sustainable Development Goal targets for 2030 will require persistent investment and creativity in improving access to quality health services, including skilled attendance at birth and access to emergency obstetric care. Community-based misoprostol has been extensively studied and recently endorsed by the WHO for the prevention of post-partum haemorrhage. There remains little consolidated information about experience with implementation and scale-up to date. This narrative review of the literature aimed to identify the political processes leading to WHO endorsement of misoprostol for the prevention of post-partum haemorrhage and describe ongoing challenges to the uptake and scale-up at both policy and community levels. We review the peer-reviewed and grey literature on expansion and scale-up and present the issues central to moving forward.
Hobday, K, Hulme, J, Homer, C, Zualo Wate, P, Belton, S & Prata, N 2018, '"My job is to get pregnant women to the hospital": a qualitative study of the role of traditional birth attendants in the distribution of misoprostol to prevent post-partum haemorrhage in two provinces in Mozambique.', Reproductive health, vol. 15, no. 1, pp. 174-174.View/Download from: Publisher's site
BACKGROUND:Post-partum haemorrhage is the leading cause of maternal deaths in Mozambique. In 2015, the Mozambican Ministry of Health launched the National Strategy for the Prevention of Post-Partum Haemorrhage at the Community Level. The strategy included the distribution of misoprostol to women in advance at antenatal care and via Traditional Birth Attendants who directly administer the medication. The study explores the role of Traditional Birth Attendants in the misoprostol program and the views of women who used misoprostol to prevent post-partum haemorrhage. METHODS:This descriptive study collected data through in-depth interviews and focus group discussions. Traditional Birth Attendants between the ages of 30-70 and women of reproductive age participated in the study. Data was collected between June-October 2017 in Inhambane and Nampula Provinces. Line by line thematic analysis was used to interpret the data using Nvivo (v.11). RESULTS:The majority of TBAs in the study were satisfied with their role in the misoprostol program and were motivated to work with the formal health system to encourage women to access facility based births. Women who used misoprostol were also satisfied with the medication and encouraged family and friends to access it when needed. Women in the community and Traditional Birth Attendants requested assistance with transportation to reach the health facility to avoid home births. CONCLUSIONS:This study contributes to the evidence base that Traditional Birth Attendants are an appropriate channel for the distribution of misoprostol for the prevention of post-partum haemorrhage at the community level. More support and resources are needed to ensure Traditional Birth Attendants can assist women to have safe births when they are unable to reach the health facility. A consistent supply of misoprostol is needed to ensure women at the community level receive this life saving medication.
Homer, C 2018, 'Getting evidence into practice - Managing hares and tortoises.', Women and birth : journal of the Australian College of Midwives, vol. 31, no. 6, pp. 431-432.View/Download from: Publisher's site
Homer, CS, Oats, J, Middleton, P, Ramson, J & Diplock, S 2018, 'Updated clinical practice guidelines on pregnancy care.', The Medical journal of Australia, vol. 209, no. 9, pp. 409-412.View/Download from: Publisher's site
INTRODUCTION:The clinical practice guidelines on pregnancy care have been developed to provide reliable and standardised guidance for health professionals providing antenatal care in Australia. They were originally released as the Clinical Practice Guidelines: Antenatal Care in two separate editions (modules 1 and 2) in 2012 and 2014. These modules have now been combined and updated to form a single set of consolidated guidelines that were publicly released in February 2018 as the Clinical Practice Guidelines: Pregnancy Care. Eleven topics have been updated and new guidance on substance use in pregnancy has been added. Main recommendations: The updated guidelines include the following key changes to practice: recommend routine testing for hepatitis C at the first antenatal visit; recommend against routine testing for vitamin D status in the absence of a specific indication; recommend discussing weight change, diet and physical activity with all pregnant women; and recommend offering pregnant women the opportunity to be weighed at every antenatal visit and encouraging women to self-monitor weight gain. Changes in management as a result of the guidelines: The guidelines will enable pregnant women diagnosed with hepatitis C to be identified and thus avoid invasive procedures that increase the risk of mother-to-baby transmission. Women can be treated postpartum, reducing the risk of liver disease and removing the risk of perinatal infection for subsequent pregnancies. Routine testing of all pregnant women for vitamin D status and subsequent vitamin D supplementation is not supported by evidence and should cease as the benefits and harms of vitamin D supplementation remain unclear. The recommendation for health professionals to provide advice to pregnant women about weight, diet and physical activity, and the opportunity to be weighed will help women to make changes leading to better health outcomes for themselves and their babies.
Homer, CSE, Castro Lopes, S, Nove, A, Michel-Schuldt, M, McConville, F, Moyo, NT, Bokosi, M & ten Hoope-Bender, P 2018, 'Barriers to and strategies for addressing the availability, accessibility, acceptability and quality of the sexual, reproductive, maternal, newborn and adolescent health workforce: addressing the post-2015 agenda', BMC PREGNANCY AND CHILDBIRTH, vol. 18.View/Download from: Publisher's site
Smith, R, Wight, R & Homer, CSE 2018, ''Asking the hard questions': Improving midwifery students' confidence with domestic violence screening in pregnancy.', Nurse education in practice, vol. 28, pp. 27-33.View/Download from: Publisher's site
Domestic violence is a global public health issue. Midwives are ideally placed to screen for, and respond to, disclosure of domestic violence. Qualified midwives and midwifery students report a lack of preparedness and low levels of confidence in working with women who disclose domestic violence. This paper reports the findings from an education intervention designed to increase midwifery students' confidence in working with pregnant women who disclose domestic violence. An authentic practice video and associated interactive workshop was developed to bring the 'woman' into the classroom and to provide role-modelling of exemplary midwifery practice in screening for and responding to disclosure of domestic violence. The findings demonstrated that students' confidence increased in a number of target areas, such as responding appropriately to disclosure and assisting women with access to support. Students' confidence increased in areas where responses needed to be individualised as opposed to being able to be scripted. Students appreciated visual demonstration (video of authentic practice) and having the opportunity to practise responding to disclosures through experiential learning. Given the general lack of confidence reported by both midwives and students of midwifery in this area of practice, this strategy may be useful in supporting midwives, students and other health professionals in increasing confidence in working with women who are experiencing domestic violence.
Vallely, LM, Egli-Gany, D, Pomat, W, Homer, CSE, Guy, R, Wand, H, Silver, B, Rumbold, AR, Kaldor, JM, Low, N & Vallely, AJ 2018, 'Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae, Mycoplasma genitalium, M-hominis, Ureaplasma urealyticum and U-parvum: a systematic review and meta-analysis protocol', BMJ OPEN, vol. 8, no. 11.View/Download from: Publisher's site
Wang, A, Homer, C & Dalinjong, PA 2018, 'Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana', PLoS ONE.View/Download from: Publisher's site
The free maternal health policy was implemented in Ghana in 2008 under the National Health Insurance Scheme (NHIS). The policy sought to eliminate out of pocket (OOP) payments and enhance the utilisation of maternal health services. It is unclear whether the policy had altered OOP payments for services. The study explored views on costs and actual OOP payments during pregnancy. The source of funding for payments was also explored.
A convergent parallel mixed methods design, involving quantitative and qualitative data collection approaches. The study was set in the Kassena-Nankana municipality, a rural area in Ghana. Women (n = 406) who utilised services during pregnancy were surveyed. Also, 10 focus groups discussions (FGDs) were held with women who used services during pregnancy as well as 28 in-depth interviews (IDIs) with midwives/nurses (n = 25) and insurance managers/directors (n = 3). The survey was analysed using descriptive statistics, focussing on costs from the women's perspective. Qualitative data were audio recorded, transcribed and translated verbatim into English where necessary. The transcripts were read and coded into themes and sub-themes.
The NHIS did not cover all expenses in relation to maternal health services. The overall mean for OOP cost during pregnancy was GH¢17.50 (US$8.60). Both FGDs and IDIs showed that women especially paid for drugs and ultrasound scan services. Sixty-five percent of the women used savings, whilst twenty-two percent sold assets to meet the OOP cost. Some women were unable to afford payments due to poverty and had to forgo treatment. Participants called for payments to be eliminated and for the NHIS to absorb the cost of emergency referrals. All participants admitted the benefits of the policy.
Women needed to make payments despite the policy. Measures should be put in place to eliminate payments to enable all women to receive services and promote universal health coverage.
Xu, F, Roberts, L, Binns, C, Sullivan, E & Homer, CSE 2018, 'Anaemia and depression before and after birth: a cohort study based on linked population data.', BMC psychiatry, vol. 18, no. 1, pp. 224-224.View/Download from: Publisher's site
To investigate the rates of hospitalisation for anaemia and depression in women in the six-year period (3 years before and after birth). To compare hospital admissions for depression in women with and without anaemia.This is a population-based cohort study. Women's birth records (New South Wales (NSW) Perinatal Data Collection) were linked with NSW Admitted Patients Data Collection records between 1 January 2001 and 31 December 2010, so that hospital admissions for mothers could be traced back for 3 years before birth and followed up 3 years after birth.NSW Australia.all women who gave birth to their first child in NSW between 1 January 2004 and 31 December 2008.Hospital admissions for both anaemia and depression were increased significantly in the year just before and after birth compared with the years before and after. Women with anaemia were more likely to be admitted to hospital for depression than those without (for principal diagnosis of depression, adjusted OR = 1.62, 95% CI = 1.25-2.11; for all diagnosis of depression, adjusted OR = 2.01, 95% CI = 1.70-2.38).Depression was associated with anaemia in women before and after birth. This finding highlight the important role of primary care providers in assessing for both anaemia and depressive symptomatology together, given the relationship between the two. Treating or preventing anaemia may help to prevent postnatal depression.
Zeki, R, Oats, JJN, Wang, AY, Li, Z, Homer, CSE & Sullivan, EA 2018, 'Cesarean section and diabetes during pregnancy: An NSW population study using the Robson classification.', The journal of obstetrics and gynaecology research, vol. 44, no. 5, pp. 890-898.View/Download from: Publisher's site
AIM:The aim of this study was to identify the main contributors to cesarean section (CS) among women with and without diabetes during pregnancy using the Robson classification and to compare CS rates within Robson groups. METHODS:A population-based cohort study was conducted of all women who gave birth in New South Wales, Australia, between 2002 and 2012. Women with pregestational diabetes (types 1 and 2) and gestational diabetes mellitus (GDM) were grouped using the Robson classification. Adjusted odd ratios (AOR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression. RESULTS:The total CS rate was 53.6% for women with pregestational diabetes, 36.8% for women with GDM and 28.5% for women without diabetes. Previous CS contributed the most to the total number of CS in all populations. For preterm birth, the contribution to the total was 20.5% for women with pregestational diabetes and 5.7% for women without diabetes. Compared to women without diabetes, for nulliparous with pregestational diabetes, the odds of CS was 1.4 (95% CI, 1.1-1.8) for spontaneous labor and 2.0 (95% CI, 1.7-2.3) for induction of labor. CONCLUSION:A history of CS was the main contributor to the total CS. Reducing primary CS is the first step to lowering the high rate of CS among women with diabetes. Nulliparous women were more likely to have CS if they had pregestational diabetes. This increase was also evident in all multiparous women giving birth. The high rate of preterm births and CS reflects the clinical issues for women with diabetes during pregnancy.
Zeki, R, Wang, AY, Lui, K, Li, Z, Oats, JJN, Homer, CSE & Sullivan, EA 2018, 'Neonatal outcomes of live-born term singletons in vertex presentation born to mothers with diabetes during pregnancy by mode of birth: a New South Wales population-based retrospective cohort study.', BMJ Paediatrics Open, vol. 2, no. 1, pp. e000224-e000224.View/Download from: Publisher's site
To investigate the association between the mode of birth and adverse neonatal outcomes of macrosomic (birth weight ≥4000 g) and non-macrosomic (birth weight <4000 g) live-born term singletons in vertex presentation (TSV) born to mothers with diabetes (pre-existing and gestational diabetes mellitus (GDM)).A population-based retrospective cohort study.New South Wales, Australia.All live-born TSV born to mothers with diabetes from 2002 to 2012.Comparison of neonatal outcomes by mode of birth (prelabour caesarean section (CS) and planned vaginal birth resulted in intrapartum CS, non-instrumental or instrumental vaginal birth).Five-minute Apgar score <7, admission to neonatal intensive care unit (NICU) or special care nursery (SCN) and the need for resuscitation.Among the 48 882 TSV born to mothers with diabetes, prelabour CS was associated with a significant increase in the rate of admission to NICU/SCN compared with planned vaginal birth.For TSV born to mothers with pre-existing diabetes, compared with non-instrumental vaginal birth, instrumental vaginal birth was associated with increased odds of the need for resuscitation in macrosomic (adjusted ORs (AOR) 2.6; 95% CI (1.2 to 7.5)) and non-macrosomic TSV (AOR 3.3; 95% CI (2.2 to 5.0)).For TSV born to mothers with GDM, intrapartum CS was associated with increased odds of the need for resuscitation compared with non-instrumental vaginal birth in non-macrosomic TSV (AOR 2.3; 95% CI (2.1 to 2.7)). Instrumental vaginal birth was associated with increased likelihood of requiring resuscitation compared with non-instrumental vaginal birth for both macrosomic (AOR 2.3; 95% CI (1.7 to 3.1)) and non-macrosomic (AOR 2.5; 95% CI (2.2 to 2.9)) TSV.Pregnant women with diabetes, particularly those with suspected fetal macrosomia, need to be aware of the increased likelihood of adverse neonatal outcomes following instrumental vaginal birth and intrapartum CS when planning mode of birth.
Sheehy, A, Gray, J, Smith, R & Homer, C 2018, 'Midwifery pre-registration education and career workforce participation and experiences', Women and Birth, vol. 31, pp. S10-S10.View/Download from: Publisher's site
Cummins, AM, Catling, C & Homer, CSE 2018, 'Enabling new graduate midwives to work in midwifery continuity of care models: A conceptual model for implementation.', Women and Birth, vol. 31, no. 8, pp. 343-349.View/Download from: Publisher's site
High-level evidence demonstrates midwifery continuity of care is beneficial for women and babies. Women have limited access to midwifery continuity of care models in Australia. One of the factors limiting women's access is recruiting enough midwives to work in continuity. Our research found that newly graduated midwives felt well prepared to work in midwifery led continuity of care models, were well supported to work in the models and the main driver to employing them was a need to staff the models. However limited opportunities exist for new graduate midwives to work in midwifery continuity of care.The aim of this paper therefore is to describe a conceptual model developed to enable new graduate midwives to work in midwifery continuity of care models.The findings from a qualitative study were synthesised with the existing literature to develop a conceptual model that enables new graduate midwives to work in midwifery continuity of care.The model contains the essential elements to enable new graduate midwives to work in midwifery continuity of care models.Each of the essential elements discussed are to assist midwifery managers, educators and new graduates to facilitate the organisational changes required to accommodate new graduates.The conceptual model is useful to show maternity services how to enable new graduate midwives to work in midwifery continuity of care models.
Thiessen, J, Bagoi, A, Homer, C & Rumsey, M 2018, 'Qualitative evaluation of a public-private partnership for reproductive health training in Papua New Guinea.', Rural and remote health, vol. 18, no. 4, pp. 4608-4608.View/Download from: Publisher's site
INTRODUCTION:The recent policy environment in both Papua New Guinea and Australia for partnering with private entities to address health issues has led to a public-private partnership (PPP) between the National Department of Health in Papua New Guinea, the Australian Government and the Oil Search Foundation. A reproductive health training unit was formed to provide health worker training in essential obstetric care and emergency obstetric care. This article provides a qualitative evaluation of the PPP, looking at facilitating features and barriers to the PPP's target of improving the competence of frontline health workers in obstetric care service provision in Papua New Guinea. METHOD:A qualitative methodology gathered data since the PPP's inception in 2012. A dataset of 85 interviews with partners and relevant stakeholders from across Papua New Guinea was analysed using thematic analysis. RESULTS:Themes of facilitating features of the PPP were (1) understanding and agreeing with the national plan for PPPs and maternal and child health; (2) having strong champions, strong relationships and a formal decision-making body; and (3) creating autonomy and branding. Themes outlining the barriers to the PPP's effectiveness were (1) lacking governance framework creating confusion in decision making and roles and responsibilities; (2) differing institutional cultures and ownership struggles; and (3) lacking capacity within the institutes themselves, particularly the National Department of Health. CONCLUSION:The findings of this service provision case study confirm what has been found in other infrastructure-led PPPs. Further research into how to overcome power imbalances between partners in a PPP as well as setting up a governance framework in a dynamic environment could inform this growing area of collaboration between the private and public sectors.
Turkmani, S, Homer, C, Varol, N & Dawson, A 2018, 'A survey of Australian midwives' knowledge, experience, and training needs in relation to female genital mutilation', Women and Birth, vol. 31, no. 1, pp. 25-30.View/Download from: Publisher's site
Female genital mutilation (FGM) involves partial or total removal of the external female genitalia or any other injury for non-medical reasons. Due to international migration patterns, health professionals in high income countries are increasingly caring for women with FGM. Few studies explored the knowledge and skills of midwives in high income countries.
To explore the knowledge, experience and needs of midwives in relation to the care of women with FGM.
An online self-administered descriptive survey was designed and advertised through the Australian College of Midwives' website.
Of the 198 midwives (24%) did not know the correct classification of FGM. Almost half of the respondents (48%) reported they had not received FGM training during their midwifery education. Midwives (8%) had been asked, or knew of others who had been asked to perform FGM in Australia. Many midwives were not clear about the law or health data related to FGM and were not aware of referral paths for affected women.
As frontline providers, midwives must have appropriate up-to-date clinical skills and knowledge to ensure they are able to provide women with FGM the care they need and deserve. Midwives have a critical role to play in the collection of FGM related data to assist with health service planning and to prevent FGM by working closely with women and communities they serve to educate and advocate for its abandonment. Therefore, addressing educational gaps and training needs are key strategies to deliver optimal quality of care.
Petrovska, K, Sheehan, A & Homer, CSE 2017, 'Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports.', Journal of Midwifery and Womens Health, vol. 62, no. 4, pp. 434-441.View/Download from: Publisher's site
INTRODUCTION: Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. METHODS: Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. RESULTS: A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. DISCUSSION: Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth.
Ten Hoope-Bender, P, Nove, A, Sochas, L, Matthews, Z, Homer, CSE & Pozo-Martin, F 2017, 'The 'Dream Team' for sexual, reproductive, maternal, newborn and adolescent health: an adjusted service target model to estimate the ideal mix of health care professionals to cover population need.', Human Resources for Health, vol. 15, no. 1, pp. 1-17.View/Download from: Publisher's site
BACKGROUND: A competent, enabled and efficiently deployed health workforce is crucial to the achievement of the health-related sustainable development goals (SDGs). Methods for workforce planning have tended to focus on 'one size fits all' benchmarks, but because populations vary in terms of their demography (e.g. fertility rates) and epidemiology (e.g. HIV prevalence), the level of need for sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workers also varies, as does the ideal composition of the workforce. In this paper, we aim to provide proof of concept for a new method of workforce planning which takes into account these variations, and allocates tasks to SRMNAH workers according to their competencies, so countries can assess not only the needed size of the SRMNAH workforce, but also its ideal composition (the 'Dream Team'). METHODS: An adjusted service target model was developed, to estimate (i) the amount of health worker time needed to deliver essential SRMNAH care, and (ii) how many workers from different cadres would be required to meet this need if tasks were allocated according to competencies. The model was applied to six low- and middle-income countries, which varied in terms of current levels of need for health workers, geographical location and stage of economic development: Azerbaijan, Malawi, Myanmar, Peru, Uzbekistan and Zambia. RESULTS: Countries with high rates of fertility and/or HIV need more SRMNAH workers (e.g. Malawi and Zambia each need 44 per 10,000 women of reproductive age, compared with 20-27 in the other four countries). All six countries need between 1.7 and 1.9 midwives per 175 births, i.e. more than the established 1 per 175 births benchmark. CONCLUSIONS: There is a need to move beyond universal benchmarks for SRMNAH workforce planning, by taking into account demography and epidemiology. The number and range of workers needed varies according to context. Allocation of tasks according to health worker compete...
Vedam, S, Rossiter, C, Homer, CSE, Stoll, K & Scarf, VL 2017, 'The ResQu Index: A new instrument to appraise the quality of research on birth place.', PLoS ONE, vol. 12, no. 8, pp. 1-19.View/Download from: Publisher's site
Place of birth is a known determinant of health care outcomes, interventions and costs. Many studies have examined the maternal and perinatal outcomes when women plan to give birth in hospitals compared with births in birth centres or at home. However, these studies vary substantially in rigour; assessing their quality is challenging. Existing research appraisal tools do not always capture important elements of study design that are critical when comparing outcomes by planned place of birth. To address this deficiency, we aimed to develop a reliable instrument to rate the quality of primary research on maternal and newborn outcomes by place of birth.The instrument development process involved five phases: 1) generation of items and a weighted scoring system; 2) content validation via a quantitative survey and a modified Delphi process with an international, multi-disciplinary panel of experts; 3) inter-rater consistency; 4) alignment with established research appraisal tools; and 5) pilot-testing of instrument usability.A Birth Place Research Quality Index (ResQu Index) was developed comprising 27 scored items that are summed to generate a weighted composite score out of 100 for studies comparing planned place of birth. Scale content validation indices were .89 for clarity, .94 for relevance and .90 for importance. The Index demonstrated substantial inter-rater consistency; pilot-testing confirmed feasibility and user-friendliness.The ResQu Index is a reliable instrument to evaluate the quality of design, methods and interpretation of reported outcomes from research about place of birth. Higher-scoring studies have greater potential to inform evidence-based selection of birth place by clinicians, policy makers, and women and their families. The Index can also guide the design of future research on place of birth.
Homer, CS, Leap, N, Edwards, N & Sandall, J 2017, 'Midwifery continuity of carer in an area of high socio-economic disadvantage in London: A retrospective analysis of Albany Midwifery Practice outcomes using routine data (1997-2009).', Midwifery, vol. 48, pp. 1-10.View/Download from: Publisher's site
OBJECTIVE: in 1997, The Albany Midwifery Practice was established within King's College Hospital NHS Trust in a South East London area of high social disadvantage. The Albany midwives provided continuity of care to around 216 women per year, including those with obstetric, medical or social risk factors. In 2009, the Albany Midwifery Practice was closed in response to concerns about safety, amidst much publicity and controversy. The aim of this evaluation was to examine trends and outcomes for all mothers and babies who received care from the practice from 1997-2009. DESIGN: a retrospective, descriptive analysis of data routinely collected over the 12.5 year period was undertaken including changes over time and outcomes by demographic features. SETTING AND PARTICIPANTS: all women booked with the Albany Midwifery Practice were included. FINDINGS: of the 2568 women included over the 12.5 year period, more than half (57%) were from Black, Asian and Minority Ethnic (BAME) communities; one third were single and 11.4% reported being single and unsupported. Almost all women (95.5%) were cared for in labour by either their primary or secondary midwife. There were high rates of spontaneous onset of labour (80.5%), spontaneous vaginal birth (79.8%), homebirth (43.5%), initiation of breastfeeding (91.5%) and breastfeeding at 28 days (74.3% exclusively and 14.8% mixed feeding). Of the 79% of women who had a physiological third stage, 5.9% had a postpartum haemorrhage. The overall rate of caesarean section was 16%. The preterm birth rate was low (5%). Ninety-five per cent of babies had an Apgar score of 8 or greater at 5minutes and 6% were admitted to a neonatal unit for more than two days. There were 15 perinatal deaths (perinatal mortality rate of 5.78 per 1000 births); two were associated with significant congenital abnormalities. There were no intrapartum intrauterine deaths. KEY CONCLUSIONS: this analysis has shown that the Albany Midwifery Practice demonstrated positive...
Coddington, R, Catling, C & Homer, CSE 2017, 'From hospital to home: Australian midwives' experiences of transitioning into publicly-funded homebirth programs.', Women and Birth, vol. 30, no. 1, pp. 70-76.View/Download from: Publisher's site
Over the past two decades, 14 publicly-funded homebirth models have been established in Australian hospitals. Midwives working in these hospitals now have the opportunity to provide homebirth care, despite many having never been exposed to homebirth before. The transition to providing homebirth care can be daunting for midwives who are accustomed to practising in the hospital environment.To explore midwives' experiences of transitioning from providing hospital to homebirth care in Australian public health systems.A descriptive, exploratory study was undertaken. Data were collected through in-depth interviews with 13 midwives and midwifery managers who had recent experience transitioning into and working in publicly-funded homebirth programs. Thematic analysis was conducted on interview transcripts.Six themes were identified. These were: skilling up for homebirth; feeling apprehensive; seeing birth in a new light; managing a shift in practice; homebirth-the same but different; and the importance of mentoring and support.Midwives providing homebirth work differently to those working in hospital settings. More experienced homebirth midwives may provide high quality care in a relaxed environment (compared to a hospital setting). Midwives acceptance of homebirth is influenced by their previous exposure to homebirth.The transition from hospital to homebirth care required midwives to work to the full scope of their practice. When well supported by colleagues and managers, midwives transitioning into publicly-funded homebirth programs can have a positive experience that allows for a greater understanding of and appreciation for normal birth.
Corcoran, PM, Catling, C & Homer, CSE 2017, 'Models of midwifery care for Indigenous women and babies: A meta-synthesis.', Women and Birth, vol. 30, no. 1, pp. 77-86.View/Download from: Publisher's site
Indigenous women in many countries experience a lack of access to culturally appropriate midwifery services. A number of models of care have been established to provide services to women. Research has examined some services, but there has not been a synthesis of qualitative studies of the models of care to help guide practice development and innovations.To undertake a review of qualitative studies of midwifery models of care for Indigenous women and babies evaluating the different types of services available and the experiences of women and midwives.A meta-synthesis was undertaken to examine all relevant qualitative studies. The literature search was limited to English-language published literature from 2000-2014. Nine qualitative studies met the inclusion criteria and literature appraisal - six from Australia and three from Canada. These articles were analysed for coding and theme development.The major themes were valuing continuity of care, managing structural issues, having negative experiences with mainstream services and recognising success.The most positive experiences for women were found with the services that provided continuity of care, had strong community links and were controlled by Indigenous communities. Overall, the experience of the midwifery services for Indigenous women was valuable. Despite this, there were still barriers preventing the provision of intrapartum midwifery care in remote areas.The expansion of midwifery models of care for Indigenous women and babies could be beneficial in order to improve cultural safety, experiences and outcomes in relation to pregnancy and birth.
Petrovska, K, Watts, NP, Catling, C, Bisits, A & Homer, CS 2017, ''Stress, anger, fear and injustice': An international qualitative survey of women's experiences planning a vaginal breech birth.', Midwifery, vol. 44, pp. 41-47.View/Download from: Publisher's site
OBJECTIVE: the outcomes of the Term Breech Trial had a profound impact on women's options for breech birth, with caesarean section now seen as the default method for managing breech birth by many clinicians. Despite this, the demand for planned vaginal breech birth from women does exist. This study aimed to examine the experiences of women who sought a vaginal breech birth to increase understanding as to how to care for women seeking this birth option. DESIGN: an electronic survey was distributed to women online via social media. The survey consisted of qualitative and quantitative questions, with the qualitative data being the focus of this paper. Open ended questions sought information on the ways in which woman sourced a clinician skilled in vaginal breech birth and the level of support and quality of information provided from clinicians regarding vaginal breech birth. Thematic analysis was used to analyse and code the qualitative data into major themes. FINDINGS: in total, 204 women from over seven countries responded to the survey. Written responses to the open ended questions were categorised into seven themes: Seeking the chance to try for a VBB; Encountering coercion and fear; Putting the birth before the baby?; Dealing with emotional wounds; Searching for information and support; Traveling across boundaries; Overcoming obstacles in the system. KEY CONCLUSIONS: for women seeking vaginal breech birth, limited system and clinical support can impede access to balanced information and options for care. Recognition of existing evidence on the safety of vaginal breech birth, as well as the presence of clinical guidelines that support it, may assist in promoting vaginal breech birth as a legitimate option that should be available to women.
Harte, D, Homer, CS, Sheehan, A, Leap, N & Foureur, M 2017, 'Using video in childbirth research: ethical approval challenges', Nursing Ethics, vol. 24, no. 2, pp. 177-189.View/Download from: Publisher's site
Hammond, A, Homer, CSE & Foureur, M 2017, 'Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting.', Midwifery, vol. 50, pp. 133-138.View/Download from: Publisher's site
OBJECTIVE: to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. DESIGN: this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews and a thematic analysis guided by study objectives and the aims of exploratory research was undertaken. SETTING: the study was set at a recently renovated tertiary hospital in a large Australian city. PARTICIPANTS: participants were 16 registered midwives working in a tertiary hospital; seven in delivery suite and nine in birth centre settings. Experience as a midwife ranged from three to 39 years and the sample included midwives in diverse roles such as educator, student support and unit manager. FINDINGS: three design characteristics were identified that supported midwifery practice. They were friendliness, functionality and freedom. Friendly rooms reduced stress and increased midwives' feelings of safety. Functional rooms enabled choice and provided options to better meet the needs of labouring women. And freedom allowed for flexible, spontaneous and responsive midwifery practice. CONCLUSION: hospital birth rooms that possess the characteristics of friendliness, functionality and freedom offer enhanced support for midwives and may therefore increase effective care provision. IMPLICATIONS FOR PRACTICE: new and existing birth rooms can be designed or adapted to better support the wellbeing and effectiveness of midwives and may thereby enhance the quality of midwifery care delivered in the hospital. Quality midwifery care is associated with positive outcomes and experiences for labouring women. Further research is required to investigate the benefit that may be transmitted to women by implementing design intended to support and enhance midwifery practice.
Sullivan, EA, Javid, N, Duncombe, G, Li, Z, Safi, N, Cincotta, R, Homer, CSE, Halliday, L & Oyelese, Y 2017, 'Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia.', Obstetrics and Gynecology, vol. 130, no. 3, pp. 591-598.View/Download from: Publisher's site
To estimate the incidence of women with vasa previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8-10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.
Dawson, A & Varol, N 2017, 'Continuing professional education on Female Genital Mutilation for obstetricians, gynecologists, and midwives in Australia: educational program development', BMC Reproductive Health, vol. 14, no. Supplement 2.View/Download from: Publisher's site
West, F, Dawson, A & Homer, CSE 2017, 'Building midwifery educator capacity using international partnerships: Findings from a qualitative study.', Nurse Education in Practice, vol. 25, pp. 66-73.View/Download from: Publisher's site
Midwifery educators play a critical role in strengthening the midwifery workforce globally, including in low and lower-middle income countries (LMIC) to ensure that midwives are adequately prepared to deliver quality midwifery care. The most effective approach to building midwifery educator capacity is not always clear. The aim of this study was to determine how one capacity building approach in Papua New Guinea (PNG) used international partnerships to improve teaching and learning. A qualitative exploratory case study design was used to explore the perspectives of 26 midwifery educators working in midwifery education institutions in PNG. Seven themes were identified which provide insights into the factors that enable and constrain midwifery educator capacity building. The study provides insights into strategies which may aid institutions and individuals better plan and implement international midwifery partnerships to strengthen context-specific knowledge and skills in teaching. Further research is necessary to assess how these findings can be transferred to other contexts.
Dalinjong, PA, Wang, A & Homer 2017, 'The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana.', Health Economics Review, vol. 7, no. 41, pp. 1-9.View/Download from: Publisher's site
To promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirth in one rural and poor area of Northern Ghana; the Kassena-Nankana municipality. Costs were taken from the perspective of women.
Quantitative and qualitative data collection techniques were used in a convergent parallel mixed methods study. The study used structured questionnaire (n = 353) and focus group discussions (FGDs =7) to collect data from women who gave birth in health facilities. Quantitative data from the questionnaire were analysed, using descriptive statistics. Qualitative data from the FGDs were recorded, transcribed and analysed to determine common themes.
The overall mean OOP payments during childbirth was GH¢33.50 (US$17), constituting 5.6% of the average monthly household income. Over one-third (36%, n = 145) of women incurred OOP payments which exceeded 10% of average monthly household income (potentially catastrophic). Sixty-nine percent (n = 245) of the women perceived that the NHIS did not cover all expenses incurred during childbirth; which was confirmed in the FGDs. Both survey and FGDs demonstrated that women made OOP payments for drugs and other supplies. The FGDs showed women bought disinfectants, soaps, rubber pads and clothing for newborns as well. Seventy-five percent (n = 264) of the women used savings, but 19% had to sell assets to finance the payments; this was supported in the FGDs.
The NHIS policy has not eliminated financial barriers associated with childbirth which impacts the welfare of some women. Women con...
Dalinjong, PA, Wang, A & Homer, C 2017, 'Demand- and supply-side factors affecting the availability of maternal health services during pregnancy in the era of the free maternal health policy: Views and perceptions of women and health providers in rural Northern Ghana', International Journal of Health Policy and Management.
Everitt, L, Homer, CS & Fenwick, J 2017, 'Working with vulnerable pregnant women who are at risk of having their babies removed by the Child Protection Agency in NSW Australia', Child Abuse Review, vol. 26, pp. 351-363.View/Download from: Publisher's site
In this paper, midwives' experiences of working with vulnerable pregnant women who were subject to child protection orders in New South Wales, Australia, and faced the possible removal of their baby at birth, known as 'assumption of care', are described. A qualitative descriptive approach was used to explore the experiences of ten midwives who had been involved in some 91 episodes of assumption of care. In‐depth interviews were undertaken and thematic analysis was used to analyse the data‐set. Four themes were elicited that demonstrated how midwives worked with vulnerable women and Community Services during the antenatal period. These were labelled: Reporting – Taking the first step; The woman‐midwife relationship remains a priority; Jumping through the 'community service' hoops; and Crunch time: The decision... sometimes justifiable sometimes not? Even though the three‐way relationship between the woman‐midwife‐Community Services could be confrontational, it was essential that midwives worked in a positive way with Community Services to improve outcomes for the woman and her unborn child
Khatri, RB, Dangi, TP, Gautam, R, Shrestha, KN & Homer, CSE 2017, 'Barriers to utilization of childbirth services of a rural birthing center in Nepal: A qualitative study.', PLoS ONE, vol. 12, no. 5, pp. 1-20.View/Download from: Publisher's site
BACKGROUND: Maternal mortality and morbidity are public health problems in Nepal. In rural communities, many women give birth at home without the support of a skilled birth attendant, despite the existence of rural birthing centers. The aim of this study was to explore the barriers and provide pragmatic recommendations for better service delivery and use of rural birthing centers. METHODS: We conducted 26 in-depth interviews with service users and providers, and three focus group discussions with community key informants in a rural community of Rukum district. We used the Adithya Cattamanchi logic model as a guiding framework for data analysis. RESULTS: Irregular and poor quality services, inadequate human and capital resources, and poor governance were health system challenges which prevented service delivery. Contextual barriers including difficult geography, poor birth preparedness practices, harmful culture practices and traditions and low level of trust were also found to contribute to underutilization of the birthing center. CONCLUSION: The rural birthing center was not providing quality services when women were in need, which meant women did not use the available services properly because of systematic and contextual barriers. Approaches such as awareness-raising activities, local resource mobilization, ensuring access to skilled providers and equipment and other long-term infrastructure development works could improve the quality and utilization of childbirth services in the rural birthing center. This has resonance for other centers in Nepal and similar countries.
Petrovska, K, Sheehan, A & Homer, CSE 2017, 'The fact and the fiction: A prospective study of internet forum discussions on vaginal breech birth', Women and Birth, vol. 30, no. 2, pp. e96-e102.View/Download from: Publisher's site
© 2016 Australian College of Midwives.Background: Women with a breech baby late in pregnancy may use the internet to gather information to assist in decision-making for birth. The aim of this study was to examine how women use English language internet discussion forums to find out information about vaginal breech birth and to increase understanding of how vaginal breech birth is perceived among women. Method: A descriptive qualitative study of internet discussion forums was undertaken. Google alerts were created with the search terms "breech birth" and "breech". Alerts were collected for a one-year period (January 2013-December 2013). The content of forum discussions was analysed using thematic analysis. Results: A total of 50 forum discussions containing 382 comments were collected. Themes that arose from the data were: . Testing the waters-which way should I go?; . Losing hope for the chance of a normal birth; . Seeking support for options-who will listen to me?; . Considering vaginal breech birth-a risky choice?; . Staying on the '. safe side'-caesarean section as a guarantee; . Exploring the positive potential for vaginal breech birth. Conclusion: Women search online for information about vaginal breech birth in an attempt to come to a place in their decision-making where they feel comfortable with their birth plan. This study highlights the need for clinicians to provide comprehensive, unbiased information on the risks and benefits of all options for breech birth to facilitate informed decision-making for the woman. This will contribute to improving the woman's confidence in distinguishing between "the fact and the fiction" of breech birth discussions online.
Petrovska, K, Watts, N, Sheehan, A, Bisits, A & Homer, C 2017, 'How do social discourses of risk impact on women's choices for vaginal breech birth? A qualitative study of women's experiences', Health, Risk and Society, vol. 19, no. 1-2, pp. 19-37.View/Download from: Publisher's site
© 2016 Informa UK Limited, trading as Taylor & Francis Group. In this article, we aim to explore the impact of social discourses of risk around childbirth on the decisions made for birth by women who planned to have a breech baby late in pregnancy. This article uses data from a qualitative descriptive study in New South Wales, Australia in 2013. In the study, we talked to 22 women about their decision-making process for planned a vaginal breech birth and the impact of social discourses of risk on this decision. In total, 12 of these women had a vaginal birth and the other 10 had a Caesarean section. In this article, we note that the mothers talked about their option for birth in a social setting in which the dominant discourse focused on the riskiness of breech birth and the vulnerability of female bodies that required medical surveillance, supervision and intervention to ensure a safe birth. Thus, for these mothers their pregnancy was seen through the societal lens of risk and medicalisation, with surgical intervention through a Caesarean section seen by society as the optimum choice. Women could resist this dominant discourse but such resistance required both justification and action, for example, the women who wanted a vaginal birth often had to resist the pressure from their families to have a Caesarean section. We identified four related strands in women's talk about resisting the dominate discourse: acknowledgment that they would be considered irrational for wanting a vaginal birth; having confidence in and believing that their body could give birth vaginally; convincing significant others that a vaginal birth was possible and desirable and looking for sources of support, for example, from new online social networks.
Roberts, LM, Davis, GK & Homer, CSE 2017, 'Pregnancy with gestational hypertension or preeclampsia: A qualitative exploration of women's experiences.', Midwifery, vol. 46, pp. 17-23.View/Download from: Publisher's site
BACKGROUND: Hypertension complicates 10% of pregnancies and involves specialised care of the woman and her baby, a longer stay in hospital, and an increased risk of physical and mental morbidity. There is limited research reporting the woman's perspective on her experience, how she coped with it psychologically, and whether the care she received influenced her experience. AIM: To gain insight into women's experience of hypertension in pregnancy and to report on what mediating factors may help improve their experience. METHODS: A qualitative descriptive study was undertaken. Data were collected through a semi-structured, face to face interview at 10-12 months postpartum. In total, 20 women who had experienced hypertension in their pregnancy were interviewed. Thematic analysis was used to analyse the data. FINDINGS: Four main themes were identified. These were: Reacting to the diagnosis, Challenges of being a mother, Processing and accepting the situation, and Moving on from the experience. The mediating factors that improved the experience were Feeling safe and trusting the care providers, Having continuity of care and carer, and Valuing social support from partner, family and friends. CONCLUSION: The diagnosis of hypertension in pregnancy has a significant impact on women. This affects their pregnancy and birth experience and their pathway to motherhood. The implications of the findings for midwifery practice include having access to multidisciplinary continuity models of care and facilitating the support for these women.
Xu, F, Sullivan, EA, Forero, R & Homer, CSE 2017, 'The association of Emergency Department presentations in pregnancy with hospital admissions for postnatal depression (PND): a cohort study based on linked population data.', BMC Emergency Medicine, vol. 17, no. 1, pp. 12-12.View/Download from: Publisher's site
BACKGROUND: To investigate the impact of presenting to an Emergency Department (ED) during pregnancy on postnatal depression (PND) in women in New South Wales (NSW), Australia. METHOD: An epidemiological population-based study using linked data from the NSW Emergency Department Data Collection (EDDC), the NSW Perinatal Data Collection (PDC) and the NSW Admitted Patients Data Collection (APDC) was conducted. Women who gave birth to their first child in NSW between 1 January 2006 and 31 December 2010 were followed up from pregnancy to the end of the first year after birth. RESULTS: The study population includes 154,328 women who gave birth to their first child in NSW between 2006 and 2010. Of these, 31,764 women (20.58%) presented to ED during pregnancy (95%CI = 20.38-20.78). Women who presented to ED during pregnancy were more likely to be admitted to hospital for the diagnosis of unipolar depression (the adjusted relative risk (RR) =1.86, 95%CI = 1.49-2.31) and the diagnosis of mild mental and behavioural disorders associated with the puerperium (the adjusted RR = 1.55, 95%CI = 1.29-1.87) than those without ED presentation. CONCLUSION: Women's hospital admissions for postnatal depression were associated with frequent ED presentations during pregnancy.
Olley, H, Psaila, K, Fowler, C, Kruske, S, Homer, C & Schmied, V 2017, ''Being the bridge and the beacon': a qualitative study of the characteristics and functions of the liaison role in child and family health services in Australia.', Journal of Clinical Nursing, vol. 26, no. 1-2, pp. 91-102.View/Download from: Publisher's site
This article explores the characteristics and functions of the liaison role in child and family health services in Australia.Liaison roles are increasingly being used to improve communication between health services and professionals and to facilitate access to support for individuals and families in need. Nurses are commonly, although not always, the professionals who undertake these roles. Research on the role and outcomes of liaison positions in child and family health services is limited in Australia and internationally.A qualitative interpretive design informed this study. Interviews and focus groups were conducted with 40 liaison and other health professionals, primarily nurses, working with families with newborn and young children in two Australian States. Data were analysed thematically.Three major themes were identified reflecting the importance of defining the role and tasks which included building bridges between services and professionals, supporting families during transition between services and supporting clinicians. Several facilitators and barriers were identified, including concerns about sustainability of the roles.Professionals working in a liaison role in child and family health services emphasise that these positions have the potential to link services and professionals, thereby providing more effective care pathways for children and families especially for those with complex and multiple vulnerabilities. While a few children and family health services in Australia provide liaison services, the extent of liaison support and the outcomes for families in Australia is unknown.Nurses working with children and families are the most likely health professionals to undertake a liaison role. In many nursing contexts, liaison roles are relatively new and those in the role have the responsibility to define the key purpose of their role. Liaison roles are multifaceted requiring the nurse to have excellent communication and negotiation skills to effectiv...
Rossiter, C, Schmied, V, Kemp, L, Fowler, C, Kruske, S & Homer, CSE 2017, 'Responding to families with complex needs: A national survey of child and family health nurses.', Journal of Advanced Nursing, vol. 73, no. 2, pp. 386-398.View/Download from: Publisher's site
To explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families.Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families.The descriptive study used cross-sectional data from the first national survey of child and family health nurses in Australia, conducted during 2011.Survey data reported how often, where and how child and family health nurses worked with families with complex needs and their confidence in nursing tasks.Many, but not all, of the 679 respondents saw families with complex needs in their regular weekly caseload. Child and family health nurses with diverse and complex caseloads reported using varied approaches to support their clients. They often undertook additional professional development and leadership roles compared with nurses who reported less complex caseloads. Most respondents reported high levels of professional confidence.For health services providing universal support and early intervention for families at risk, the findings underscore the importance of appropriate education, training and support for child and family health professionals. The findings can inform the organisation and delivery of services for families in Australia and internationally. This article is protected by copyright. All rights reserved.
Cummins, AM, Denney-Wilson, E & Homer, CSE 2017, 'The mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia.', Nurse Education in Practice, vol. 24, pp. 106-111.View/Download from: Publisher's site
The aim of this paper was to explore the mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia. Most new graduates find employment in hospitals and undertake a new graduate program rotating through different wards. A limited number of new graduate midwives were found to be working in midwifery continuity of care. The new graduate midwives in this study were mentored by more experienced midwives. Mentoring in midwifery has been described as being concerned with confidence building based through a personal relationship. A qualitative descriptive study was undertaken and the data were analysed using continuity of care as a framework. We found having a mentor was important, knowing the mentor made it easier for the new graduate to call their mentor at any time. The new graduate midwives had respect for their mentors and the support helped build their confidence in transitioning from student to midwife. With the expansion of midwifery continuity of care models in Australia mentoring should be provided for transition midwives working in this way.
Foureur, M, Turkmani, S, Clack, DC, Davis, DL, Mollart, L, Leiser, B & Homer, CSE 2017, 'Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians.', Women and Birth, vol. 30, no. 1, pp. 3-8.View/Download from: Publisher's site
One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section.Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC).To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women.A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted.The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted.Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.
BACKGROUND: Strengthening midwifery is a global priority. Recently, global evidence has provided momentum toward developing the midwifery workforce. In 2014, the State of the World's Midwifery 2014 Report explored midwifery services in 73 low to middle income countries. In the South Pacific region, only Papua New Guinea and the Solomon Islands were included. This means that there is little known on the state of midwifery in the small island countries in the South Pacific. AIM: To explore the current situation of the education, regulation and association of midwives in 12 small island nations of the South Pacific and determine the gaps in these areas. METHODS: A descriptive study was undertaken. Data were collected through a survey completed by key representatives (usually the Chief Nursing and Midwifery Officer) from each of the 12 countries. Ethical approval was received from the relevant Human Research Ethics Committee. FINDINGS: Many of the countries had few midwives, in some instances, only two midwives for the whole country. Midwifery education programs included post-graduate diploma, certificates and bachelor degrees. Midwives were required to be registered nurses in all countries. Regulation and licensing also varied - most countries did not have a separate licensing system for midwives. Only three countries have a specific professional association for midwives. CONCLUSION: The variation and the small number of midwives poses challenges for workforce planning. Consideration could be given to developing regional standards and potentially a shared curriculum framework. Ongoing collaboration and networking between countries is a critical part of future developments.
Turkmani, S, Homer, C, Varol, N & Dawson, A 2017, 'A survey of Australian midwives' knowledge, experience, and training needs in relation to female genital mutilation', Women and Birth, vol. 30, no. Supplement 1, pp. 30-30.View/Download from: Publisher's site
Introduction: Female genital mutilation (FGM) involves partial or total removal of the external female genitalia or any other injury for non-medical reasons. Due to international migration patterns, health professionals in high-income countries are increasingly caring for women with FGM. Few studies have explored the knowledge and skills of midwives in high-income countries.
Aim: To explore the knowledge, experience and needs of midwives in relation to the care of women with FGM in Australia
Methods: An online self-administrated descriptive survey was designed and advertised through the Australian College of Midwives' website and e-bulletin to explore the perspectives of midwives regarding the care of women with FGM across states and territories of Australia.
Results: The survey revealed gaps in midwives knowledge of FGM. Of the 198 midwives (24%) did not know the correct classification of FGM. Almost half of the respondents (48%) reported they had not received FGM training during their midwifery education. Midwives (8%) had been asked, or knew of others who had been asked to perform FGM in Australia. Many midwives were not clear about the law or collecting FGM related health data and were not aware of referral paths for affected women.
Conclusion: As frontline providers, midwives must have appropriate up-to-date clinical skills and knowledge to ensure they are able to provide women with FGM the care they need and deserve. Midwives have a critical role to play in the collection of FGM related data to assist with health service planning and to prevent FGM by working closely with women, their partners and communities they serve to educate and advocate for its abandonment. Therefore, addressing educational gaps and training needs are key strategies to deliver optimal quality of care.
Farquhar, CM, Li, Z, Lensen, S, McLintock, C, Pollock, W, Peek, MJ, Ellwood, D, Knight, M, Homer, CS, Vaughan, G, Wang, A & Sullivan, E 2017, 'Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case-control study.', BMJ Open, vol. 7, no. 10, pp. 1-9.View/Download from: Publisher's site
Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.Case-control study.Sites in Australia and New Zealand with at least 50 births per year.Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.Data were collected using the Australasian Maternity Outcomes Surveillance System.Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).The incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
Catling, C, Petrovska, K, Watts, N, Bisits, A & Homer, CS 2016, 'Barriers and facilitators for vaginal breech births in Australia: Clinician's experiences.', Women and Birth, vol. 29, no. 2, pp. 138-143.View/Download from: Publisher's site
Since the Term Breech Trial in 2000, few Australian clinicians have been able to maintain their skills to facilitate vaginal breech births. The overwhelming majority of women with a breech presentation have been given one birth option, that is, caesarean section. The aim of this study was to explore clinician's experiences of caring for women when facilitating a vaginal breech birth.A descriptive exploratory design was undertaken. Nine clinicians (obstetricians and midwives) from two tertiary hospitals in Australia who regularly facilitate vaginal breech birth were interviewed. The interviews were analysed thematically.Participants were five obstetricians and four midwives. There were two overarching themes that arose from the data: Facilitation of and Barriers to vaginal breech birth. A number of sub-themes are described in the paper.In order to facilitate vaginal breech birth and ensure it is given as an option to women, it is necessary to educate, upskill and support colleagues to increase their confidence and abilities, carefully counsel and select suitable women, and approach the option in a calm, collaborative way.
Catling, C, Petrovska, K, Watts, NP, Bisits, A & Homer, CS 2016, 'Care during the decision-making phase for women who want a vaginal breech birth: Experiences from the field.', Midwifery, vol. 34, pp. 111-116.View/Download from: Publisher's site
few women are given the option of a vaginal breech birth in Australia, unless the clinicians feel confident and have the skills to facilitate this mode of birth. Few studies describe how clinicians provide care during the decision-making phase for women who choose a vaginal breech birth. The aim of this study was to explore how experienced clinicians facilitated decisions about external cephalic version and mode of birth for women who have a breech presentation.a descriptive exploratory design was undertaken with nine experienced clinicians (obstetricians and midwives) from two tertiary hospitals in Australia. Data were collected through face to face interviews and analysed thematically.five obstetricians and four midwives participated in this study. All were experienced in caring for women having a vaginal breech birth and were currently involved in providing such a service. The themes that arose from the data were: Pitching the discussion, Discussing safety and risk, Being calm and Providing continuity of care.caring for women who seek a vaginal breech birth includes careful selection of appropriate women, full discussions outlining the risks involved, and undertaking care with a calm manner, ensuring continuity of care. Health services considering establishing a vaginal breech service should consider that these elements are included in the establishment and implementation processes.
In 1989, the first major state-wide report into maternity services, known as the Shearman Report after its author, was released in New South Wales, the most populous state in Australia.This paper reflects upon the report and tracks the progress of five of its key recommendations. The recommendations are still some of the major issues facing maternity services across the country. These are: community-based maternity care, rural maternity services, hospital visiting rights for privately practising midwives, obstetric intervention, and midwifery continuity of maternity care.In some ways, much has changed in 25 years including the terminology used in the report, the importance of midwifery continuity of care and the woman-centred nature of many services. However, in other ways, there is still a long way to go to address these major issues. Despite more than a quarter of a century, many recommendations have not been fulfilled, especially access to care in rural areas, rates of obstetric intervention, and the issue of visiting rights for privately practising midwives which has gone backwards.A continued and renewed effort is needed to ensure that the forward thinking recommendations of the Shearman Report are ultimately realised for all women and their families.
Petrovska, K, Watts, NP, Catling, C, Bisits, A & Homer, CSE 2016, 'Supporting Women Planning a Vaginal Breech Birth: An International Survey', Birth: Issues in Perinatal Care, vol. 43, no. 4, pp. 353-357.View/Download from: Publisher's site
The aim of this study was to explore the experiences of women who planned a vaginal breech birth.
An online survey was developed consisting of questions regarding women's experiences surrounding planned vaginal breech birth. The survey was distributed between April 2014 and January 2015 to closed membership Facebook groups that had a consumer focus on vaginal breech birth.
In total, 204 unique responses to the survey were obtained from women who had sought the option of a vaginal breech birth in a previous pregnancy. Most women (80.8%) stated that they were happy with the birth choices they made, and a significant proportion (89.4%) would attempt a vaginal breech birth in subsequent pregnancies. Less than half of women were formally referred to a clinician skilled in vaginal breech birth when their baby was diagnosed breech (41.8%), while the remainder sourced a clinician themselves. Half of the women felt supported by their care provider (56.7%) and less than half (42.3%) felt supported by family and friends.
The women who responded to this international survey sought the option of a vaginal breech birth, were subsequently happy with this decision, and would attempt a vaginal breech birth in their next pregnancy. Access to vaginal breech birth is important for some women; however, this choice may be challenging to achieve. Consistent information and support from clinicians is important to assist decision-making.
Watts, NP, Petrovska, K, Bisits, A, Catling, C & Homer, CSE 2016, 'This baby is not for turning: Women's experiences of attempted external cephalic version', BMC PREGNANCY AND CHILDBIRTH, vol. 16.View/Download from: Publisher's site
West, F, Homer, C & Dawson, A 2016, 'Building midwifery educator capacity in teaching in low and lower-middle income countries. A review of the literature', Midwifery, vol. 33, pp. 12-23.View/Download from: Publisher's site
© 2015 Elsevier Ltd. Aim and objective: midwifery educators play a critical role in strengthening the midwifery workforce in low and lower-middle income countries (LMIC) to ensure that women receive quality midwifery care. However, the most effective approach to building midwifery educator capacity is not always clear. This paper will explore approaches used to build midwifery educator capacity in LMIC and identify evidence to inform improved outcomes for midwifery education. Design: a structured search of bibliographic electronic databases (CINAHL, OVID, MEDLINE, PubMed) and the search engine Google Scholar was performed. It was decided to also review peer reviewed research, grey literature and descriptive papers. Papers were included in the review if they were written in English, published between 2000 and 2014 and addressed building knowledge and/or skills in teaching and/or clinical practice in midwifery educators who work in training institutions in LMIC. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was used to guide the reporting process. The quality of papers was appraised in discussion with all authors. The findings sections of the research papers were analysed to identify successful elements of capacity building approaches. Findings: eighteen (six research and 12 discursive) papers were identified as related to the topic, meeting the inclusion criteria and of sufficient quality. The findings were themed according to the key approaches used to build capacity for midwifery education. These approaches are: skill and knowledge updates associated with curriculum review, involvement in leadership, management and research training and, participation in a community of practice within regions to share resources. Key conclusions: the study provides evidence to support the benefits of building capacity for midwifery educators. Multilevel approaches that engaged individuals and institutions in building capacity alongside an enablin...
West, F, Homer, CS & Dawson, A 2016, 'Working Together to Build Midwifery Educator Capacity', International Journal of Evidence-Based Healthcare, vol. 14, pp. S40-S40.View/Download from: Publisher's site
Badman, SG, Vallely, LM, Toliman, P, Kariwiga, G, Lote, B, Pomat, W, Homer, C, Guy, R, Luchters, S, Morgan, C, Garland, SM, Tabrizi, S, Whiley, D, Rogerson, SJ, Mola, G, Wand, H, Donovan, B, Causer, L, Kaldor, J & Vallely, A 2016, 'A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: results of a feasibility study in Papua New Guinea', BMC Infectious Diseases, vol. 16, no. 1, pp. 1-6.View/Download from: Publisher's site
Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is feasible in the high-burden, low-income setting of Papua New Guinea.
Women attending their first antenatal clinic visit were invited to participate. CT/NG and TV were tested using the GeneXpert platform (Cepheid, USA), and BV tested using BVBlue (Gryphus Diagnostics, USA). Participants received same-day test results and antibiotic treatment as indicated. Routine antenatal care including HIV and syphilis screening were provided.
Point-of-care testing was provided to 125/222 (56 %) of women attending routine antenatal care during the three-month study period. Among the 125 women enrolled, the prevalence of CT was 20.0 %; NG, 11.2 %; TV, 37.6 %; and BV, 17.6 %. Over half (67/125, 53.6 %) of women had one or more of these infections. Most women were asymptomatic (71.6 %; 47/67). Women aged 24 years and under were more likely to have one or more STI compared with older women (odds ratio 2.38; 95 % CI: 1.09, 5.21). Most women with an STI received treatment on the same day (83.6 %; 56/67). HIV prevalence was 1.6 % and active syphilis 4.0 %.
Point-of-care STI testing and treatment using a combination of novel, newly-available assays was feasible during routine antenatal care in this setting. This strategy has not previously been evaluated...
© 2016 Australian College of Midwives. Background: In, many high and middle-income countries, childbearing women have a variety of birthplaces available to them including home, birth centres and traditional labour wards. There is good evidence indicating that birthplace impacts on outcomes for women but less is known about the impact on midwives. Aim: To explore the way that birthplace impacts on midwives in Australia and the United Kingdom. Method: A qualitative descriptive study was undertaken. Data were gathered through focus groups conducted with midwives in Australia and in the United Kingdom who worked in publicly-funded maternity services and who provided labour and birth care in at least two different settings. Findings: Five themes surfaced relating to midwifery and place including: 1. practising with the same principles; 2. creating ambience: controlling the environment; 3. workplace culture: being watched 4. Workplace culture: "busy work" versus "being with"; and 5. midwives' response to place. Discussion: While midwives demonstrate a capacity to be versatile in relation to the physicality of birthplaces, workplace culture presents a challenge to their capacity to "be with" women. Conclusion: Given the excellent outcomes of midwifery led care, we should focus on how we can facilitate the work of midwives in all settings. This study suggests that the culture of the birthplace rather than the physicality is the highest priority.
Davis, GK, Roberts, L, Mangos, G, Henry, A, Pettit, F, O'Sullivan, A, Homer, CSE, Craig, M, Harvey, SB & Brown, MA 2016, 'Postpartum physiology, psychology and paediatric follow up study (P4 Study) - Study protocol', PREGNANCY HYPERTENSION-AN INTERNATIONAL JOURNAL OF WOMENS CARDIOVASCULAR HEALTH, vol. 6, no. 4, pp. 374-379.View/Download from: Publisher's site
Hoope-Bender, PT, Lopes, ST, Nove, A, Michel-Schuldt, M, Moyo, NT, Bokosi, M, Codjia, L, Sharma, S & Homer, C 2016, 'Midwifery 2030: a woman's pathway to health. What does this mean?', Midwifery, vol. 32, pp. 1-6.View/Download from: Publisher's site
The 2014 State of the World's Midwifery report included a new framework for the provision of woman-centred sexual, reproductive, maternal, newborn and adolescent health care, known as the Midwifery2030 Pathway. The Pathway was designed to apply in all settings (high-, middle- and low-income countries, and in any type of health system). In this paper, we describe the process of developing the Midwifery2030 Pathway and explain the meaning of its different components, with a view to assisting countries with its implementation. The Pathway was developed by a process of consultation with an international group of midwifery experts. It considers four stages of a woman's reproductive life: (1) pre-pregnancy, (2) pregnancy, (3) labour and birth, and (4) postnatal, and describes the care that women and adolescents need at each stage. Underpinning these four stages are ten foundations, which describe the systems, services, workforce and information that need to be in place in order to turn the Pathway from a vision into a reality. These foundations include: the policy and working environment in which the midwifery workforce operates, the effective coverage of sexual, reproductive, maternal, newborn and adolescent services (i.e. going beyond availability and ensuring accessibility, acceptability and high quality), financing mechanisms, collaboration between different sectors and different levels of the health system, a focus on primary care nested within a functional referral system when needed, pre- and in-service education for the workforce, effective regulation of midwifery and strengthened leadership from professional associations. Strengthening of all of these foundations will enable countries to turn the Pathway from a vision into reality.
Lack, BM, Smith, RM, Arundell, MJ & Homer, CS 2016, 'Narrowing the Gap? Describing women's outcomes in Midwifery Group Practice in remote Australia.', Women and birth : journal of the Australian College of Midwives, vol. 29, pp. 465-470.View/Download from: Publisher's site
In Australia, Aboriginal women and babies experience higher maternal and perinatal morbidity and mortality rates than their non-Aboriginal counterparts. Whilst midwifery led continuity of care has been shown to be safe for women and their babies, with benefits including reducing the preterm birth rate, access to this model of care in remote areas remains limited. A Midwifery Group Practice was established in 2009 in a remote city of the Northern Territory, Australia, with the aim of improving outcomes and access to midwifery continuity of care.The aim of this paper is to describe the maternal and newborn outcomes for women accessing midwifery continuity of care in a remote context in Australia.A retrospective descriptive design using data from two existing electronic databases was undertaken and analysed descriptively.In total, 763 women (40% of whom were Aboriginal) gave birth to 769 babies over a four year period. There were no maternal deaths and the rate of perinatal mortality was lower than that across the Northern Territory. Lower rates of preterm birth (6%) and low birth weight babies (5%) were found in comparison to population based data.Continuity of Midwifery Care can be effectively provided to remote dwelling Aboriginal women and appears to improve outcomes for women and their infants.
Lopes, SC, Nove, A, ten Hoope-Bender, P, de Bernis, L, Bokosi, M, Moyo, NT & Homer, CSE 2016, 'A descriptive analysis of midwifery education, regulation and association in 73 countries: the baseline for a post-2015 pathway', HUMAN RESOURCES FOR HEALTH, vol. 14.View/Download from: Publisher's site
Pascal, M & Homer, CS 2016, 'Models of postnatal care for low-income countries: A review of the literature', International Journal of Childbirth, vol. 6, no. 2, pp. 104-132.View/Download from: Publisher's site
PURPOSE: This review aims to identify the key features of effective models of postnatal care involving midwifery personnel and to determine which models may be appropriate for implementation in lowincome countries.
STUDY DESIGN: A narrative synthesis of English language, peer-reviewed articles from 2004 to 2014 was undertaken. Four online library databases were searched. Inclusion/exclusion criterion and a quality appraisal were applied.
MAJOR FINDINGS: Twenty-two studies were included in the review, but only 4 were from lowincome countries. Midwifery-led models of postnatal care are cost-effective to provide high-quality care in every settings for every women in respect of 2 core components of quality care that are woman-centered care and continuity of care. Midwifery postnatal care is provided at hospital, in community settings, and at home, all presenting different strengths and weaknesses. Combinations of models of midwifery postnatal care and collaboration between stakeholders have had positive impacts on the quality of postnatal care. To be completely effective, this requires a better management and support of midwifery personnel though. Women and midwifery personnel's satisfaction needs to be considered to identify the local means and needs and to plan a suitable model of midwifery postnatal care at each location.
MAIN CONCLUSION: Low-income countries could develop a midwifery-led model of postnatal care. This will require identifying women and midwifery personnel's needs and the available resources and involving the stakeholders collaboratively to provide a suitable model of midwifery postnatal care. Education and practice will need to be addressed as well as promotion to the population. There is a need to conduct more research on midwifery postnatal care in low-income countries to evaluate how to best use them and what aspect of the midwifery postnatal care can be strengthened.
Shaban, I, Mohammad, K & Homer, CS 2016, 'Development and Validation of Women's Satisfaction With Hospital-Based Intrapartum Care Scale in Jordan', Journal of Transcultural Nursing, vol. 27, no. 3, pp. 256-261.View/Download from: Publisher's site
Background: Measuring satisfaction with care during labor is an important way to improve maternity services for women. This study was undertaken to develop an instrument to measure women's satisfaction with intrapartum hospital-based care. Method: A multidimensional instrument was initially developed, using three core aspects identified from the literature. An expert panel was convened to further modify the instrument. Finally, a total of 300 low-risk women who gave birth in the past 2 months were asked to complete the instrument to assess validity and reliability. Findings: The 14-item instrument was found to have content and construct validity as well as a high level of reliability (α = .88). Conclusions: This new instrument is a valid and reliable measure of satisfaction with intrapartum care in a Jordanian setting. The instrument can provide valuable information on the quality of services and on future planning for maternity services.
Vallely, LM, Homiehombo, P, Walep, E, Moses, M, Tom, M, Nataraye, E, Kelly-Hanku, A, Vallely, A, Ninnes, C, Mola, G, Morgan, C, Kaldor, JM, Wand, H, Whittaker, A & Homer, CS 2016, 'Feasibility and acceptability of clean birth kits containing self-administered misoprostol for prevention of postpartum haemorrhage in rural Papua New Guinea', International Journal of Gynecology and Obstetrics, vol. 133, no. 3, pp. 301-306.View/Download from: Publisher's site
To determine the feasibility and acceptability of providing clean birth kits (CBKs) containing misoprostol for self-administration in a rural setting in Papua New Guinea.
A prospective intervention study was conducted between April 8, 2013, and October 24, 2014. Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena. Participants received individual instruction and were then given a CBK containing 600 μg misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their understanding of correct use of items in the CBK. Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up.
Among 200 participants, 106 (53.0%) had an unsupervised birth, and 99 (93.4%) of these women used the CBK. All would use the CBK again and would recommend it to others. Among these 99 women, misoprostol was self-administered by 98 (99.0%), all of whom would take the drug again and would recommend it to others.
The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities. Large-scale interventions should be planned to further evaluate impact and acceptability.
Xu, F, Sullivan, E, Binns, C & Homer, C 2016, 'Mental disorders in new parents before and after birth: a population-based cohort study', British Journal of Psychiatry, vol. 2, no. 3, pp. 233-243.View/Download from: Publisher's site
Yoshida, S, Martines, J, Lawn, JE, Wall, S, Souza, JP, Rudan, I, Cousens, S, neonatal health research priority setting group, Aaby, P, Adam, I, Adhikari, RK, Ambalavanan, N, Arifeen, SE, Aryal, DR, Asiruddin, S, Baqui, A, Barros, AJ, Benn, CS, Bhandari, V, Bhatnagar, S, Bhattacharya, S, Bhutta, ZA, Black, RE, Blencowe, H, Bose, C, Brown, J, Bührer, C, Carlo, W, Cecatti, JG, Cheung, P-Y, Clark, R, Colbourn, T, Conde-Agudelo, A, Corbett, E, Czeizel, AE, Das, A, Day, LT, Deal, C, Deorari, A, Dilmen, U, English, M, Engmann, C, Esamai, F, Fall, C, Ferriero, DM, Gisore, P, Hazir, T, Higgins, RD, Homer, CS, Hoque, DE, Irgens, L, Islam, MT, de Graft-Johnson, J, Joshua, MA, Keenan, W, Khatoon, S, Kieler, H, Kramer, MS, Lackritz, EM, Lavender, T, Lawintono, L, Luhanga, R, Marsh, D, McMillan, D, McNamara, PJ, Mol, BWJ, Molyneux, E, Mukasa, GK, Mutabazi, M, Nacul, LC, Nakakeeto, M, Narayanan, I, Olusanya, B, Osrin, D, Paul, V, Poets, C, Reddy, UM, Santosham, M, Sayed, R, Schlabritz-Loutsevitch, NE, Singhal, N, Smith, MA, Smith, PG, Soofi, S, Spong, CY, Sultana, S, Tshefu, A, van Bel, F, Gray, LV, Waiswa, P, Wang, W, Williams, SLA, Wright, L, Zaidi, A, Zhang, Y, Zhong, N, Zuniga, I & Bahl, R 2016, 'Setting research priorities to improve global newborn health and prevent stillbirths by 2025.', Journal of Global Health, vol. 6, no. 1, pp. 010508-010508.View/Download from: Publisher's site
In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025.We used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakehol...
Scarf, V, Catling, C, Viney, R & Homer, CS 2016, 'Costing alternative birth settings for women at low risk of complications: A systematic review', PLoS One, vol. 11, no. 2, pp. 1-17.View/Download from: Publisher's site
There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications.
Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data.
Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care.
There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.
Cummins, A, Denney-Wilson, E & Homer, CS 2016, 'The challenge of employing and managing new graduate midwives in midwifery group practices in hospitals', Journal of Nursing Management, vol. 24, no. 5, pp. 614-623.View/Download from: Publisher's site
Dawson, A, Kililo, M, Geita, L, Mola, G, Brodie, P, Rumsey, M, Copeland, F, Neill, A & Homer, C 2016, 'Midwifery capacity building in Papua New Guinea: Key achievements and ways forward', Women and Birth, vol. 29, no. 2, pp. 180-188.View/Download from: Publisher's site
Moores, A, Puawe, P, Buasi, N, West, F, Samor, M, Joseph, N, Rumsey, M, Dawson, A & Homer, C 2016, 'Education, employment and practice: Midwifery graduates in Papua New Guinea', Midwifery, vol. 41, pp. 22-29.View/Download from: Publisher's site
Moores, A, Puawe, P, Buasi, N, West, F, Samor, MK, Joseph, N, Rumsey, M, Dawson, A & Homer, CSE 2016, 'Continuing professional development and challenges facing newly graduated midwives in Papua New Guinea', Pacific Journal of Reproductive Health, vol. 1, no. 4.View/Download from: Publisher's site
Varol, N, Dawson, A, Turkmani, S, Hall, J, Nanayakkara, S, Jenkins, G, Homer, C & McGeechan, K 2016, 'Obstetric outcomes for women with female genital mutilation at an Australian hospital, 2006–2012: a descriptive study', BMC Pregnancy and Childbirth, vol. 16, no. 328, pp. 1-10.View/Download from: Publisher's site
Women, who have been subjected to female genital mutilation (FGM), can suffer serious and irreversible physical, psychological and psychosexual complications. They have more adverse obstetric outcomes as compared to women without FGM. Exploratory studies suggest radical change to abandonment of FGM by communities after migration to countries where FGM is not prevalent. Women who had been subjected to FGM as a child in their countries of origin, require specialised healthcare to reduce complications and further suffering. Our study compared obstetric outcomes in women with FGM to women without FGM who gave birth in a metropolitan Australian hospital with expertise in holistic FGM management.
The obstetric outcomes of one hundred and ninety-six women with FGM who gave birth between 2006 and 2012 at a metropolitan Australian hospital were analysed. Comparison was made with 8852 women without FGM who gave birth during the same time period. Data were extracted from a database specifically designed for women with FGM and managed by midwives specialised in care of these women, and a routine obstetric database, ObstetriX. The accuracy of data collection on FGM was determined by comparing these two databases. All women with FGM type 3 were deinfibulated antenatally or during labour. The outcome measures were (1) maternal: accuracy and grade of FGM classification, caesarean section, instrumental birth, episiotomy, genital tract trauma, postpartum blood loss of more than 500 ml; and (2) neonatal: low birth weight, admission to a special care nursery, stillbirth.
The prevalence of FGM in women who gave birth at the metropolitan hospital was 2 to 3 %. Women with FGM had similar obstetric outcomes to women without FGM, except for statistically significant higher risk of first and second degree perineal tears, and caesarean section. However, none of the caesarean sections were performed for FGM indications. The ObstetriX database was only 35 % accur...
Catling, C, Medley, N, Foureur, M, Ryan, C, Leap, N, Teate, A & Homer, CSE 2015, 'Group versus conventional antenatal care for women (Intervention)', Cochrane Database of Systematic Reviews.View/Download from: Publisher's site
Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model.
1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies.
2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies.
All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible.
Data collection and analysis
Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy.
We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473)...
Catling, C, Watts, N, Petrovska, K, Sjostedt, C, Bisits, A & Homer, CSE 2015, ''Normal' vaginal breech birth: The clinicians' perspective', WOMEN AND BIRTH, vol. 28, no. 1, pp. S43-S43.View/Download from: Publisher's site
Catling, CJ, Medley, N, Foureur, M, Ryan, C, Leap, N, Teate, A & Homer, CS 2015, 'Group versus conventional antenatal care for women.', Cochrane Database Syst Rev, vol. 2, p. CD007622.View/Download from: Publisher's site
Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model.
Catling, CJ, Medley, N, Foureur, M, Ryan, C, Leap, N, Teate, A & Homer, CS 2015, 'Group versus conventional antenatal care for women.', The Cochrane database of systematic reviews, vol. 2, p. CD007622.View/Download from: Publisher's site
BACKGROUND: Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. OBJECTIVES: 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies.2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. MAIN RESULTS: We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) ...
Everitt, L, Fenwick, J & Homer, CSE 2015, 'Midwives experiences of removal of a newborn baby in New South Wales, Australia: Being in the 'head' and 'heart' space', Women and Birth, vol. 28, no. 2, pp. 95-100.View/Download from: Publisher's site
Homer, CSE, Watts, NP, Petrovska, K, Sjostedt, CM & Bisits, A 2015, 'Women's experiences of planning a vaginal breech birth in Australia', BMC Pregnancy and Childbirth, vol. 15, pp. 89-89.View/Download from: Publisher's site
Lopes, SC, Titulaer, P, Bokosi, M, Homer, CSE & ten Hoope-Bender, P 2015, 'The involvement of midwives associations in policy and planning about the midwifery workforce: A global survey', Midwifery, vol. 31, no. 11, pp. 1096-1103.View/Download from: Publisher's site
Moores, A, West, F, Puawe, P, Buasi, N & Homer, CSE 2015, 'Developing 'super' midwives - Motivation to become a midwife in Papua New Guinea', WOMEN AND BIRTH, vol. 28, no. 1, pp. S24-S24.View/Download from: Publisher's site
Renfrew, MJ 2015, 'Improving midwifery care worldwide--authors' reply', Lancet, vol. 385, no. 9962, p. 27.View/Download from: Publisher's site
Sword, W, Heaman, M, Biro, MA, Homer, CS, Yelland, J, Akhtar-Danesh, N & Bradford-Janke, A 2015, 'Quality of prenatal care questionnaire: Psychometric testing in an Australia population', BMC Pregnancy and Childbirth, vol. 10, pp. 214-214.View/Download from: Publisher's site
The quality of antenatal care is recognized as critical to the effectiveness of care in optimizing maternal and child health outcomes. However, research has been hindered by the lack of a theoretically-grounded and psychometrically sound instrument to assess the quality of antenatal care. In response to this need, the 46-item Quality of Prenatal Care Questionnaire (QPCQ) was developed and tested in a Canadian context. The objective of this study was to validate the QPCQ and to establish its internal consistency reliability in an Australian population.
Study participants were recruited from two public maternity services in two Australian states: Monash Health, Victoria and Wollongong Hospital, New South Wales. Women were eligible to participate if they had given birth to a single live infant, were 18 years or older, had at least three antenatal visits during the pregnancy, and could speak, read and write English. Study questionnaires were completed in hospital. A confirmatory factor analysis (CFA) was conducted. Construct validity, including convergent validity, was further assessed against existing questionnaires: the Patient Expectations and Satisfaction with Prenatal Care (PESPC) and the Prenatal Interpersonal Processes of Care (PIPC). Internal consistency reliability of the QPCQ and each of its six subscales was assessed using Cronbach's alpha.
Two hundred and ninety-nine women participated in the study. CFA verified and confirmed the six factors (subscales) of the QPCQ. A hypothesis-testing approach and an assessment of convergent validity further supported construct validity of the instrument. The QPCQ had acceptable internal consistency reliability (Cronbach's alpha = 0.97), as did each of the six factors (Cronbach's alpha = 0.74 to 0.95).
The QPCQ is a valid and reliable self-report measure of antenatal care quality. This instrument fills a scientific gap and can be used in research to examine relationships between...
Vallely, LM, Homiehombo, P, Kelly-Hanku, A, Vallely, A, Homer, CSE & Whittaker, A 2015, 'Childbirth in a rural highlands community in Papua New Guinea: A descriptive study', MIDWIFERY, vol. 31, no. 3, pp. 380-387.View/Download from: Publisher's site
Duffield, CM, Roche, MA, Dimitrelis, S, Homer, C & Buchan, J 2015, 'Instability in patient and nurse characteristics, unit complexity and patient and system outcomes.', Journal of Advanced Nursing, vol. 71, no. 6, pp. 1288-1298.View/Download from: Publisher's site
AIMS: To explore key factors related to nursing unit instability, complexity and patient and system outcomes. BACKGROUND: The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration. DESIGN: Descriptive. METHODS: Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample. RESULTS: Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave). CONCLUSION: Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity.
Nurse turnover is a critical issue facing workforce planners across the globe, partic- ularly in light of protracted and continuing workforce shortages. An ageing population coupled with the rise in complex and chronic diseases, have contributed to increased demands placed on the health system and importantly, nurses who themselves are ageing. Costs associated with nurse turnover are attracting more attention; however, existing measurements of turnover show inconsistent findings, which can be attributed to differences in study design, metrics used to calculate turnover and variations in definitions for turnover. This paper will report the rates and costs of nurse turnover across three States in Australia.
Schmied, V, Homer, CS, Fowler, CM, Psalia, K, Barclay, L, Wilson, I, Kemp, L, Fasher, M & Kruske, S 2015, 'Implementing a national approach to universal child and family health services in Australia: professionals' views of the challenges and opportunities', Health and Social Care in the Community, vol. 23, no. 2, pp. 159-170.View/Download from: Publisher's site
Australia has a well-accepted system of universal child and family health (CFH) services. However, government reports and research indicate that these services vary across states and territories, and many children and families do not receive these services. The aim of this paper was to explore professionals' perceptions of the challenges and opportunities in implementing a national approach to universal CFH services across Australia. Qualitative data were collected between July 2010 and April 2011 in the first phase of a three-phase study designed to investigate the feasibility of implementing a national approach to CFH services in Australia. In total, 161 professionals participated in phase 1 consultations conducted either as discussion groups, teleconferences or through email conversation. Participants came from all Australian states and territories and included 60 CFH nurses, 45 midwives, 15 general practitioners (GPs), 12 practice nurses, 14 allied health professionals, 7 early childhood education specialists, 6 staff from non-government organisations and 2 Australian government policy advisors. Data were analysed thematically. Participants supported the concept of a universal CFH service, but identified implementation barriers. Key challenges included the absence of a minimum data set and lack of aggregated national data to assist planning and determine outcomes; an inconsistent approach to transfer of information about mothers and newborns from maternity services to CFH nursing services or GPs; poor communication across disciplines and services; issues of access and equity of service delivery; workforce limitations and tensions around role boundaries. Directions for change were identified, including improved electronic data collection and communication systems, reporting of service delivery and outcomes between states and territories, professional collaboration, service co-location and interprofessional learning and development.
Cummins, AM, Denney-Wilson, E & Homer, CSE 2015, 'The experiences of new graduate midwives working in midwifery continuity of care models in Australia', Midwifery, vol. 31, no. 4, pp. 438-444.View/Download from: Publisher's site
Moores, A, Catling, C, West, F, Neill, A, Rumsey, M, Kilio Samor, M & Homer, CSE 2015, 'What motivates midwifery students to study midwifery in Papua New Guinea?', Pacific Journal of Reproductive Health, vol. 1, no. 2, pp. 60-67.View/Download from: Publisher's site
Introduction: Midwives in Papua New Guinea have a vital role to play in addressing the high maternal and neonatal mortality rate. Attracting applicants in sufficient numbers and quality to study midwifery has been challenging in some countries.
Aim: The aim of this study was to explore the motivation of students to study midwifery in Papua New Guinea. Findings from this study will assist in midwifery workforce recruitment and retention.
Methods: Between 2012-2014, midwifery students (n=298) from the four midwifery schools in Papua New Guinea were surveyed and interviewed on their perceptions regarding their midwifery studies. One part of the data collection process asked the students to describe their motivation to become a midwife with the question: Why did you choose to study midwifery? A content and thematic analysis was undertaken.
Results: 194 (65% response rate) students provided between 1-3 different responses to the question, making a total of 246 responses. Three main themes emerged which were recognising a public need; recognising professional needs; and, building upon experience.
Discussion: Forty-one percent (n=101) of midwifery students in Papua New Guinea studied midwifery because they wanted to help lower the high maternal mortality in the country. This is a unique finding reflecting the reality of maternal and child health in Papua New Guinea and is of great contrast to the motivations of midwifery students in similarly low to middle income countries in the region and globally.
Dawson, A, Homer, CS, Turkmani, S, Black, K & Varol, N 2015, 'A systematic review of doctors' experiences and needs to support the care of women with female genital mutilation.', International Journal of Gynecology and Obstetrics, vol. 131, no. 1, pp. 35-40.View/Download from: Publisher's site
BACKGROUND: Female genital mutilation (FGM) involves partial or complete removal of the external female genitalia or other injury for non-therapeutic reasons. Little is known about the knowledge and skills of doctors who care for affected women and their practice in relation to FGM. OBJECTIVES: To examine the FGM experiences and educational needs of doctors. SEARCH STRATEGY: A structured search of five bibliographic databases was undertaken to identify peer-reviewed research literature published in English between 2004 and 2014 using the keywords "female genital mutilation," "medical," "doctors," "education," and "training." SELECTION CRITERIA: Observational, quasi-experimental, and non-experimental descriptive studies were suitable for inclusion. DATA COLLECTION AND ANALYSIS: A narrative synthesis of the study findings was undertaken and themes were identified. MAIN RESULTS: Ten papers were included in the review, three of which were from low-income countries. The analysis identified three themes: knowledge and attitudes, FGM-related medical practices, and education and training. CONCLUSIONS: There is a need for improved education and training to build knowledge and skills, and to change attitudes concerning the medicalization of FGM and reinfibulation.
Dawson, A, Turkmani, S, Fray, S, Nanayakkara, S, Varol, N & Homer, C 2015, 'Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience', Midwifery, vol. 31, no. 1, pp. 229-238.View/Download from: Publisher's site
to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care.
an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014.
10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial.
professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice.
Implications for practice
improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation.
Dawson, AJ, Turkmani, S, Varol, N, Nanayakkara, S, Sullivan, E & Homer, CS 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia.', Women and Birth, vol. 28, no. 3, pp. 207-214.View/Download from: Publisher's site
Female genital mutilation (FGM) has serious health consequences, including adverse obstetric outcomes and significant physical, sexual and psychosocial complications for girls and women. Migration to Australia of women with FGM from high-prevalence countries requires relevant expertise to provide women and girls with FGM with specialised health care. Midwives, as the primary providers of women during pregnancy and childbirth, are critical to the provision of this high quality care.To provide insight into midwives' views of, and experiences working with, women affected by FGM.A descriptive qualitative study was undertaken using focus group discussions with midwives from four purposively selected antenatal clinics and birthing units in three hospitals in urban New South Wales. The transcripts were analysed thematically.Midwives demonstrated knowledge and recalled skills in caring for women with FGM. However, many lacked confidence in these areas. Participants expressed fear and a lack of experience caring for women with FGM. Midwives described practice issues, including the development of rapport with women, working with interpreters, misunderstandings about the culture of women, inexperience with associated clinical procedures and a lack of knowledge about FGM types and data collection.Midwives require education, training and supportive supervision to improve their skills and confidence when caring for women with FGM. Community outreach through improved antenatal and postnatal home visitation can improve the continuity of care provided to women with FGM.
McDonnell, N, Knight, M, Peek, MJ, Ellwood, D, Homer, CS, McLintock, C, Vaughan, G, Pollock, W, Li, Z, Javid, N & Sullivan, E 2015, 'Amniotic fluid embolism: an Australian-New Zealand population-based study.', BMC Pregnancy and Childbirth, vol. 15, no. 1.View/Download from: Publisher's site
Amniotic fluid embolism (AFE) is a major cause of direct maternal mortality in Australia and New Zealand. There has been no national population study of AFE in either country. The aim of this study was to estimate the incidence of amniotic fluid embolism in Australia and New Zealand and to describe risk factors, management, and perinatal outcomes.A population-based descriptive study using the Australasian Maternity Outcomes Surveillance System (AMOSS) carried out in 263 eligible sites (>50 births per year) covering an estimated 96 % of women giving birth in Australia and all 24 New Zealand maternity units (100 % of women giving birth in hospitals) between January 1 2010-December 31 2011. A case of AFE was defined either as a clinical diagnosis (acute hypotension or cardiac arrest, acute hypoxia and coagulopathy in the absence of any other potential explanation for the symptoms and signs observed) or as a post mortem diagnosis (presence of fetal squames/debris in the pulmonary circulation).Thirty-three cases of AFE were reported from an estimated cohort of 613,731women giving birth, with an estimated incidence of 5.4 cases per 100 000 women giving birth (95 % CI 3.5 to 7.2 per 100 000). Two (6 %) events occurred at home whilst 46 % (n = 15) occurred in the birth suite and 46 % (n = 15) in the operating theatre (location not reported in one case). Fourteen women (42 %) underwent either an induction or augmentation of labour and 22 (67 %) underwent a caesarean section. Eight women (24 %) conceived using assisted reproduction technology. Thirteen (42 %) women required cardiopulmonary resuscitation, 18 % (n = 6) had a hysterectomy and 85 % (n = 28) received a transfusion of blood or blood products. Twenty (61 %) were admitted to an Intensive Care Unit (ICU), eight (24 %) were admitted to a High Dependency Unit (HDU) and seven (21 %) were transferred to another hospital for further management. Five woman died (case fatality rate 15 %) giving an estimated maternal morta...
Sullivan, EA, Dickinson, JE, Vaughan, GA, Peek, MJ, Ellwood, D, Homer, CSE, Knight, M, McLintock, C, Wang, A, Pollock, W, Pulver, LJ, Li, Z, Javid, N, Denney-Wilson, E & Callaway, L 2015, 'Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study', BMC Pregnancy and Childbirth, vol. 15, pp. 322-322.View/Download from: Publisher's site
Fox, D, Sheehan, A & Homer, CS 2014, 'Experiences of Women Planning a Home Birth Who Require Intrapartum Transfer to Hospital: A Metasynthesis of the Qualitative Literature', International Journal of Childbirth, vol. 4, no. 2, pp. 103-119.View/Download from: Publisher's site
Recent evidence supports the safety of planned home birth for low-risk women when professional midwifery care and adequate collaborative arrangements for referral and transfer are in place. The purpose of this article is to synthesize the qualitative literature on the experiences of women planning a home birth, who are subsequently transferred from home to hospital.
Homer, CS, Friberg, IK, Dias, MA, ten Hoope-Bender, P, Sandall, J, Speciale, AM & Bartlett, L 2014, 'The projected effect of scaling up midwifery', The Lancet, vol. 384, no. 9948, pp. 1164-1157.View/Download from: Publisher's site
This is paper 2 in the Lancet Series on Midwifery, published online June 2014.
Homer, CS, Scarf, VL, Catling, C & Davis, D 2014, 'Culture-based versus risk-based screening for the prevention of group B streptococcal disease in newborns: A review of national guidelines', Women and Birth, vol. 27, no. 1, pp. 46-51.View/Download from: Publisher's site
Background: Maternal colonisation with group B streptococcus (GBS) is recognised as the most frequent cause of severe early onset infection in newborns. National and international guidelines outline two approaches to the prevention of early onset disease in the neonate: risk based management and antenatal culture-based screening. We undertook an analysis of existing national and international guidelines in relation to GBS in pregnancy using a standardised and validated instrument to highlight the different recommended approaches to care.
Harte, JD, Leap, N, Fenwick, J, Homer, CS & 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.View/Download from: Publisher's site
Hammond, AD, Foureur, M & Homer, CS 2014, 'The hardware and software implications of hospital birth room design: A midwifery perspective', Midwifery, vol. 30, no. 7, pp. 825-830.View/Download from: Publisher's site
Hammond, AD, Homer, CS & 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.View/Download from: Publisher's site
Homer, CS, Thornton, T, Scarf, VL, Ellwood, D, Oats, J, Foureur, M, Sibbritt, D, McLachlan, HL, Forster, D & Dahlen, H 2014, 'Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data', BMC Pregnancy and Childbirth, vol. 14, pp. 206-206.View/Download from: Publisher's site
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.
Copeland, F, Dahlen, HG & Homer, CSE 2014, 'Conflicting contexts: Midwives' interpretation of childbirth through photo elicitation', Women and Birth, vol. 27, no. 2, pp. 126-131.View/Download from: Publisher's site
Farrokh-Eslamlou, H, Aghlmand, S, Eslami, M & Homer, CS 2014, 'Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran', Journal of Family Planning and Reproductive, vol. 40, no. 2, pp. 89-95.View/Download from: Publisher's site
We investigated whether use of the World Health Organizations (WHOs) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran.
Homer, CSE, Friberg, IK & Bastos Dias, MA 2014, 'Erratum: The projected eff ect of scaling up midwifery (Lancet (2014) 384 (1146-57))', The Lancet, vol. 384, no. 9948, p. 1098.View/Download from: Publisher's site
Javid, N, Sullivan, E, Halliday, LE, Duncombe, G & Homer, CS 2014, '"Wrapping myself in cotton wool": Australian women's experience of being diagnosed with vasa praevia', BMC Pregnancy and Childbirth, vol. 14, pp. 318-318.View/Download from: Publisher's site
This is the first study to describe women's experience of being diagnosed with or suspected to have VP. The findings from this research reveal the dilemmas these women face even if their baby is ultimately born healthy. Their need for clear and consistent information, sensitive care, support and continuity is evident. Clinicians can use these findings in developing information, counselling and models of care for these women.
Mohammad, KI, Shaban, IA, Homer, CS & Creedy, D 2014, 'Women's Satisfaction with hospital-based intrapartum care: A Jordanian Study', International Journal of Nursing and Midwifery, vol. 6, no. 3, pp. 32-39.View/Download from: Publisher's site
Exploring patient satisfaction can contribute to quality maternity care but is not routinely conducted in many Middle Eastern countries. This study investigated the prevalence and factors associated with satisfaction during labor and birth among Jordanian women using a descriptive cross-sectional design. Women (n=298) were recruited from four maternal and child health centers in Al-Mafraq city, Jordan. Participants completed an intrapartum care scale which measured satisfaction with three areas of care: interpersonal, information and involvement in decision making, and physical environment. Overall, only 17.8% of women were satisfied with intrapartum care. Around 13% of women were satisfied with interpersonal care, 20.5% with information and involvement in decision making, and 18.8% with physical birth environment. Regression analyses revealed that low satisfaction was associated with experiencing an episiotomy, poor pain relief during labour, and vaginal birth. Health care professionals, policy-makers as well as hospital administrators need to consider the factors that contribute to low satisfaction with childbirth in any effort to improve care.
ten Hoope-Bender, P, de Bernis, L, Campbell, J, Downe, S, Fauveau, V, Fogstad, H, Homer, CS, Kennedy, H, Matthews, Z, McFadden, A, Renfrew, M & Lerberghe, W 2014, 'Improvement of maternal and newborn health through midwifery', The Lancet, vol. 384, no. 9949, pp. 1226-1235.View/Download from: Publisher's site
This is the fi nal paper in a Series in which we provide evidence (analyses of systematic reviews, case studies, analysis, and modelling of deaths averted) for the contribution of midwifery to the survival, health, and wellbeing of childbearing women and newborn infants.
Dawson, A, Buchan, J, Duffield, CM, Homer, CS & Wijewardena, K 2014, 'Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence', Health Policy and Planning, vol. 29, no. 3, pp. 396-408.View/Download from: Publisher's site
Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives.
Dawson, A, Stasa, H, Roche, MA, Homer, CS & Duffield, CM 2014, 'Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies', BMC Nursing, vol. 13, no. 11.View/Download from: Publisher's site
Background This study aimed to reveal nurses' experiences and perceptions of turnover in Australian hospitals and identify strategies to improve retention, performance and job satisfaction. Nursing turnover is a serious issue that can compromise patient safety, increase health care costs and impact on staff morale. A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories. Method A qualitative design was used to analyze responses from 362 nurses collected from a national survey of nurses from medical and surgical nursing units across 3 Australian States/Territories. Results Key factors affecting nursing turnover were limited career opportunities; poor support; a lack of recognition; and negative staff attitudes. The nursing working environment is characterised by inappropriate skill-mix and inadequate patient-staff ratios; a lack of overseas qualified nurses with appropriate skills; low involvement in decision-making processes; and increased patient demands. These issues impacted upon heavy workloads and stress levels with nurses feeling undervalued and disempowered. Nurses described supportive strategies: improving performance appraisals, responsive preceptorship and flexible employment options. Conclusion Nursing turnover is influenced by the experiences of nurses. Positive steps can be made towards improving workplace conditions and ensuring nurse retention. Improving performance management and work design are strategies that nurse managers could harness to reduce turnover.
Duffield, CM, Roche, MA, Homer, CS, Buchan, J & Dimitrelis, S 2014, 'A comparative review of nurse turnover rates and costs across countries', Journal of Advanced Nursing, vol. 70, no. 12, pp. 2703-2712.View/Download from: Publisher's site
Measuring and comparing the costs and rates of turnover is difficult because of differences in definitions and methodologies. A comparative review of turnover data was conducted using four studies that employed the original Nursing Turnover Cost Calculation Methodology. A significant proportion of turnover costs are attributed to temporary replacement, highlighting the importance of nurse retention.
Psalia, K, Kruske, S, Fowler, CM, Homer, CS & Schmied, V 2014, 'Smoothing out the transition of care between maternity and child and family health services: perspectives of child and family health nurses and midwives?', BMC Pregnancy Childbirth, vol. 14, pp. 1-13.View/Download from: Publisher's site
Background: In Australia, women who give birth are transitioned from maternity services to child and health
services once their baby is born. This horizontal integration of services is known as Transition of Care (ToC). Little is
known of the scope and processes of ToC for new mothers and the most effective way to provide continuity of
services. The aim of this paper is to explore and describe the ToC between maternity services to CFH services from
the perspective of Australian midwives and child and family health (CFH) nurses.
Method: This paper reports findings from phase two of a three phase mixed methods study investigating the
feasibility of implementing a national approach to CFH services in Australia (the CHoRUS study). Data were
collected through a national survey of midwives (n = 655) and CFH nurses (n = 1098). Issues specifically related to
ToC between maternity services and CFH services were examined using descriptive statistics and content analysis of
Results: Respondents described the ToC between maternity services and CFH services as problematic. Key
problems identified included communication between professionals and services and transfer of client information.
Issues related to staff shortages, early maternity discharge, limited interface between private and public health
systems and tension around role boundaries were also reported. Midwives and CFH nurses emphasised that these
issues were more difficult for families with identified social and emotional health concerns. Strategies identified by
respondents to improve ToC included improving electronic transfer of information, regular meetings between
maternity and CFH services, and establishment of liaison roles.
Conclusion: Significant problems exist around the ToC for all families but particularly for families with identified
risks. Improved ToC will require substantial changes in information transfer processes and in the professional
relationships which currently exist be...
Schmied, V, Fowler, CM, Rossiter, C, Homer, CS, Kruske, S & CHoRUS team 2014, 'Nature and frequency of services provided by child and family health nurses in Australia: results of a national survey', Australian Health Review, vol. 38, no. 2, pp. 177-185.View/Download from: Publisher's site
Objective. Australia has a system of universal child and family health (CFH) nursing services providing primary health services from birth to school entry. Herein, we report on the findings of the first national survey of CFH nurses, including the ages and circumstances of children and families seen by CFH nurses and the nature and frequency of the services provided by these nurses across Australia.
Cummins, AM, Catling, C, Hogan, R & Homer, CS 2014, 'Addressing culture shock in 1st year midwifery students: maximising the initial clinical experience', Women and Birth, vol. 27, no. 4, pp. 271-275.View/Download from: Publisher's site
Background Many Bachelor of Midwifery students have not had any exposure to the hospital setting prior to their clinical placement. Students have reported their placements are foreign to them, with a specialised confusing `language. It is important to provide support to students to prevent culture shock that may lead to them leaving the course.
Dawson, A, Brodie, PM, Copeland, FH, Rumsey, M & Homer, CS 2014, 'Collaborative approaches towards building midwifery capacity in low income countries: A reviewof experiences', Midwifery, vol. 30, no. 4, pp. 391-402.View/Download from: Publisher's site
Sibbritt, D, Catling, C, Adams, J, Shaw, A & Homer, CS 2014, 'The self-prescibed use of aromatherapy oils by pregnant women', Women and Birth, vol. 27, no. 1, pp. 41-45.View/Download from: Publisher's site
Davidson, PM, Newton, PJ, Ferguson, C, Daly, J, Elliott, D, Homer, CS, Duffield, CM & Jackson, DE 2014, 'Rating and Ranking the Role of Bibliometrics and Webometrics in Nursing and Midwifery', The Scientific World Journal, vol. 2014.View/Download from: Publisher's site
Background. Bibliometrics are an essential aspect of measuring academic and organizational performance. Aim. This review seeks to describe methods for measuring bibliometrics, identify the strengths and limitations of methodologies, outline strategies for interpretation, summarise evaluation of nursing and midwifery performance, identify implications for metric of evaluation, and specify the implications for nursing and midwifery and implications of social networking for bibliometrics and measures of individual performance.
Catling, C, Coddington, B, Foureur, M, Homer, CS, Birthplace in Australia Study & National Publicly-funded Homebirth Consortium 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.View/Download from: Publisher's site
Objective: To report maternal and neonatal outcomes for Australian women planning a publicly funded homebirth from 2005 to 2010.
Catling-Paull, C, Coddington, RL, Foureur, MJ & Homer, CSE 2013, 'Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years REPLY', MEDICAL JOURNAL OF AUSTRALIA, vol. 199, no. 11, pp. 743-743.View/Download from: Publisher's site
Background: There is no Australian data on the characteristics of women who consult with midwives. Aim: To determine the profile of women who consult midwives in Australia. Methods: This cross-sectional research was conducted as part of the Australian Longitudinal Study on Womens Health (ALSWH). Participants were the younger (3136 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n = 801). The main outcome measure was consultation with a midwife.
Teate, A, Leap, N & Homer, CSE 2013, 'Midwives' experiences of becoming CenteringPregnancy facilitators: A pilot study in Sydney, Australia', Women and Birth, vol. 26, no. 1, pp. e31-e36.View/Download from: Publisher's site
Hammond, AD, Foureur, M, Homer, CS & 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.View/Download from: Publisher's site
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.
Tracy, SK, Hartz, D, Tracy, M, Allen, J, Forti, A, Hall, B, White, J, Lainchbury, A, Stapleton, H, Beckmann, M, Bisits, A, Homer, CS, Foureur, M, Welsh, A & Kildea, SV 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.View/Download from: Publisher's site
Background Women at low risk of pregnancy complications benefit from continuity of midwifery care, but no trial evidence exists for women with identified risk factors. We aimed to assess the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors.
Dawson, A & Homer, CS 2013, 'How does the mining industry contribute to sexual and reproductive health in developing countries? A narrative synthesis of current evidence to inform nursing practice', Journal Of Clinical Nursing, vol. 22, no. 23-24, pp. 3597-3609.View/Download from: Publisher's site
Aims and objectives. The aim of this review was to explore client and provider experiences and related health outcomes of sexual and reproductive health interventions that have been led by or that have involved mining companies. Background. Miners, and those living in communities surrounding mines in developing countries, are a vulnerable population with a high sexual and reproductive health burden. People in these communities require specific healthcare services although the exact delivery needs are unclear. There are no systematic reviews of evidence to guide delivery of sexual and reproductive health interventions to best address the needs of men and women in mining communities.
Dawson, A & Homer, CS 2013, 'Managing the International Humanitarian and Development Health Workforce: a review of experiences and needs', Asia Pacific Journal of Health Management, vol. 8, no. 1, pp. 14-23.
The overseas development and humanitarian assistance provided by high income nations includes considerable investment directed at improving health in low and middle income countries. Governments, non-government organisations and consulting companies employ international health staff in low and middle income countries to deliver health interventions, manage programs and provide technical assistance. There are no reviews of evidence to guide the management, support and training of these staff, especially in relation to capacity building. We undertook a narrative synthesis of research to examine the needs and experiences of international health personnel engaged in development and humanitarian work. We found that altruism and a desire for professional and personal development motivated most international workers, however their roles are not always clear, affecting the delivery of quality care and services. Staff supply and skill-mix, short contracts, remuneration, leadership and workload were highlighted as issues. A lack of preparedness was also noted and staff identified strategies for coping in the field. Current efforts towards the professionalisation of health development and humanitarian staff may provide mechanisms to better support the workforce to respond and be accountable to the needs of countries. A performance management framework may need to be developed requiring research and validation
Background: Consideration of the needs of pregnant women and their ability and willingness to attend maternal services and pay for them is central to the provision of accessible and acceptable maternal care.
Ith, P, Dawson, A, Homer, CS & Whelan, AK 2013, 'Practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia', Midwifery, vol. 29, no. 4, pp. 300-307.View/Download from: Publisher's site
Maternal and perinatal morbidity and mortality rates in Cambodia are high. The provision of quality care by skilled birth attendants (SBAs )in a supportive working environment is an important strategy to reduce morbidity and mortality.There has been little emphasis on examining this issue in Cambodia.
Campbell, J, de Bernis, L, Downe, S, Fogstad, H, Homer, CS, Powell Kennedy, H, Matthews, Z, Renfrew, M & ten Hoope-Bender, P 2013, 'Maternal health post-2015', The Lancet, vol. 381, no. 9879, pp. 1717-1718.View/Download from: Publisher's site
We welcome the publication of the manifesto for maternal health post-2015 (Feb 23, p 601).1 Implementation of the steps outlined in this manifesto would result in substantive improvements in maternal and neonatal health. At the Global Maternal Health Conference (Arusha, Tanzania), Richard Horton gave specific attention to skilled workers, especially midwives and those providing midwifery services. But in the published manifesto,1 it has been replaced by the fully trained front-line worker, a phrase open to broad interpretation. Midwifery is essential for maternal and neonatal survival and health.25 Without its explicit inclusion in international and national strategies, the actions needed to decrease morbidity and mortality will be hard to implement fully, or, in some cases, at all. We declare that we have no conflicts of interest.
Vaginal birth after caesarean (VBAC) is a controversial issue with strong opinions for and against. The means in which women work through the different opinions and options using the internet should be of interest to midwives, obstetricians and policy makers. The aim of this study was to examine how women use English language internet blog sites to discuss the option of VBAC and what factors influence these women's decision to have a VBAC or repeat caesarean section.
Halliday, LE, Peek, MJ, Ellwood, DA, Homer, CS, Knight, M, McLintock, C, Jackson-Pulver, L & Sullivan, E 2013, 'The Australasian Maternity Outcomes Surveillance System: An evaluation of stakeholder engagement, usefulness, simplicity, acceptability, data quality and stability', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 53, no. 2, pp. 152-157.View/Download from: Publisher's site
Background: The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts active, prospective surveillance of severe maternal conditions in Australia and New Zealand (ANZ). AMOSS captures greater than 96% of all births, and utilises an online, active case-based negative reporting system.
Hancock, H 2013, '"Bouncing back": how Australia's leading women's magazines portray the postpartum 'body'.', Women and birth : journal of the Australian College of Midwives, vol. 26, no. 2, p. 158.View/Download from: Publisher's site
Hatamleh, R, Shaban, I & Homer, CS 2013, 'Evaluating the Experience of Jordanian Women With Maternity Care Services', Health Care for Women International, vol. 34, no. 6, pp. 499-512.View/Download from: Publisher's site
Evaluation of womenâs experiences about the care they receive during childbirth is important to assess the quality of maternity services. We explored the experiences of Jordanian women to examine whether they were satisfied with their childbirth experiences.
Lee, N, Martensson, LB, Homer, CS, Webster, J, Gibbons, K, Stapleton, H, Dos Santos, N, Beckmann, M, Gao, Y & Kildea, SV 2013, 'Impact on Caesarean section rates following injections of sterile water (ICARIS): a multicentre randomised controlled trial', BMC Pregnancy and Childbirth, vol. 13, pp. 105-105.View/Download from: Publisher's site
Background: Sterile water injections have been used as an effective intervention for the management of back pain during labour. The objective of the current research is to determine if sterile water injections, as an intervention for back pain in labour, will reduce the intrapartum caesarean section rate.
Psaila, K, Schmied, V, Kruske, S & Homer, C 2013, 'Transition of care...How well is it done? Findings from the CHoRUS study', Women and Birth, vol. 26, pp. S18-S18.View/Download from: Publisher's site
Sheehy, AD, Davis, DL & Homer, CS 2013, 'Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence', Women and Birth, vol. 26, no. 2, pp. 152-157.View/Download from: Publisher's site
The approach to the prevention of early onset GBS disease in the newborn varies considerably from country to country. The Centre for Disease Control in the United States advocates universal culture based screening with the administration of intra-partum antibiotics, usually benzylpenicillin or ampicillin, to women who are colonised with GBS. National groups in the UK and New Zealand advocate a risk-based approach where intra-partum antibiotics are given to women with identified risk factors. The Canadian Taskforce on preventive health care has identified a third approach; where intra-partum antibiotics are given to women with a positive GBS culture and an identified risk factor. There are no national guidelines or consensus in Australia.
Vallely, LM, Homiehombo, P, Kelly, A, Vallely, A, Homer, CS & Whittaker, A 2013, 'Exploring women's perspectives of access to care during pregnancy and childbirth: A qualitative study from rural Papua New Guinea', Midwifery, vol. 29, no. 10, pp. 1222-1229.View/Download from: Publisher's site
Objectives: to explore women's perceptions and experiences of pregnancy and childbirth in a rural community in PNG
Gray, JE, Leap, N, Sheehy, AD & Homer, CS 2013, 'Students' perceptions of the follow-through experience in 3 year bachelor of midwifery programmes in Australia', Midwifery, vol. 29, no. 4, pp. 400-406.View/Download from: Publisher's site
Background: providing opportunities for students to participate in midwifery continuity of care experiences is a challenge in many midwifery education programmes. The `follow-through experience' was a deliberate strategy introduced into midwifery education programmes in Australia to ensure that students experienced midwifery continuity of care.
Raymond, J, Homer, CS, Smith, RM & Gray, JE 2013, 'Learning through authentic assessment: An evaluation of a new development in the undergraduate midwifery curriculum', Nurse Education in Practice, vol. 13, no. 5, pp. 471-476.View/Download from: Publisher's site
Assessment is a powerful influence on learning, and can form an important strategy amongst a variety of teaching and learning approaches. Authentic assessment activities are designed to mimic the complexity of 'real world' situations that students may encounter in professional life, and require the application of a combination of skills related to knowledge, skills and attitude.
Homer, CS, Besley, KJ, Bell, J, Davis, DL, Adams, J, Porteous, A & Foureur, M 2013, 'Does continuity of care impact decision making in the next birth after a caesarean section(VBAC)? A randomised controlled trial', BMC Pregnancy Childbirth, vol. 13, pp. 140-140.View/Download from: Publisher's site
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.
Roth, H, Homer, C & Fenwick, J 2012, '"Bouncing back'': How Australia's leading women's magazines portray the postpartum 'body'', Women and Birth, vol. 25, no. 3, pp. 128-134.View/Download from: Publisher's site
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.
Homer, CS & Catling, C 2012, 'Safe timing for an urgent Caesarean section: what is the evidence to guide policy?', Australian Health Review, vol. 36, no. 3, pp. 277-281.View/Download from: Publisher's site
To determine, from the evidence, what is the optimum decision to delivery (DDI) intervals in emergency Caesarean sections (CS). The aim of the study was to help guide policy in maternity services and identify issues relating to DDI and safe practice in maternity care. A systematic review of the literature was undertaken. Assessment of the quality of eligible papers was undertaken using the Critical Appraisal Skills Program (CASP) rating. There is no strong evidence that a DDI of 30 min or less is associated with improved outcomes for babies or mothers. Some evidence suggests that a DDI of greater than 30 min but less than 75 min confers benefit, but these findings were confounded by the indications for the emergency CS. Urgent CS should occur as soon as possible, but there is insufficient evidence to support a definite time frame, such as 30 min. A consistency of approach and nomenclature in describing the urgency of CS is necessary, which would enable criteria for further audit regarding DDI. Staff training should be addressed to improve transfer systems for CS. Antenatal risk assessment and congruence with role delineation and service delivery capacity is important.
Homer, CS, Ryan, CL, Leap, N, Foureur, M, Teate, A & Catling, C 2012, 'Group versus conventional antenatal care for women (Review)', The Cochrane Database of Systematic Reviews, no. 11, pp. 1-59.View/Download from: Publisher's site
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, CSE, Foureur, MJ, Allende, T, Pekin, F, Caplice, S & Catling-Paull, C 2012, ''It's more than just having a baby' women's experiences of a maternity service for Australian Aboriginal and Torres Strait Islander families', Midwifery, vol. 28, no. 4, pp. e509-e515.View/Download from: Publisher's site
Ith, P, Dawson, A & Homer, CS 2012, 'Challenges to Reaching MDG5: A Qualitative Analysis of the Working Environment of Skilled Birth Attendants in Cambodia', International Journal of Childbirth, vol. 2, no. 3, pp. 153-162.View/Download from: Publisher's site
Objective: To explore the working environment of skilled birth attendants (SBAs) in one region in Cambodia and the factors affecting their motivation and performance.
Ith, P, Dawson, A & Homer, CS 2012, 'Quality of maternity care practices of skilled birth attendants in Cambodia', International Journal of Evidence-Based Healthcare, vol. 10, no. 1, pp. 60-67.View/Download from: Publisher's site
The World Health Organization's recommended package of interventions for the integrated management of pregnancy and childbirth provides guidance for the use of evidence-based interventions to ensure the best outcomes for mother and newborn. However, the extent to which skilled birth attendants (SBAs) follow evidence-based guidelines is not known. There are few studies into childbirth practices of SBAs in Cambodia. The aim of this study was to observe practices of SBAs during labour, birth and the immediate post-partum period and their consistency with evidence-based guidelines. Methods: A structured non-participant observation study was undertaken. Data were collected using an observational checklist of evidence-based practices adapted from the Cambodian clinical assessment tools for associate degree in midwifery. Maternity care settings in one provincial hospital, two district referral hospitals and two health centres in one province of Cambodia were purposively selected. Results: Twenty-five SBAs who attended 40 women during labour, birth and the postnatal period were observed. The results showed that the use of the partograph was low; birth companions were not permitted; cleanliness during birth was lacking; management of the third stage of labour was inappropriate; monitoring of mother and baby in the early postnatal period was lacking; the SBAs lacked skills in neonatal resuscitation; skin-to-skin contact with the newborn and early breastfeeding were rare; and intramuscular injection of vitamin K varied. Conclusion: The findings suggest that the current SBA practices during labour, birth and the immediate postpartum period in one province of Cambodia are not consistent with evidence-based guidelines. Service improvements that address evidence-based practices are likely to have an impact on clean and safe childbirth, thereby enhancing outcomes for Cambodia women.
Ith, P, Dawson, A & Homer, CSE 2012, 'Challenges to Reaching MDG5:A Qualitative Analysis of the Working Environment of Skilled Birth Attendants in Cambodia', International Journal of Childbirth, vol. 2, no. 3, pp. 153-162.View/Download from: Publisher's site
OBJECTIVE: To explore the working environment of skilled birth attendants (SBAs) in one region in Cambodia and the factors affecting their motivation and performance.METHODS: A descriptive qualitative design was employed using focus group discussions with SBAs in 2 health centers and 3 referral hospitals in 1 province. Data were analyzed using a thematic approach.FINDINGS: Five interrelated themes were identified as the main factors impacting on the SBA's working environment. These were the physical environment, remuneration and incentives, workplace culture, management practice, and professional development opportunities. The desire to supplement income also impacted on SBAs' motivation, skill development and maintenance, and technical skills.CONCLUSION: Low wages and inadequate incentives within the context of a poorly functioning health system affected the working environment of SBAs in 1 province of Cambodia. These issues are likely to also affect the quality of maternity care. Policies that improve the working environment of staff through adequate remuneration and incentives and effective performance management systems need to be developed and implemented.
Barclay, L, Gao, Y, Homer, CS & Wild, K 2012, 'Unintended Consequences of Policy Decisions to Reduce Maternal Mortality in the Asia Pacific', International Journal of Childbirth, vol. 2, no. 4, pp. 222-229.View/Download from: Publisher's site
Objectives: To describe the role of midwives and maternity care in three low resource settings and to challenge some policy options introduced to reduce maternal mortality for women residing in rural and remote areas.
Campbell, J, de Bernis, L, Fogstad, H, Homer, CS, Powell Kennedy, H, Limbu, M, Matthews, Z, Renfrew, M & ten Hoope-Bender, P 2012, 'Family planning, health systems, and the health workforce', The Lancet, vol. 380, pp. 1147-1147.
Campbell, J, de Bernis, L, Fogstad, H, Homer, CS, Powell Kennedy, H, Renfrew, M & ten Hoope-Bender, P 2012, 'Family planning, health systems, and the health workforce', The Lancet, vol. 380, no. 9848, pp. 1147-1147.
The Lancetâs Family Planning Series is extremely timely and repositions an often forgotten but crucial issue. The Series addresses the reduction of population growth from the fundamentally important perspectives of sustainability, economics, human rights, policy, and health, and effectively highlights the multiple connections in todayâs global world. Core to making these links work is an effective health system and a competent workforce, without which the ability to ensure access to family planning is compromised.
Dahlen, HG & Homer, CS 2012, 'Web-Based News Reports On Midwives Compared With Obstetricians: A Prospective Analysis', Birth: issues in perinatal care, vol. 39, no. 1, pp. 48-56.View/Download from: Publisher's site
Background: The media both creates and reflects public opinion. The way in which health professionals are depicted in the media is likely to influence views held by and about different health professions. The aim of this study was to examine how midwives
Homer, CS, Griffiths, M, Brodie, PM, Kildea, S, Curtin, AM & Ellwood, D 2012, 'Developing a Core Competency Model and Educational Framework for Primary Maternity Services: A national consensus approach', Women and Birth, vol. 25, no. 3, pp. 122-127.View/Download from: Publisher's site
An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals. Participants: Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services.
Homer, CS, Lees, T, Stowers, P, Aiavao, F, Sheehy, AD & Barclay, L 2012, 'Traditional Birth Attendants in Samoa: Integration With the Formal Health System', International Journal of Childbirth, vol. 2, no. 1, pp. 5-11.View/Download from: Publisher's site
A traditional birth attendant (TBA) is a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs. In many parts of the world, TBAs continue to provide a significant proportion of maternity care during pregnancy, birth, and the postpartum period. In Samoa, TBAs are recognized part of both the formal and informal health care system. The aim of this research was to examine the contribution that TBAs made in the provision of maternity care in Samoa. A descriptive study was undertaken, and 100 TBAs who had attended more than 400 births a year were interviewed as part of a broader Safe Motherhood Needs Assessment. The findings highlighted that although TBAs can work in collaboration with individual health providers or facilities or be integrated into the health system, TBAs were often practicing autonomously within their communities, independent of collaborative links. This study showed that formal recognition and registration of TBAs would improve the recording of births and augment their partnership to the formal health care system. This formal registration process has since been implemented to improve monitoring and evaluation and assist future research with this important group.
UNLABELLED: Objective. To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Design. Cross-sectional, descriptive study. Setting. An Australian public hospital antenatal clinic. SAMPLE POPULATION: Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women. Main Outcome Measures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a). Results. There was a high prevalence of self reported LPP during the pregnancy (71%). An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition. Most women (71%) had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy.
Shaban, I, Barclay, L, Lock, L & Homer, CS 2012, 'Barriers to developing midwifery as a primary health-care strategy: A Jordanian study', Midwifery, vol. 28, no. 1, pp. 106-111.View/Download from: Publisher's site
Aim: to identify the current barriers to developing midwifery as a primary health-care strategy in Jordan and to explore the strategies to overcome these barriers. Design: an exploratory design using an action research approach was undertaken. Workshop discussion groups and reflection were used to collect the data. A thematic approach was taken for the analysis. Participants: data were collected from a convenience sample of 64midwives and educatorswho attended workshops. Findings: the professional identity and image for midwifery has been confused within a medically dominated health system and has not been seen as a primary health strategy. Midwives are not able to practice to the full role and scope of the midwife. Implications for practice: key issues identified need to be addressed before midwifery can be part of a primary health-care strategy in Jordan.
Shahheidari, M & Homer, CS 2012, 'Impact of the Design of Neonatal Intensive Care Units on Neonates, Staff, and Families', Journal of Perinatal and Neonatal Nursing, vol. 26, no. 3, pp. 260-266.View/Download from: Publisher's site
Newborn intensive care is for critically ill newborns requiring constant and continuous care and supervision. The survival rates of critically ill infants and hospitalization in neonatal intensive care units (NICUs) have improved over the past 2 decades because of technological advances in neonatology. The design of NICUs may also have implications for the ealth of babies, parents, and staff. It is important therefore to articulate the design features of NICU that are associated with improved outcomes. The aim of this study was to explore the main features of the NICU design and to determine the advantages and limitations of the designs in terms of outcomes for babies, parents, and staff, predominately nurses. A systematic review of English-language, peer-reviewed articles was conducted for a period of 10 years, up to January 2011. Four online library databases and a number of relevant professional Web sites were searched using key words. There were 2 main designs of NICUs: open bay and single family room. The open-bay environment develops communication and interaction with medical staff and nurses and has the ability to monitor multiple infants simultaneously. The single-family rooms were deemed superior for patient care and parent satisfaction. Key factors associated with improved outcomes included increased privacy, increased parental involvement in patient care, assistance with infection control, noise control, improved sleep, decreased length of hospital stay, and reduced rehospitalization. The design of NICUs has implications for babies, parents, and staff. An understanding of the positive design features needs to be considered by health service planners, managers, and those who design such specialized units.
Smith, RM, Brodie, PM & Homer, CS 2012, 'Reviewing and reflecting on practice: The midwives experiences of credentialling', Women and Birth, vol. 25, no. 4, pp. 159-165.View/Download from: Publisher's site
Background: In 2005, the NSW Health Department issued a directive requiring midwives who worked in midwifery-led models of care to undergo a process known as credentialling. Credentialling involved a four-step process: self-assessment, face-to-face panel review of midwifery practice, assessment of emergency management skills and discussion of a case study from practice.
Wheeler, J, Davis, DL, Fry, M, Brodie, PM & Homer, CS 2012, 'Is Asian ethnicity an independent risk factor for severe perineal trauma in childbirth? A systematic review of the literature', Women and Birth, vol. 25, no. 3, pp. 107-113.View/Download from: Publisher's site
Objective: To undertake a systematic review of the literature to determine whether Asian ethnicity is an independent risk factor for severe perineal trauma in childbirth. Method: Ovid Medline, CINAHL, and Cochrane databases published in English were used to identify appropriate research articles from 2000 to 2010, using relevant terms in a variety of combinations. All articles included in this systematic review were assessed using the Critical Appraisal Skills Programme (CASP) making sense of evidence tools. Findings: Asian ethnicity does not appear to be a risk factor for severe perineal trauma for women living in Asia. In contrast, studies conducted in some Western countries have identified Asian ethnicity as a risk factor for severe perineal trauma. It is unknown why (in some situations) Asian women are more vulnerable to this birth complication. The lack of an international standard definition for the term Asian further undermines clarification of this issue. Nevertheless, there is an urgent need to explore why Asian women are reported to be significantly at risk for severe perineal trauma in some Western countries. Conclusion: Current research on this topic is confusing and conflicting. Further research is urgently required to explore why Asian women are at risk for severe perineal trauma in some birth settings.
Fenwick, JH, Hammond, AD, Raymond, JJ, Smith, RA, Gray, J, Foureur, M, Homer, CS & 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.View/Download from: Publisher's site
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.
Gray, JE, Leap, N, Sheehy, AD & Homer, CS 2012, 'The 'follow-through' experience in three-year Bachelor of Midwifery programs in Australia: A survey of students', Nurse Education in Practice, vol. 12, no. 5, pp. 258-263.View/Download from: Publisher's site
The follow-through experience in Australian midwifery education is a strategy that requires midwifery students to follow a number of women through pregnancy, labour and birth and into the parenting period. The experience was introduced by the Australian College of Midwives as part of national standards for the three-year Bachelor of Midwifery programs. Anecdotally, the introduction caused considerable debate. A criticism was that these experiences were incorporated with little evidence of their value. An online survey was undertaken to explore the follow-through experience from the perspectives of current and former students. There were 101 respondents, 93 current students with eight recent graduates. Participants were positive about developing relationships with women. They also identified aspects of the follow-through experience that were challenging. Support to assist with the experience was often lacking and the documentation required varied. Despite these difficulties, 75% felt it should be mandatory as it facilitated positive learning experiences. The follow-through experience ensured that students were exposed to midwifery continuity of care. The development of relationships with women was an important aspect of learning. Despite these challenges, there were significant learning opportunities. Future work and research needs to ensure than an integrated approach is taken to enhance learning.
Smith, RM, Gray, JE, Raymond, JE, Catling, C & Homer, CS 2012, 'Simulated Learning Activities: Improving Midwifery Students' Understanding of Reflective Practice', Clinical Simulation in Nursing, vol. 8, no. 9, pp. 451-457.View/Download from: Publisher's site
Graduate Diploma in Midwifery students at an Australian university poorly evaluated a compulsory theoretical subject (unit of study) titled Becoming a Reflective Practitioner over several years. Method: Authentic practice-based simulated scenarios were introduced to improve student learning and as an innovative approach to teaching reflective practice. The introduction was evaluated using student feedback surveys, pre- and post simulation knowledge questionnaires, and 6-week retention-of-knowledge questionnaires. Students reported improved levels of satisfaction, greater earning, and increasing knowledge in the simulated practice area. The students rated the scenarios as useful in increasing reflective practice, but this was secondary to skill acquisition. Simulated activities may prove useful in developing reflective practice, but further investigation is required to examine how to shift the focus from clinical skill acquisition to reflective practice.
Risks associated with maternal-infant bed-sharing are widely documented and promoted. This study aims to examine sleep patterns and strategies including bed-sharing. Women aged over 18 who have infants aged up to 24 months were eligible to participate in an anonymous online questionnaire in March 2010. A representative sample of 1,000 respondents was randomly selected from a total sample of 2000. The challenge of facilitating infant sleeping was highlighted, with 92% of respondents having difficulties at some point. Almost all (97%) felt sleep-deprived at some time, with almost half reporting that they were always or regularly deprived of sleep. Sleep deprivation exacerbated exhaustion or feeling run down (75%), irritability (70%), made mothers less patient with their infants (63%) and put additional strain on their relationship with their partner (37%). Strategies to facilitate infant sleeping included rocking and patting (50%), giving a dummy/comforter (46%) and allowing the baby to fall asleep in their arms (47%) or after feeding (45%). Just under half (41%) utilised bed-sharing as a sleep strategy at night. Bed-sharing was more likely to be used if babies experienced frequent waking at night and unstable sleep patterns. Maternal-infant bed-sharing continues to be an infant sleep strategy used by mothers, despite the risks involved. This study highlights that mothers still continue to bed-share despite preventative health campaigns and the known risks. Thus, health promotion should be modified to include a stronger emphasis on risk minimisation strategies.
Vaughan, G, Pollock, W, Peek, M, Knight, M, Ellwood, D, Homer, CS, Pulver, LJ, McLintock, C, Ho, MT & Sullivan, E 2012, 'Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 52, no. 2, pp. 195-203.View/Download from: Publisher's site
The Australasian Maternity Outcomes Surveillance System (AMOSS) conducts surveillance and research of rare and serious conditions in pregnancy. This multi-centre population health study is considered low risk with minimal ethical impact. Objective: To describe the ethics/governance review pathway undertaken by AMOSS. Method: Prospective, descriptive study during 2009- 2011 of the governance/ethical review processes required to gain approval for Australian and New Zealand (ANZ) maternity units with more than 50 births per year (n = 303) to participate in AMOSS. Results: Review processes ranged from a single application for 24 NZ sites, a single application for eligible hospitals in two Australian states, full Health Research Ethics Committee (HREC) applications for individual hospitals, through simple letters of support. As of September 2011, 46 full/expedited ethics applications, 131 site governance applications and 136 letters of support requests were made over 33 months, involving an estimated 3261 hours by AMOSS staff/investigators, and an associated resource burden by participating sites, to obtain approval to receive nonidentifiable data from 291 hospitals. Conclusion: The AMOSS research system provides an important resource to enhance knowledge of conditions that cause rare and serious maternal morbidity. Yet the highly variable ethical approval processes required to implement this study have been excessively repetitive and burdensome. This process jeopardises timely, efficient research project implementation, without corresponding benefits to research participants. The resource burden to establish research governance for AMOSS confirms the urgent need for the Harmonisation of Multi- centre Ethical Review (HoMER) to further streamline ethics/governance review processes for multi- centre research.
Catling, C, Dahlen, H & Homer, CS 2011, 'Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study', Women and Birth, vol. 24, no. 3, pp. 122-128.View/Download from: Publisher's site
Background: Hospital birth is commonly thought to be a safer option than homebirth, despite many studies showing similar rates of safety for low risk mothers and babies when cared for by qualified midwives with systems of back-up in place. Recently in Australia, demand has led to the introduction of a small number of publicly-funded homebirth programs. Womens confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored. Aim: The aim of the study was to explore the reasons why multiparous women feel confident to have a homebirth within a publicly-funded model of care in Australia. Methods: Ten multiparous English-speaking women who chose to have a homebirth with the St George Hospital Homebirth Program were interviewed in the postnatal period using semistructured, open-ended questions. Interviews were transcribed, then a thematic analysis was undertaken. Results: Women, having already experienced a normal birth, demonstrated a strong confidence in their ability to give birth at home and described a confidence in their bodies, their midwives, and the health system. Women weighed up the risks of homebirth through information they gathered and integration with their previous experience of birth, their family support and self-confidence. Discussion: Women choosing publicly-funded homebirth display strong confidence in both themselves to give birth at home, and their belief in the health systems ability to cope with any complications that may arise.
Catling, C, Johnston, RA, Ryan, CL, Foureur, M & Homer, CS 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.View/Download from: Publisher's site
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.
Catling, C, Johnston, RA, Ryan, CL, Foureur, M & Homer, CS 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.View/Download from: Publisher's site
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, McDonnell, N, Moores, A & Homer, CS 2011, 'Maternal mortality in Australia: Learning from Maternal Cardiac Arrest', Nursing and Health Sciences, vol. 13, no. 1, pp. 10-15.View/Download from: Publisher's site
Cardiac arrest in pregnancy is fortunately a rare event that few midwives will see during their career. The increase in maternal age, the Body Mass Index, cesarean sections, multiple pregnancies, and comorbidities over recent years have increased the probability of cardiac arrest. The early warning signs of impending maternal cardiac arrest are either absent or go unrecognized. Maternal mortality reviews highlight the deficiencies that maternity care providers have in managing cardiac arrest in pregnancy.The aim of this article is to address the knowledge deficiencies of health professionals by reviewing the physiological changes in pregnant women that complicate the management of cardiopulmonary resuscitation, using a case scenario. There are key differences in the management of pregnant women, when compared to standard adult resuscitation. The outcome is dependent on the speed of the response and the consideration of a number of crucial pregnancy-specific interventions. Staff members need to be adequately trained in order to deal with maternal cardiac arrest and have access to training packages and in-service education programs. As cardiac arrest in pregnancy is a rare event, emergency drill simulations are an important component of ongoing education.
Catling-Paull, C, Dahlen, H & Homer, CSE 2011, 'Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study', WOMEN AND BIRTH, vol. 24, no. 4, pp. 180-180.View/Download from: Publisher's site
Catling-Paull, C, Homer, CSE, Foureur, M, Azzopardi, C, Cameron, D, Clarke, J, Elmes, R, Kitschke, J, Koay, A, Lennon, K, McMurtrie, J, Pratt, J, Skewes, R & White, J 2011, 'Introducing ... the National Publicly Funded Homebirth Consortium', WOMEN AND BIRTH, vol. 24, pp. S36-S37.View/Download from: Publisher's site
Sheehy, AD, Foureur, M, Catling, C & Homer, CS 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.View/Download from: Publisher's site
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
Dahlen, H, Homer, CS, Leap, N & Tracy, SK 2011, 'From social to surgical: historical perspectives on perineal care during labour and birth', Women and Birth, vol. 24, no. 3, pp. 105-111.View/Download from: Publisher's site
A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98138 A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a reemergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice.
Foureur, M, Leap, N, Davis, DL, Forbes, I & Homer, CS 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.View/Download from: Publisher's site
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.
Teate, A, Leap, N, Rising, S & Homer, CS 2011, 'Women's Experiences Of Group Antenatal Care In Australia-The Centeringpregnancy Pilot Study', Midwifery, vol. 27, no. 2, pp. 138-145.View/Download from: Publisher's site
Objective: to describe the experiences of women who were participants in the Australian CenteringPregnancy Pilot Study. CenteringPregnancy is an innovative model of care where antenatal care is provided in a group environment.
Homer, CS, Johnston, RA & 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.View/Download from: Publisher's site
Objectives to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality. Design and setting cross-sectional analytic study of hospital births in New South Wales using population-based data from 19982006. Participants women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria. Measurements data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400 g birth weight in the state.
Sibbritt, D, Homer, CSE & Adams, J 2011, 'The self-prescribed use of aromatherapy oils by pregnant women: Cause for concern?', WOMEN AND BIRTH, vol. 24, pp. S24-S24.View/Download from: Publisher's site
Homer, CS 2011, 'The 'Ready for Child' structured antenatal training programme increases likelihood of mother's arriving at the maternity ward in active labour and decreases use of epidural analgesia', Evidence-Based Nursing, vol. 14, no. 1, pp. 16-17.View/Download from: Publisher's site
Antenatal education programmes have been implemented in many settings around the world. There is, however, uncertainty about their effectiveness. Many studies have failed to show a benefi t for women in terms of birth outcomes. A systematic review in The Cochrane Database of Systematic Reviews included nine trials (2,284 women). The findings were inconclusive with inconsistent results and small sample sizes. The authors of the Cochrane Review stated that the 'effects of general antenatal education for childbirth or parenthood, or both, remain largely unknown'. Few large well-conducted randomised controlled trials have been undertaken which make the study by Maimburg and colleagues particularly exciting.
Homer, CS, Kurinczuk, J, Spark, P, Brocklehurst, P & Knight, M 2011, 'Planned vaginal delivery or planned caesarean delivery in women with extreme obesity', BJOG: an International Journal of Obstetrics and Gynaecology, vol. 118, no. 4, pp. 480-487.View/Download from: Publisher's site
Objective To compare the outcomes of planned vaginal versus planned caesarean delivery in a cohort of extremely obese women (body mass index = 50 kg/m2). Design A national cohort study using the UK Obstetric Surveillance System (UKOSS). Setting All hospitals with consultant-led maternity units in the UK. Population Five hundred and ninety-one extremely obese women delivering in the UK between September 2007 and August 2008. Methods Prospective cohort identification through UKOSS routine monthly mailings. Main outcome measures Anaesthetic, postnatal and neonatal complication rates. Results After adjustment, there were no significant differences in anaesthetic, postnatal or neonatal complications between women with planned vaginal delivery and planned caesarean delivery, with the exception of shoulder dystocia (3% versus 0%, P = 0.019). There were no significant differences in any outcomes in the subgroup of women who had no identified medical or antenatal complications. Conclusions This study does not provide evidence to support a routine policy of caesarean delivery for extremely obese women on the basis of concern about higher rates of delivery complications, but does support a policy of individualised decision-making on the mode of delivery based on a thorough assessment of potential risk factors for poor delivery outcomes
Homer, CSE 2011, 'The 'Ready for Child' structured antenatal training programme increases likelihood of mother's arriving at the maternity ward in active labour and decreases use of epidural analgesia.', Evidence-based nursing, vol. 14, no. 1, pp. 16-17.View/Download from: Publisher's site
Shaban, I, Hatamleh, R, Khresheh, R & Homer, CS 2011, 'Childbirth practices in Jordanian public hospitals: consistency with evidence-based maternity care?', International Journal of Evidence-Based Healthcare, vol. 9, pp. 25-31.View/Download from: Publisher's site
Background: In 1996, the World Health Organization stated that `childbirth is a natural process and in normal birth, there should be a valid reason to interfere with this natural process and encouraged practices that are evidence-based. The practices encouraged included avoiding unnecessary augmentation of labour, facilitating upright position for birth and restricting the use of routine episiotomy. Many countries have been slow to fully implement evidence-based practice in maternity care. The aim of this study was to examine maternity hospital practices in Jordan and assess their consistency with evidence-based maternity care. Methods: An explorative research design with non-participant observation was used. Data were collected from low-risk women during labour and birth using a questionnaire for maternal characteristics and an observational checklist. A proportional stratified sample was selected to recruit from three major public hospitals in Jordan. Data were analysed using descriptive statistics. Results: A total of 460 women were observed during labour and birth. The majority were multiparous (80%). A range of interventions were observed in women having a normal labour including augmentation (95%), continuous external fetal monitoring (77%), lithotomy position for birth (100%), and more than one third (37%) had an episiotomy with varying degrees of laceration (58%). Conclusions: Childbirth practices were largely not in accordance with the World Health Organization evidencebased practices for normal birth. High levels of interventions were observed, many of which may not have been necessary in this low-risk population. Further work needs to occur to explore the reasons why evidence-based practice is not implemented in these hospitals.
Sullivan, KJ, Lock, L & Homer, CS 2011, 'Factors That Contribute To Midwives Staying In Midwifery: A Study In One Area Health Service In New South Wales, Australia', Midwifery, vol. 27, no. 3, pp. 331-335.View/Download from: Publisher's site
Objective: the Australian health workforce is experiencing workforce shortages like many other countries. Managing retention is one important element of workforce planning. Determining the drivers of retention in midwifery can assist workforce planning.
Hammond, AD, Gray, JE, Smith, RM, Fenwick, JH & Homer, CS 2011, 'Same ... Same But Different: Expectations Of Graduates From Two Midwifery Education Courses In Australia', Journal Of Clinical Nursing, vol. 20, no. 15-16, pp. 2315-2324.View/Download from: Publisher's site
Aims and objectives. To identify the expectations and workforce intentions of new graduate midwives from two different preregistration educational courses at one Australian university. Background. In Australia there are two different educational pathways to midwifery qualification, one offered for registered nurses, commonly at a postgraduate level and the other for non-nurses, at an undergraduate level. The knowledge about midwifery graduates in general is reasonably limited and there is no specific research that examines the similarities and differences between graduates from the two different courses. Design. A cross-sectional design was used. Method. Data were collected by questionnaire from both undergraduate and postgraduate midwifery graduates in 2007 and 2008 at one Australian university. Data were analysed using descriptive statistics. Results. Almost all the graduates from the two different pre-registration courses intended to enter the midwifery workforce with both groups rating the factors that influenced this decision similarly. There were, however, significant differences in graduates age and their intention to work part time. Their views of their ideal roles and subsequent uptake into formal new graduate transition programmes differed. Graduates from the two courses also reported philosophical differences regarding their concepts of job satisfaction and ways their jobs could be improved.
Schmied, V, Donovan, J, Kruske, S, Kemp, L, Homer, CS & Fowler, CM 2011, 'Commonalities and challenges: A review of Australian state and territory maternity and child health policies', Contemporary Nurse, vol. 40, no. 1, pp. 106-117.View/Download from: Publisher's site
Nurses and midwives play a key role in providing universal maternal, child and family health services in Australia. However, the Australian federation of states and territories has resulted in policy frameworks that differ across jurisdictions and services that are fragmented across disciplines and sectors. This paper reports the findings of a study that reviewed and synthesised current Australian service policy or frameworks for maternity and child health services in order to identify the degree of commonality across jurisdictions and the compatibility with international research on child development. Key maternity and child health service policy documents in each jurisdiction were sourced. The fi ndings indicate that current policies were in line with international research and policy directions, emphasising prevention and early intervention, continuity of care, collaboration and integrated services. The congruence of policies suggests the time is right to consider the introduction of a national approach to universal maternal, child health services.
Adams, J, Lui, C, Sibbritt, D, Broom, A, Wardle, J & Homer, CS 2011, 'Attitudes And Referral Practices Of Maternity Care Professionals With Regard To Complementary And Alternative Medicine: An Integrative Review', Journal of Advanced Nursing, vol. 67, no. 3, pp. 472-483.View/Download from: Publisher's site
Aim. This paper presents an integrative literature review examining the attitudes and referral practices of midwives and other maternity care professionals with regard to complementary and alternative treatment and its use by pregnant women. Background.
Davidson, PM, Homer, CS, Duffield, CM & Daly, J 2011, 'A moment in history and a time for celebration: The performance of nursing and midwifery in Excellence in Research for Australia', Collegian, vol. 18, no. 2, pp. 43-44.View/Download from: Publisher's site
The long awaited and much anticipated results of Australia's first national university system wide research evaluation exercise were delivered in February this year. The Excellence in Research Assessment (ERA) examined `research quality within Australia's higher education institutions using a combination of indicators and expert review by committees comprising experienced, internationally-recognised experts' (Australian Research Council, 2011). In the discipline review for nursing some twenty three universities were assessed. Midwifery was included in the Nursing category as the Field of Research (FoR) code (the way the groups were clustered together) for nursing includes midwifery. The results for nursing and midwifery were impressive and they demonstrated that nine of the twenty three research programs in this category that were assessed were world class or above world class. In fact, nursing and midwifery in the FoR code 1110 was noted to be a `particularly strong performer' (Australian Research Council, 2011). This demonstrates that nurses and midwives in Australia are engaged in high quality research which is influencing practice and policy and making a difference to the health care of Australians. In addition, the research of many nurses and midwives was also considered in other categories including public health, health services and clinical medicine. This shows that our disciplines are well represented across the health field and the commitment to interdisciplinary practice to solve complex health care problems.
Homer, CS, Biggs, JB, Vaughan, G & Sullivan, E 2011, 'Mapping Maternity Services In Australia: Location, Classification And Services', Australian Health Review, vol. 35, no. 2, pp. 222-229.View/Download from: Publisher's site
Abstract Objective. To describe maternity services available to Australian women and, in particular, the location, classification of services and support services available. Design. A descriptive study was conducted using an online survey that was emailed to eligible hospitals. Inclusion criteria for the study included public and private maternity units with greater than 50 births per year. In total, 278 maternity units were identified. Units were asked to classify their level of acuity (Levels 26). Results. A total of 150 (53%) maternity units responded. Those who responded were reasonably similar to those who did not respond, and were representative of Australian maternity units. Almost three-quarters of respondents were from public maternity units and almost 70% defined themselves as being in a rural or remote location. Maternity units with higher birth rates were more likely to classify themselves as providing higher acuity services, that is, Levels 5 and 6. Private maternity units were more likely to have higher acuity classifications. Interventions such as induction of labour, either using an artificial rupture of membranes (ARM) and oxytocin infusion or with prostaglandins, were common across most units. Although electronic fetal monitoring (EFM) was also widely available, access to fetal scalp pH monitoring was low. Conclusion. Maternity service provision varies across the country and is defined predominately by location and annual birth rate.
O'Sullivan, EA, Peek, M, Knight, M, Ellwood, D, Homer, CSE, Pulver, LJ, Vaughan, GA & Callaway, L 2011, 'Extreme morbid obesity in pregnancy: Risk management and resources', WOMEN AND BIRTH, vol. 24, pp. S25-S25.View/Download from: Publisher's site
Homer, CS, Catling, C, Sinclair, D, Faizah, N, Balasubramanian Appiah, V, Foureur, M, Hoang, DB & Lawrence, EM 2010, 'Developing an interactive electronic maternity record', Birtish Journal of Midwifery, vol. 18, no. 6, pp. 384-389.View/Download from: Publisher's site
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.
McMurtrie, J, Catling-Paull, C, Teate, A, Caplice, S, Chapman, M & Homer, C 2010, 'The St. George Homebirth Program: an evaluation of the first 100 booked women (vol 49, pg 631, 2009)', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 50, no. 1, pp. 100-100.View/Download from: Publisher's site
Foureur, M, Davis, DL, Fenwick, JH, Leap, N, Iedema, RA, Forbes, I & Homer, CS 2010, 'The Relationship Between Birth Unit Design And Safe, Satisfying Birth: Developing A Hypothetical Model', Midwifery, vol. 26, no. 5, pp. 520-525.View/Download from: Publisher's site
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, DL, Forbes, I & Homer, CS 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.
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
Advanced midwifery practice is a controversial notion in midwifery, particularly at present in Australia. The proposed changes in legislation around access to the publicly funded Medical Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) in 20092010 have meant that the issue of advanced midwifery practice has again taken prominence. Linking midwifery access to MBS and PBS to a safety and quality framework that includes an `advanced midwifery credentialling framework is particularly challenging. The Haxton and Fahy paper in the December 2009 edition of Women and Birth is timely as it enables a reflection upon these issues and encourages debate and discussion about exactly what is midwifery, what are we educating our students for and is working to the full scope of practice practising at advanced level? This paper seeks to address some of these questions and open up the topic for further debate.
Foureur, M, Ryan, CS, Nicholl, M & Homer, CS 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.View/Download from: Publisher's site
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
Background: adverse events in maternity care are relatively common but often avoidable. International patient safety strategies advocate measuring safety culture as a strategy to improve patient safety. Evidence suggests it is necessary to fully understa
Dahlen, HG & Homer, CS 2010, 'Infant feeding in the first 12 weeks following birth: A comparison of patterns seen in Asian and non-Asian women in Australia', Women and Birth, vol. 23, no. 1, pp. 22-28.View/Download from: Publisher's site
Background There is a belief amongst midwives that Asian women are less likely to breastfeed compared to non-Asian women. The aim of this research was to compare the infant feeding decisions of Asian and non-Asian women on discharge from two Sydney hospitals, and at 6 and 12 weeks following birth. Participants 235 Asian and 462 non-Asian first time mothers. Methods A secondary analysis was undertaken into data from a randomised clinical trial of a perineal management technique (perineal warm packs). Simple descriptive statistics were used for analysis and Chi-square and logistic regression was used to examine differences between women from Asian and non-Asian backgrounds. Results Compared with non-Asian women, Asian women were no less likely to exclusively breastfeed on discharge from hospital (83% vs. 87%, OR 0.7, 95% CI 0.41.2), at 6 weeks (60% vs. 61%, OR 1, 95% CI 0.71.4) or 12 weeks postpartum (51% vs. 56%, OR 0.8, 95% CI 0.61.2). They were, however, significantly more likely to be partially breastfeeding on discharge from hospital (10% vs. 2%, OR 5.3, 95% CI 2.312.4), at 6 weeks (22% vs. 11%, OR 1.9, 95% CI 1.23.2) and 12 weeks postpartum (17% vs. 8%, OR 2.2, 95% CI 1.23.9).
Dahlen, HG, Barclay, L & Homer, CS 2010, 'Processing The First Birth: Journeying Into 'Motherland'', Journal Of Clinical Nursing, vol. 19, no. 13-14, pp. 1977-1985.View/Download from: Publisher's site
Aims and objectives. To explore first-time mothers' experiences of birth at home and in hospital in Australia. Background. The first birth has unique physical and psychological impacts on women. With the first birth, women become mothers. Design. A groun
Dahlen, HG, Barclay, L & Homer, CS 2010, ''Reacting To The Unknown': Experiencing The First Birth At Home Or In Hospital In Australia', Midwifery, vol. 26, no. 4, pp. 415-423.View/Download from: Publisher's site
Objective: to explore the experiences of a small group of first-time mothers giving birth at home or in hospital. Design: a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Setting: Sydney,
Dahlen, HG, Barclay, L & Homer, CS 2010, 'The Novice Birthing: Theorising First-Time Mothers' Experiences Of Birth At Home And In Hospital In Australia', Midwifery, vol. 26, no. 1, pp. 53-63.View/Download from: Publisher's site
Objective: to explore first-time mothers' experiences of birth at home and in hospital in Australia. Design: a grounded theory methodology was used. Data were genereated from in-depth interviews with women in thire own homes. Setting: Sydney, Australia.
Dahlen, HG, Homer, CS, Tracy, SK & Bisits, A 2010, 'Planned home and hospital births in South Australia, 1991-2006: differences in outcomes', Medical Journal of Australia, vol. 192, no. 12, pp. 726-726.
Homer, CS 2010, 'The homebirth debate in Australia: A clash of philosophies', Precedent, vol. -, no. 98, pp. 38-42.
Homer, CS, Kurinczuk, J, Spark, P, Brocklehurst, P & Knight, M 2010, 'A Novel Use Of A Classification System To Audit Severe Maternal Morbidity', Midwifery, vol. 26, no. 5, pp. 532-536.View/Download from: Publisher's site
Objective: obstetric haemorrhage remains a significant cause of maternal morbidity and mortality worldwide and is significant in terms of patient safety and quality of care. One drastic outcome of haemorrhage is the need for peripartum hysterectomy. A cl
Schmied, V, Mills, A, Kruske, S, Kemp, L, Fowler, CM & Homer, CS 2010, 'The nature and impact of collaboration and integrated service delivery for pregnant women, children and families', Journal Of Clinical Nursing, vol. 19, no. 23-24, pp. 3516-3526.View/Download from: Publisher's site
Aim. This paper explores the impact of models of integrated services for pregnant women, children and families and the nature of collaboration between midwives, child and family health nurses and general practitioners. Background. Increasingly, maternity and child health services are establishing integrated service models to meet the needs of pregnant women, children and families particularly those vulnerable to poor outcomes. Little is known about the nature of collaboration between professionals or the impact of service integration across universal health services. Design. Discursive paper. Methods. A literature search was conducted using a range of databases and combinations of relevant keywords to identify papers reporting the process, and/or outcomes of collaboration and integrated models of care. Results. There is limited literature describing models of collaboration or reporting outcomes. Several whole-of-government and community-based integrated service models have been trialled with varying success. Effective communication mechanisms and professional relationships and boundaries are key concerns. Liaison positions, multidisciplinary teams and service co-location have been adopted to communicate information, facilitate transition of care from one service or professional to another and to build working relationships. Conclusions. Currently, collaboration between universal health services predominantly reflects initiatives to move services from the level of coexistence to models of cooperation and coordination.
Sullivan, E, Ellwood, D, Peek, M, Knight, M, Jackson Pulver, LR, Homer, CS, Elliott, E, McLintock, C, Thompson, J, Zurynski, Y, Ho, T, McDonnell, N & Pollock, W 2010, 'Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study', British Medical Journal, vol. 340:c1279, no. NA, pp. 1-6.
Objective To describe the epidemiology of 2009 A/H1N1 influenza in critically ill pregnant women. Design Population based cohort study. Setting All intensive care units in Australia and New Zealand. Participants All women with 2009 H1N1 influenza who were pregnant or recently post partum and admitted to an intensive care unit in Australia or New Zealand between 1 June and 31 August 2009. Main outcome measures Maternal and neonatal mortality and morbidity.
Bowyer, L, Catling, C, Diamond, T, Homer, CS, Davis, GK & Craig, MS 2009, 'Vitamin D, PTH and calcium levels in pregnant women and their neonates', Clinical Endocrinology, vol. 70, no. 3, pp. 372-377.View/Download from: Publisher's site
To determine the prevalence of vitamin D deficiency in pregnant women and their neonates and to examine factors associated with vitamin D deficiency. Population-based study of pregnant women and their neonates from South-eastern Sydney, Australia. Serum 25 hydroxy-vitamin D (25-OHD), PTH, calcium, albumin, phosphate and alkaline phosphatase were measured in women at 23-32 weeks gestation and on cord blood at delivery. Maternal skin phototype was recorded using the Fitzpatrick scale. Vitamin D deficiency (defined as 25-OHD <= 25 nmol/l) was found in 144 of 971 (15%) women and 98 of 901 (11%) neonates. Median 25-OHD was 52 nmol/l (range 17-174) in mothers and 60 nmol/l (17-245) in neonates. Maternal 25-OHD levels varied by season, with lowest levels in late winter/early spring (P < 0.001). Factors associated with maternal vitamin D deficiency in multiple logistic regression were (OR, 95% CI): maternal birthplace outside Australia: 2.2 (1.4-3.5, P = 0.001), dark skin phototype: 2.7 (1.6-4.5, P < 0.001), wearing a veil: 21.7 (11.7-40.3, P < 0.001) and younger maternal age: 0.93 (0.89-0.97, P = 0.001). Maternal vitamin D deficiency increased the risk of neonatal vitamin D deficiency (OR 17.2, 95% CI 8.8-34.3) and birth weight was lower among infants of deficient vs. sufficient mothers: mean (SD) 3245 g (545) vs. 3453 g (555), P < 0.001. Vitamin D deficiency is common among pregnant women; immigrant, veiled and dark skinned women are at greatest risk. Maternal vitamin D deficiency increases the risk of neonatal vitamin D deficiency and lower birth weight.
McMurtrie, JE, Catling, C, Teate, A, Caplice, SL, Chapman, M & Homer, CS 2009, 'The St. George Homebirth Program: An evaluation of the first 100 booked women', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 49, no. 6, pp. 631-636.View/Download from: Publisher's site
Background: The St. George Homebirth Program was the first publicly funded homebirth model of care set up in New South Wales. This program provides access to selected women at low obstetric risk the option of having their babies at home. There are only four other publicly funded homebirth programs operating in Australia. Aims: To report the outcomes of the first 100 women booked at the St. George Homebirth Program. Methods: A prospective descriptive study was undertaken. Data were collected on the first 100 women who gave birth between November 2005 and March 2009. Two databases were accessed and missing data were followed up by review of the relevant charts. Results: Of the first 100 booked women, 63 achieved a homebirth, 30 were transferred to hospital or independent midwifery care in the antenatal period and seven were transferred intrapartum. Two women were transferred to hospital in the early postnatal period, one for a postpartum haemorrhage and one for hypotension. One baby suffered mild respiratory distress, was treated in the emergency department and was discharged home within four hours. Conclusion: The St. George Hospital homebirth program has provided reassuring outcomes for the first 100 women it has cared for over the past four years. Wider availability of this service could be achieved provided there is the appropriate close collaboration between providers and effective processes for consultation, referral and transfer. The outcomes of women and babies in publicly funded homebirth programs deserve further study, and the development of a national prospective database of all planned homebirths would contribute to this knowledge.
Homer, CS, Henry, K, Schmied, V, Kemp, L, Leap, N & Briggs, CJ 2009, ''It looks good on paper': Transitions of care between midwives and child and family health nurses in New South Wales', Women and Birth, vol. 22, no. 2, pp. 64-72.View/Download from: Publisher's site
Background The way in which women and their babies transition from maternity services to the care of child and family health nurses differs across Australia. The aim of the study was to understand the transition of care from one service to another and how to promote collaboration in the first few weeks after the birth. Method A descriptive study was undertaken. All midwifery, child and family health and Families NSW managers in NSW were invited to participate by completing a questionnaire. Results There was a wide range of transition of care models. These varied by setting, geography, context and history. Three main models emerged from the analysis. These were as follows: 1. Structured, non-verbal communication system that relied on paper-based or computerised systems. This included either centralised referral or centre-based referral processes. 2. Liaison person model which was similar to purposeful contact, but with everything vested in one clinician who is responsible for the coordination and organisation. 3. Purposeful contact model which was mostly for identified at-risk women and included continuity of care with formal networks and face to face contact.
Homer, CS, Passant, L, Brodie, PM, Kildea, SV, Leap, N, Pincombe, J & Thorogood, C 2009, 'The role of the midwife in Australia: Views of women and midwives', Midwifery, vol. 25, no. 6, pp. 673-681.View/Download from: Publisher's site
Objective to research the role of midwives in Australia from the perspectives of women and midwives. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. Design a multi-method approach with qualitative data collected from surveys with women and interviews with midwives. Setting participants represented each state and territory in Australia. Participants midwives who were randomly selected by the regulatory authorities across the country and women who were consumers of midwifery care and involved in maternity activism. Key conclusions midwives and women identified a series of key elements that were required of a midwife. These included: being woman centred; providing safe and supportive care; and working in collaboration with others when necessary. These findings were consistent with much of the international literature. Implications for practice a number of barriers to achieving the full role of the midwife were identified. These included a lack of opportunity to practice across the full spectrum of maternity care, the invisibility of midwifery in regulation and practice, the domination of medicine, workforce shortages, the institutional system of maternity care, and the lack of a clear image of what midwifery is within the wider community. These barriers must be addressed if midwives in Australia are to be able to function according to the full potential of their role.
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.
Homer, C, Ryan, C, Leap, N, Foureur, M & Teate, A 2009, 'Group versus conventional antenatal care for pregnant women', Cochrane Database of Systematic Reviews, no. 1.View/Download from: Publisher's site
Dahlen, HG, Homer, CS, Cooke, M, Upton, AM, Nunn, RA & Brodrick, BS 2009, ''Soothing the ring of fire': Australian women's and midwives' experiences of using perineal warm packs in the second stage of labour', Midwifery, vol. 25, no. 2, pp. 39-48.View/Download from: Publisher's site
Objective to determine women's and midwives experiences of using perineal warm packs in the second stage of labour. Design as part of a randomised controlled trial (Warm Pack Trial), women and midwives were asked to complete questionnaires about the effects of the warm packs on pain, perineal trauma, comfort, feelings of control, satisfaction and intentions for use during future births. Setting two hospitals in Sydney, Australia. Participants a randomised controlled trial was undertaken. In the late second stage of labour, nulliparous women (n=717) giving birth were randomly allocated to having warm packs (n=360) applied to their perineum or standard care (n=357). Standard care was defined as any second stage practice carried out by midwives that did not include the application of warm packs to the perineum. Three hundred and two nulliparous women randomised to receive warm packs (84%) received the treatment. Questionnaires were completed by 266 (88%) women who received warm packs, and 270 (89%) midwives who applied warm packs to these women. Intervention warm, moist packs were applied to the perineum in the late second stage of labour.
Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality. Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.
Homer, CS, Hanna, E & McMichael, AJ 2009, 'Climate change threatens the achievement of the millennium development goal for maternal health', Midwifery, vol. 25,, pp. 606-612.
Khresheh, R, Homer, C & Barclay, L 2009, 'A comparison of labour and birth outcomes in Jordan with WHO guidelines: a descriptive study using a new birth record', MIDWIFERY, vol. 25, no. 6, pp. E11-E18.View/Download from: Publisher's site
Schmied, V, Cooke, M, Gutwein, R, Steinlein, E & Homer, CS 2009, 'An evaluation of strategies to improve the quality and content of hospital-based postnatal care in a metropolitan Australian hospital', Journal Of Clinical Nursing, vol. 18, no. 13, pp. 1850-1861.View/Download from: Publisher's site
Aim and objective. This study aimed to design, implement and evaluate strategies to improve the quality and content of hospital-based postnatal care. Background. Following birth, women report physical health problems, difficulties with breastfeeding, a lack of parenting self-efficacy and there is high occurrence of postnatal distress and depression. Despite these significant needs, women are frequently dissatisfied with the advice and support they receive from hospital-based postnatal care. Design. A pre/post test design compared the effect of multifaceted strategies on perceptions of quality and content of postnatal care, knowledge and experience of postnatal problems, parenting self-efficacy and breastfeeding outcomes. The key strategy, `one-to-one time, focused on providing women an uninterrupted period of time each day when a midwife would be available to discuss womens concerns about their health and that of their baby. Method. A convenience sample of 146 women at baseline and 148 women postintervention completed a postal self-report questionnaire between 24 weeks postpartum. Results. There were no significant differences between baseline and postintervention groups in perceived quality of care, breastfeeding outcomes and maternal self-efficacy. Women experiencing health issues, including insufficient milk supply, backache, abnormal bleeding and urinary incontinence, were more likely to report that they received good or excellent care and advice in the postintervention group. Strategies to increase rest appeared effective with women less likely to report excessive tiredness postintervention.
Adams, J, Lui, C, Sibbritt, D, Broom, A, Wardle, J, Homer, CS & Beck, S 2009, 'Women's Use of Complementary and Alternative Medicine During Pregnancy: : A Critical Review Of The Literature', Birth: issues in perinatal care, vol. 36, no. 3, pp. 237-245.View/Download from: Publisher's site
Background: The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile,""motivation and condition of use,""perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Dahlen, HG & Homer, CS 2008, 'Perinael trauma and postpartum perineal morbidity in asian and non-asian primiparous women giving birth in Australia', Journal of Obstetric, Gynaecological & Neonatal Nursing, vol. 37, no. 4, pp. 455-463.View/Download from: Publisher's site
Objectives: To describe the postpartum perineal morbidity of primiparous women who had a vaginal birth and compare outcomes between Asian and non-Asian women in the first 2 days following the birth and at 6 and 12 weeks postpartum. Design: Data from a randomized clinical trial of a perineal management technique (perineal warm packs) were used to address the study objective. Setting: Two maternity hospitals in Sydney, Australia. Participants: Primiparous women who had a vaginal birth in the trial were included (n=697). One third of the women were identified as "Asian." Results: Compared with non-Asian women, Asian women were significantly more likely to have an episiotomy; require perineal suturing; sustain a third- or fourth-degree perineal tear; and report their perineal pain as being moderate to severe on day 1 following the birth. Asian women were less likely to give birth in an upright position or to resume sexual intercourse by 6 or 12 weeks following the birth. Conclusion: More research is needed into methods that could reduce the high rates of perineal trauma experienced by Asian women, and midwives need to be able to offer appropriate support for Asian women.
Dahlen, HG & Homer, CS 2008, 'What are the views of midwives in relation to perineal repair?', Women and Birth, vol. 21, no. 1, pp. 27-36.
Purpose To determine the views of midwives towards perineal repair and the most effective way to teach and support midwives in developing this skill. Procedure A questionnaire was distributed to 111 midwives who attended a 1-day seminar. Information was sought on a range of views relating to perineal repair, including experience, confidence, education and accreditation, attitudes and trends. Findings One hundred and six (96%) questionnaires were returned. All respondents (100%) believed midwives should be taught to undertake perineal repair. The most important reason was to provide continuity of care for women. Experience increased confidence and enjoyment in undertaking perineal repair as well as lessening fears over the impact of suturing on women. Experience did not significantly impact on concerns regarding legal implications associated with perineal repair. Three quarters of respondents reported that midwifery students should have practical experience of perineal repair. There was strong support for doctors and midwives to undertake perineal repair education together (96%), preferably in a 1-day workshop format (56%); for standards to be set by the professional colleges (midwifery and obstetrics) (66%); for midwives and doctors to be accredited as competent before performing perineal repair independently (>90%) and for regular updates in perineal repair (93%). The majority of midwives (73%) felt that they were more likely to suture than 5 years ago, due mainly to a greater appreciation of woman centred care (35%). Over 60% of midwives said they would not suture a first-degree tear more than half of the time and 13% would not suture a second-degree tear more than half of the time.
Dahlen, HG, Barclay, L & Homer, CS 2008, 'Preparing for the first birth: Mothers' experiences at home and in hospital in Australia', Journal of Perinatal Education, vol. 17, no. 4, pp. 21-32.View/Download from: Publisher's site
The aim of this research was to explore the experiences of a group of first-time mothers who had given birth at home or in hospital in Australia. Data were generated from in-depth interviews with 19 women and analyzed using a grounded theory approach. One of the categories to emerge from the analysis, ``Preparing for Birth, is discussed in this article. Preparing for Birth consisted of two subcategories, ``Finding a Childbirth Setting and ``Setting Up Birth Expectations, which were mediated by beliefs, convenience, finances, reputation, imagination, education and knowledge, birth stories, and previous life experiences. Overall, the women who had planned home births felt more prepared for birth and were better supported by their midwives compared with women who had planned hospital births.
Dahlen, HG, Barclay, LM & Homer, C 2008, 'Preparing for the first birth: mothers' experiences at home and in hospital in australia.', The Journal of perinatal education, vol. 17, no. 4, pp. 21-32.View/Download from: Publisher's site
The aim of this research was to explore the experiences of a group of first-time mothers who had given birth at home or in hospital in Australia. Data were generated from in-depth interviews with 19 women and analyzed using a grounded theory approach. One of the categories to emerge from the analysis, "Preparing for Birth," is discussed in this article. Preparing for Birth consisted of two subcategories, "Finding a Childbirth Setting" and "Setting Up Birth Expectations," which were mediated by beliefs, convenience, finances, reputation, imagination, education and knowledge, birth stories, and previous life experiences. Overall, the women who had planned home births felt more prepared for birth and were better supported by their midwives compared with women who had planned hospital births.
Griffiths, M & Homer, CS 2008, 'Developing a review process for Australian midwives: a report of the Midwifery Practice Review Project process', Women and Birth, vol. 21, no. 3, pp. 119-126.View/Download from: Publisher's site
Objective To develop a formal, robust and transparent process that supports and enables midwives to reflect on their own midwifery practice in relation to recognised professional standards and to identify, prioritise and act upon individual professional development and learning needs for the provision of safe, high quality care to women and their families within the full scope of midwifery practice. This process was part of a national project commissioned by the Australian College of Midwives and funded by the Australian Council for Safety and Quality in Health Care and is part of the Continuing Professional Development, MidPLUS program developed by the Australian College of Midwives. Approach A multi-method, staged approach was used to develop the national Midwifery Practice Review process. Data to inform the development of the Midwifery Practice Review process was collected through a literature review, workshop consultations, written submissions and the pilot testing of a draft process. Finally, a national training workshop was undertaken to train reviewers to carry out reviews and to ensure the final process was validated and was feasible and acceptable to midwives and consumers. Setting Maternity care settings in each state and territory throughout Australia. Participants Midwives, other health professionals and consumers of midwifery care. Findings The Midwifery Practice Review process was developed through research and national consultation prior to being validated in practice.
Homer, CS, Brown, MA, Mangos, G & Davis, GK 2008, 'Non-proteinuric pre-eclampsia - a novel risk indicator in women with gestational hypertension', Journal of Hypertension, vol. 26, no. 2, pp. 295-302.View/Download from: Publisher's site
Objective: To determine whether outcomes differed for women with pre-eclampsia according to the presence of proteinuria and whether non-proteinuric pre-eclampsia is similar to gestational hypertension. Design: From 1987 to 2005, at three hospitals in Sydney, Australia, women referred to the obstetric medicine team were recruited. Outcomes for three groups were compared: proteinuric pre-eclampsia, non-proteinuric pre-eclampsia and gestational hypertension. Results: Women with proteinuric pre-eclampsia were more likely to have severe hypertension (39 versus 30%, P = 0.003), deliver preterm infants (39 versus 30%, P = 0.007) and had a higher perinatal mortality rate (25.2 versus 5.7 per 1000, P = 0.02) than those with non-proteinuric pre-eclampsia, who were more likely to have thrombocytopenia and liver disease. Women with non-proteinuric pre-eclampsia were more likely to have multiple pregnancies (3.9 versus 9.9%, P < 0.001), experience severe hypertension (8.9 versus 29.7%, P < 0.001), and deliver preterm infants (11.3 versus 30.2%, P < 0.001) who were small for gestational age (12.7 versus 20.9%, P < 0.001) than those with gestational hypertension. Conclusion: This study highlights differences between non-proteinuric pre-eclampsia and gestational hypertension. The subclassification of 'non-proteinuric pre-eclampsia' should be added to existing classification systems to alert clinicians to potential risks.
Schmied, V, Cooke, M, Gutwein, R, Steinlein, E & Homer, CS 2008, 'Time to listen:Strategies to improve hospital-based postnatal care', Women and Birth, vol. 21, no. 3, pp. 99-105.View/Download from: Publisher's site
Summary Background In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care. Aim To design and implement strategies to improve hospital-based postnatal care at a Sydney metropolitan hospital. Method This was an Action Research study. In Phase One, midwives considered the literature and participated in group discussions and interviews to determine their perceptions of postnatal care and the factors that facilitate or hinder the provision of quality care. In Phase Two, midwives participated in 12 working group meetings to design strategies to improve care. Results Several important principles of postnatal care were described, including building a relationship with women, meeting their individual needs, being flexible in approach and providing continuity of care. `Listening to women, `being there, and `normalising experiences and expectations were believed to be critical to achieving these principles. A key strategy `One to One Time was designed to provide women with an uninterrupted period of time each day with a midwife who was available to listen to their needs and concerns and discuss issues related to their health and that of their baby. Conclusion Midwives designed and implemented strategies that they believed would improve in-hospital postnatal care.
Homer, CS, Passant, L, Kildea, SV, Pincombe, J, Thorogood, C, Leap, N & Brodie, PM 2007, 'The development of national competency standards for the midwife in Australia', Midwifery, vol. 23, no. 4, pp. 350-360.View/Download from: Publisher's site
OBJECTIVE: to develop and validate national competency standards for midwives in Australia. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. DESIGN: a multi-method, staged approach was used to collect data through a literature review, workshop consultations, interviews, surveys and written submissions in order to develop national competency standards for Australian midwives. Subsequently, direct observation of practice in a range of settings ensured validation of the competencies. SETTING: maternity-care settings in each state and territory in Australia. PARTICIPANTS: midwives, other health professionals and consumers of midwifery care. FINDINGS: The national competency standards for the midwife were developed through research and consultation before being validated in practice. KEY CONCLUSIONS: the national competency standards are currently being implemented into education, regulation and practice in Australia. These will be minimum competency standards required of all midwives who seek authority to practise as a midwife in Australia. It is expected that all midwives will demonstrate that they are able to meet the competency standards relevant to the position they hold. IMPLICATIONS FOR PRACTICE: the competency standards establish a national standard for midwives and reinforce responsibility and accountability in the provision of quality midwifery care through safe and effective practice. In addition, individual midwives may use the competency standards as the basis of their ongoing professional development plans.
AIM: To determine the accuracy of the estimation of blood loss using simulated clinical examples. SETTING: Over 100 attendees came together at a seminar about postpartum haemorrhage in June 2006. Five blood loss assessment stations were constructed, each containing a simulated clinical example. Each station was numbered and was made up of a variety of equipment used in birthing suites. Over 5L of 'artificial' blood was made. The artificial blood was similar to the colour and consistency of real blood. SAMPLE: A convenience sample of 88 participants was given a response sheet and asked to estimate blood loss at each station. Participants included midwives, student midwives and an obstetrician. RESULTS: Blood in a container (bedpan, kidney dish) was more accurately estimated than blood on sanitary pads, sheets or clothing. Lower volumes of blood were also estimated correctly by more participants than the higher volumes. DISCUSSION: Improvements are still needed in visual estimation of blood loss following childbirth. Education programs may increase the level of accuracy. CONCLUSION: We encourage other clinicians and educators to embark upon a similar exercise to assist midwives and others to improve their visual estimation of blood loss after birth. Accurate estimations can ensure that women who experience significant blood loss can receive appropriate care and the published rates of postpartum haemorrhage are correct.
Dahlen, H, Homer, CS, Cooke, M, Upton, A, Nunn, R & Brodrick, B 2007, 'Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor. A randomized control trial', Birth: issues in perinatal care, vol. 34, no. 4, pp. 282-290.View/Download from: Publisher's site
Perineal warm packs are widely used during childbirth in the belief that they reduce perineal trauma and increase comfort during late second stage of labor. The aim of this study was to determine the effects of applying warm packs to the perineum on perineal trauma and maternal comfort during the late second stage of labor. Methods: A randomized controlled trial was undertaken. In the late second stage of labor, nulliparous women (n = 717) giving birth were randomly allocated to have warm packs (n = 360) applied to their perineum or to receive standard care (n = 357). Standard care was defined as any second-stage practice carried out by midwives that did not include the application of warm packs to the perineum. Analysis was on an intention-totreat basis, and the primary outcome measures were requirement for perineal suturing and maternal comfort. Results: The difference in the number of women who required suturing after birth was not significant. Women in the warm pack group had significantly fewer third- and fourth-degree tears and they had significantly lower perineal pain scores when giving birth and on day 1 and day 2 after the birth compared with the standard care group. At 3 months, they were significantly less likely to have urinary incontinence compared with women in the standard care group. Conclusions: The application of perineal warm packs in late second stage does not reduce the likelihood of nulliparous women requiring perineal suturing but significantly reduces third- and fourth-degree lacerations, pain during the birth and on days 1 and 2, and urinary incontinence. This simple, inexpensive practice should be incorporated into second stage labor care
Dahlen, HG, Ryan, M, Homer, CS & Cooke, M 2007, 'An Australian prospective cohort study of risk factors for severe perineal trauma during childbirth', Midwifery, vol. 23, no. 2, pp. 196-203.View/Download from: Publisher's site
Objective to determine risk factors for the occurrence of severe perineal trauma (third and fourth degree tears) during childbirth.Design a prospective cohort study was conducted using the hospital's computerised obstetric information system. Additional
Davis, GK, Mackenzie, C, Brown, MA, Homer, CS, Holt, J, Mchugh, L & Mangos, G 2007, 'Predicting Transformation From Gestational Hypertension To Preeclampsia In Clinical Practice A Possible Role For 24 Hour Ambulatory Blood Pressure Monitoring', Hypertension In Pregnancy, vol. 26, no. 1, pp. 77-87.View/Download from: Publisher's site
Objective To identify parameters that may assist clinicians in predicting which women will develop preeclampsia (PE) after initially presenting with gestational hypertension (GH). Methods 118 women were recruited to the study with GH or PE. They were div
Homer, CS & Dahlen, HG 2007, 'Obstetric-induced incontinence: A black hole of preventable morbidity? An 'alternative' opinion', The Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 47, no. 2, pp. 86-90.View/Download from: Publisher's site
Moss, JR, Crowther, CA, Hiller, JE, Willson, KJ, Robinson, JS, Chipps, D, Myszka, R, Hendon, S, McLean, M, Merker, H, Bradford, J, Tuffnell, D, West, J, Hinton, R, Woodford, D, Cave, D, Armstrong, C, Vacca, A, Joubert, P, Mego, S, Heazelwood, V, Grunstein, H, Fleming, S, Marney, B, Harris, K, Ebert, J, Bryce, R, Judd, S, Keirse, M, Verco, C, Ferriman, E, Mason, G, Lidelle-Johnson, C, Pearce, J, de Swiet, M, Lindberg, A, Ludwig, D, Wickremachandran, K, Dekker, G, Duggan, P, Hocking, I, Jeffries, W, Kennedy-Andrews, S, Kretschmer, N, Millar, H, Mowbray, J, Archer, C, Hughes, C, Matthews, G, Morton, M, Price, N, Purins, L, Tamlin, N, Sieben, J, Cocks, C, Gregora, M, Hamwood, S, Pinn, G, Rutherford, C, Sheehan, C, Stubss, T, Smith-Orr, V, Rutter, S, Bruce, C, Fraser, R, Pridmore, B, Hague, W, Phillips, P, Sladek, M, Torr, S, Burton, G, Hitchman, R, Kelso, I, McElduff, A, Morris, J, Homer, C, Davis, G, Bridger, P, Chadha, Y, Gibson, D, Ratnapala, M, Watson, D, Rane, A, Robinson, A, Whitahall, J, Dunstone, S, Chadwick, R, Dederer, A, Lawrence, A, Crowther, C, Burnet, R, McPhee, A, Robinson, J, Thomas, A, Alton, S, Hayton, J, Paynter, J, Deussen, A & Avery, J 2007, 'Costs and consequences of treatment for mild gestational diabetes mellitus - Evaluation from the ACHOIS randomised trial', BMC Pregnancy and Childbirth, vol. 7.View/Download from: Publisher's site
Background: Recommended best practice is that economic evaluation of health care interventions should be integral with randomised clinical trials. We performed a cost-consequence analysis of treating women with mild gestational diabetes mellitus by dietary advice, blood glucose monitoring and insulin therapy as needed compared with routine pregnancy care, using patient-level data from a multi-centre randomised clinical trial. Methods: Women with a singleton pregnancy who had mild gestational diabetes diagnosed by an oral glucose-tolerance test between 24 and 34 weeks' gestation and their infants were included. Clinical outcomes and outpatient costs derived from all women and infants in the trial. Inpatient costs derived from women and infants attending the hospital contributing the largest number of enrolments (26.1%), and charges to women and their families derived from a subsample of participants from that hospital (in 2002 Australian dollars). Occasions of service and health outcomes were adjusted for maternal age, ethnicity and parity. Analysis of variance was used with bootstrapping to confirm results. Primary clinical outcomes were serious perinatal complications; admission to neonatal nursery; jaundice requiring phototherapy; induction of labour and caesarean delivery. Economic outcome measures were outpatient and inpatient costs, and charges to women and their families. Results: For every 100 women with a singleton pregnancy and positive oral glucose tolerance test who were offered treatment for mild gestational diabetes mellitus in addition to routine obstetric care, $53,985 additional direct costs were incurred at the obstetric hospital, $6,521 additional charges were incurred by women and their families, 9.7 additional women experienced induction of labour, and 8.6 more babies were admitted to a neonatal nursery. However, 2.2 fewer babies experienced serious perinatal complication and 1.0 fewer babies experienced perinatal death. The incremental cost p...
Roberts, L, Homer, CS, Davis, GK & Miller, T 2007, 'Misoprostol to induce labour A review of its use in a NSW hospital', Australian & New Zealand Journal Of Obstetrics & Gynaecology, vol. 47, no. 4, pp. 291-296.View/Download from: Publisher's site
Background Induction of labour (IOL) is a common procedure in maternity care. Misoprostol is a prostaglandin E-1 analogue that is effective, cheap and easily stored but not licensed for this use in Australia. Despite evidence supporting the use of misopr
Homer, CS 2006, 'Challenging Midwifery Care, Challenging Midwives and Challenging the System.', Women and Birth, vol. 19, no. 3, pp. 79-83.
The purpose of this paper is to generate debate and discussion about the state of midwifery services in Australia today. While numerous reports have been published that highlight what women want in maternity care, widespread change has not occurred. This paper presents the story of Alice (a real woman with a fictitious name). Alice's story highlights the challenges that women face in dealing with a system that is often inflexible. While the health systems, and those who work within them, usually have the best intentions to try to provide the type of care that women want, they are not always successful. The paper summarises the evidence and support for models of continuity of midwifery care and outlines a series of strategies to ensure that change can occur. Finally, the paper challenges all midwives to work towards widespread, system-level change in Australian maternity services
Homer, CS 2006, 'Maternal death: a time for reflection', Women and Birth, vol. 19, no. 2, pp. 37-38.
Homer, CS 2006, 'Re Collaboration In Maternity Care. A Response To what Do I Think Of Midwife-led Units?'', Australian & New Zealand Journal Of Obstetrics & Gynaecology, vol. 46, no. 3, pp. 262-264.
Mackenzie, C, Davis, G, Brown, M, Homer, C, Holt, J, McHugh, L & Mangos, G 2006, 'Predicting transformation from gestational hypertension to preeclampsia using 24 hour ambulatory blood pressure monitoring (ABPM).', HYPERTENSION IN PREGNANCY, vol. 25, pp. 165-165.
Brown, MA, Holt, J, Mangos, G, Murray, N, Curtis, J & Homer, CS 2005, 'Microscopic hematuria in pregnancy: Relevance to pregnancy outcome', American Journal of Kidney Diseases, vol. 45, no. 4, pp. 667-673.View/Download from: Publisher's site
The significance of dipstick or microscopic hematuria in pregnancy is uncertain, with some studies suggesting this is associated with a greater risk for preeclampsia. We sought to determine the prevalence and clinical significance of microscopic hematuria during pregnancy. METHODS: This was a prospective case-control study in the antenatal Clinic of St George Hospital, Kogarah, Australia, a teaching hospital without tertiary referral antenatal care, with approximately 2,600 deliveries per year. One thousand pregnant women attending for routine antenatal care were invited to have a routine urinalysis performed and be referred to a nephrology clinic for further investigation if dipstick microscopic hematuria was detected on more than 1 occasion before 32 weeks' gestation. Main outcome measures were the prevalence of dipstick hematuria, prevalence of hematuria confirmed by urine microscopy, and the development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby. RESULTS: One hundred seventy-eight of 902 women (20%) who entered the study had dipstick hematuria on at least 2 occasions in pregnancy; 66 of 126 women (53%) who had hematuria before 32 weeks attended the nephrology clinic, where microscopic hematuria was confirmed in 40 women (61%). Renal imaging results were normal in all except 1 woman, and all women had a serum creatinine level of 0.90 mg/dL or less (< or =80 micromol/L). The development of preeclampsia or gestational hypertension or delivery of a small-for-gestational-age baby were similar in women with and without dipstick hematuria. Microscopic hematuria persisted in half (15 women) of those who attended for follow-up after 3 months postpartum. CONCLUSION: Dipstick hematuria is very common during pregnancy, but rarely signifies a disorder likely to impact on the pregnancy outcome. Postpartum follow-up is recommended to detect women who have persistent hematuria and presumed underlying mild glomerulonephritis.
Brown, MA, Mangos, G, Davis, GK & Homer, CS 2005, 'The natural history of white coat hypertension during pregnancy', British Journal of Obstetrics and Gynecology, vol. 112, no. 5, pp. 601-606.
Objective White coat hypertension (WCH) is a common phenomenon with a long term prognosis intermediate between those with true hypertension and true normotension. The natural history of this phenomenon throughout pregnancy remains unknown. We assessed the likelihood of women with an initial diagnosis of WCH developing pre-eclampsia (PE) as their pregnancy progressed. Design Prospective observational study. Setting St George Hospital, a teaching and University hospital. Population Two hundred and forty-one pregnant women with an early pregnancy diagnosis of essential hypertension (EH). Methods Eighty-six women had this diagnosis (EH) confirmed pre-pregnancy by 24-hour ambulatory blood pressure monitoring (ABPM) or repeated automated home blood pressure (BP) self-measurement. The remaining 155 underwent 24-hour ABPM in early pregnancy to establish their diagnosis. Women found to have WCH did not receive antihypertensives during their pregnancy, whereas those with confirmed EH received oxprenolol or methyldopa. Women with WCH had repeated 24-hour ABPM and/or BP assessments in a pregnancy day assessment unit until delivery. Main outcome measure The development of PE in women with WCH or EH.
Homer, CS 2005, 'Sexually transmitted diseases and pregnancy', Australian Midwifery News, vol. 5, no. 3, pp. 28-29.
Homer, CS 2004, 'Informed consent and childbirth: coming to terms with the 21st century', Australian Midwifery Journal, vol. 17, no. 3, pp. 9-11.
Homer, CS 2004, 'Shoulder dystocia', Australian Midwifery News, vol. 14, no. 4, pp. 13-16.
Homer, CS & Brickwood, KJ 2004, ''Helping partners quit' - A project to help pregnant women and their partners to stop smoking', Achievements in Nursing, vol. 6, pp. 5-7.
Homer, CS, Roberts, L, Bowyer, L & Brown, MA 2004, 'Multi-centre research involving review of medical records: negotiating the obstacle course of ethics approval', Medical Journal of Australia, vol. 180, no. 3, pp. 139-139.
Roberts, LM, Bowyer, L, Homer, CS & Brown, MA 2004, 'Erratum: Multicentre research: Negotiating the ethics approval obstacle course (The Medical Journal of Australia (2004) vol. 180 (139))', Medical Journal of Australia, vol. 180, no. 6, p. 262.View/Download from: Publisher's site
Roberts, LM, Bowyer, L, Homer, CS & Brown, MA 2004, 'Multicentre research: negotiating the ethics approval obstacle course', MEDICAL JOURNAL OF AUSTRALIA, vol. 180, no. 3, pp. 139-139.View/Download from: Publisher's site
Roberts, LM, Bowyer, L, Homer, CS & Brown, MA 2004, 'Multicentre research: negotiating the ethics approval obstacle course (vol 180, pg 139, 2004)', MEDICAL JOURNAL OF AUSTRALIA, vol. 180, no. 6, pp. 262-262.View/Download from: Publisher's site
Brown, MA, Homer, CS, Davis, GK & Mangos, G 2003, 'In reply: The clinical utility of routine urinalysis in pregnancy', Medical Journal fo Australia, vol. 178, no. 10, pp. 524-525.
Brown, MA, Homer, CS, Davis, GK & Mangos, G 2003, 'The clinical utility of routine urinalysis in pregnancy - Reply', MEDICAL JOURNAL OF AUSTRALIA, vol. 178, no. 10, pp. 524-525.View/Download from: Publisher's site
Homer, CS, Davis, GK & Urquhart, V 2003, 'Getting research into practice using protocol development', Achievements in Nursing, vol. 5, pp. 24-26.
Homer, CS, Passant, L & Wills, J 2003, 'From student to midwife: the experiences of newly graduated midwives working in an innovative model of midwifery care', Australian Journal of Midwifery, vol. 16, no. 4, pp. 18-21.
In 2001, a new model of midwifery care was established in the Birth Centre at St George Hospital, a metropolitan hospital in NSW. The new model was designed to encompass the principles and recommendations from numerous government reports and research. The model also build on the previous successful implementation of a team midwifery program (Homer et al 2001b; Homer et al 2001a). Four newly graduated midwives, together with four more experienced midwives were employed to work in the models of midwifery care. This small study evaluates the first 10 months' using qualitative and quantitative data.
Murphy, DJ & Redman, CW 2003, 'The clinical utility of routine urinalysis in pregnancy', MEDICAL JOURNAL OF AUSTRALIA, vol. 178, no. 10, pp. 524-524.View/Download from: Publisher's site
Davis, GK, Homer, CS & Brown, MA 2002, 'Hypertension in Pregnancy: Do consensus statements makes a difference?', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 42, no. 4, pp. 369-373.
Homer, CS 2002, 'Immersion in Water During First Stage of Labor', Birth, vol. 29, no. 1, pp. 76-77.
Homer, CS 2002, 'Private Health Insurance Uptake and the Impact on Normal Birth and Costs: A hypothetical model', Australian Health Review, vol. 25, no. 2, pp. 32-37.
Homer, CS, Davis, GK, Cooke, M & Barclay, L 2002, 'Womens Experiences of Continuity of Midwifery Care in a Randomised Controlled Trial in Australia', Midwifery, vol. 18, no. 2, pp. 102-112.View/Download from: Publisher's site
Homer, CS, Farrell, TJ, Davis, GK & Brown, MA 2002, 'Women's worry and the risk-associated pregnancy team', British Journal of Midwifery, vol. 10, no. 6, pp. 356-359.
Considerable attention is paid to the treatment and clinical outcomes of `atrisk pregnancies but the level of worry experienced by these women has not been addressed. A multidisciplinary team, known as the Risk Associated Pregnancy (RAP) team, cared for 159 women with risk-associated pregnancies. Their level of worry was compared with that of 699 women with normal pregnancies (NPs): 360 receiving continuity of midwifery care and 339 receiving standard care. Underlying level of anxiety was similar among groups. Women managed by the RAP team reported a lower level of worry than women in either of the NP groups.
Homer, CS, Sheehan, A & Cooke, M 2002, 'Initial Infant Feeding Decisions and Duration of Breastfeeding in Women from English, Arabic and Chinese-speaking backgrounds in Australia', Breastfeeding Review, vol. 10, no. 2, pp. 27-32.
Murray, N, Homer, CS, Davis, GK, Curtis, J, Mangos, G & Brown, MA 2002, 'The Clinical Utility of Routine Urinalysis in Pregnancy: A prospective study', Medical Journal of Australia, vol. 177, no. 9, pp. 477-480.
Urquhart, V, Homer, CS, Farrell, TJ, Steinlein, E & Sutherland-Fraser, SJ 2002, 'Urinary catheterisation of women undergoing an elective caesarean section: A quality improvement project', Achievements in Nursing, vol. 4, pp. 38-39.
This paper describes a quality assurance project, which was undertaken between the Divisions of Women's and Children's Health and Surgery at St George Hospital. The aim of the project was to determine the optimal venue for insertion of a urinary catheter prior to an elective caesarean section. Prior to this project, the urinary catheter had been inserted on the ward before women were transferred to the Operating Theatre (OT). The project sought to answer the question: would women prefer to have their urinary catheter inserted on the ward or in the OT after their epidural anaesthesia had commenced?
Homer, CS, Davis, GK, Brodie, PM, Sheehan, A, Barclay, L, Wills, J & Chapman, M 2001, 'Collaboration in Maternity Care: A randomised controlled trial comparing community-based continuity of care with standard hospital care', British Journal of Obsterics and Gynaecology, vol. 108, no. 1, pp. 16-22.View/Download from: Publisher's site
Homer, CS, Matha, DV, Jordan, LG, Wills, J & Davis, GK 2001, 'Community-based Continuity of Midwifery Care Versus Standard Hospital care: A cost analysis', Australian Health Review, vol. 24, no. 1, pp. 85-89.
This paper reports the costs of providing a new model of maternity care compared to standard care in an Australian public hospital. The mean cost of providing care per woman was lower in the group who had the new model of care compared with standard care ($2,579 versus $3,483). Cost savings associated with new model of care were maintained even after costs associated with admission to special care nursery were excluded. The cost saving was also sustained even when the caesarean section rate in the new model of care increased to beyond that of the standard care group
Karnatanis, E, Alcock, D, Phelan, LK, Homer, CS & Davis, GK 2001, 'Introducing external cephalic version to clinical practice', Australian and New Zealand Journal of Obstetrics & Gynaecology, vol. 41, no. 4, pp. 395-397.View/Download from: Publisher's site
A service offering external cephalic version to all women with breech presentations at 36-38 weeks' gestation was introduced at St George Hospital in July 1997. This paper describes how this service was established and reports the clinical outcomes over the first three years; 116 external cephalic versions (ECV) were attempted on 114 women and success was achieved in 58 women (51 %). Of the 58 women, 43 (74 %) subsequently had vaginal deliveries. There were no fetal deaths, immediate Caesarean sections, or placental abruptions as a result of the ECV procedure. There were two (2 %) episodes of transient fetal bradycardia following ECV, both of which returned to normal with a subsequent normal neonatal outcome. Pre- and post-ECV Kleihauer levels were collected with no increase in levels as a result of the ECV ECV is a procedure that can, and should, be provided as part of a public hospital service.
Homer, C, Davis, G, Petocz, P, Barclay, L, Matha, D & Chapman, M 2000, 'Birth centre or labour ward? A comparison of the clinical outcomes of low-risk women in a NSW hospital.', The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, vol. 18, no. 1, pp. 8-12.
A number of birth centres were established in New South Wales as a result of the Shearman Report (NSW Health Department 1989). The objective of this study was to compare the obstetric outcomes, primarily caesarean section rates, of low-risk women presenting in spontaneous labour to the birth centre with those attending the hospital's conventional labour ward. The study showed that there was no significant difference in the caesarean section rate between the groups (3.5% in the birth centre and 4.3% in the labour ward). We suggest that the site of birthing does not affect clinical outcomes for low-risk women at this hospital. These results are relevant to contemporary clinical practice as they question the basis upon which birth centres have been popularised, that is, the medicalisation of birth in conventional labour wards increases intervention rates.
Homer, CS & Brodie, PM 2000, 'What do Women feel about Community-based antenatal care?', Australian & New Zealand Journal of Public Health, vol. 24, no. 6, pp. 590-595.View/Download from: Publisher's site
Homer, CS, Davis, GK, Petocz, P & Barclay, L 2000, 'Birth Centre or Labour Ward? A comparison of the clinical outcomes of low-risk women in a NSW Hospital', Australian Journal of Advanced Nursing, vol. 18, no. 1, p. 37115.
The objective of this study was to compare the obstetric outcomes, primarily caesarean section rates, of low-risk women presenting in spontaneous labour to the birth centre with those attending the hospital's conventional labour ward.
Homer, CS, Davis, GK & Everitt, LS 1999, 'The Introduction Of A Woman-held Record Into A Hospital Antenatal Clinic The Bring Your Own Records Study', Australian & New Zealand Journal Of Obstetrics & Gynaecology, vol. 39, no. 1, pp. 54-57.View/Download from: Publisher's site
We report the introduction of a woman-held record into an antenatal clinic in a NSW teaching hospital using a randomized controlled trial, In 1997, 150 women were randomized to either retaining their entire antenatal record through pregnancy (women-held
Ravaldi, C, Ricca, V, Wilson, A, Homer, C & Vannacci, A, 'Previous psychopathology predicted severe COVID-19 concern, anxiety and PTSD symptoms in pregnant women during lockdown in Italy'.View/Download from: Publisher's site
Italy was the first COVID-19 pandemic epicenter among European countries and established a period of full lockdown, consisting of travel bans, mandatory staying at home and temporary closure of non-essential businesses. Similar measures are known risk factors for psychological disturbances in the general population, still very little is known about their impact on pregnant women's mental health during COVID-19 pandemic.
The national survey 'COVID-19 related Anxiety and StreSs in prEgnancy, poSt-partum and breaStfeeding' (COVID-ASSESS) was conducted during the first month of full lockdown in Italy. The questionnaire was specifically developed to examine COVID-19 concerns and included the psychometric tests NSESSS for PTSD and STAI-Y for anxiety. A multivariable logistic regression model was fitted to explore the association of the concern, anxiety and PTSD symptoms with age, gestational weeks, parity, days of lockdown, assisted reproductive technology use, psychopathological history and previous perinatal losses.
Out of 1015 pregnant women reached, 737 (72.6%) fully answered the questionnaire; no woman reported a COVID-19 infection. Median age was 34.4 years [quartiles 31.7, 37.2], median days in lockdown were 13.1 [11.0, 17.0], median gestational weeks were 27.8 [19.8, 34.0]. Clinically significant PTSD symptoms were present in 75 women (10.2%, NSESSS cut-off 24) and clinically significant anxiety symptoms were present in 160 women (21.7%, STAI-Y1 cut-off 50). Women were less worried about their own health than the health of their baby and of their elderly relatives. Previous anxiety predicted higher concern and PTSD symptoms; previous depression and anxiety were independently associated with current PTSD symptoms.
Atchan, MA & Homer, CS 2014, 'Routine care of postpartum women' in Abbott, J, Bowyer, L & Finn, M (eds), Obstetrics & Gynaecology: An Evidence Based Guide, Elsevier, Australia, pp. 219-230.
The puerperium refers to the 6 weeks during which a woman physiologically returns to her prepregnant state. These changes are a result of the withdrawal of pregnancy hormones.
Homer, CS & Broom, A 2012, 'Evidence-Based Paradigms and Contemporary Midwifery' in Broom, A & Adams, J (eds), Evidence-Based Healthcare in Context: Critical Social Science Perspectives, Ashgate, Farnham, Surrey, UK, pp. 155-176.
Adams, J, Lui, C, Sibbritt, D, Broom, A, Wardle, J, Homer, CS, Steel, AE & Beck, S 2012, 'Women's use of complementary and alternative medicine during pregnancy: A critical review of the literature' in Adams, J, Andrews, G, Barnes, J, Broom, A & Magin, P (eds), Traditional, Complementary and Integrative Medicine, Palgrave Macmillan, Basingstoke, pp. 35-43.
The use of complementary and alternative medicine has attracted much attention and debate in recent years. The objective of this critical review is to examine the evidence base on use of complementary products and therapies during pregnancy. It examines an important but neglected issue in maternity care. Methods: A database search was conducted in MEDLINE, CINAHL, AMED, and Maternity and Infant Care. A total of 24 papers published between 1999 and 2008 met the selection criteria and were included in the review. Results: Findings of these 24 papers were extracted and reported under four themes: "user prevalence and profile," "motivation and condition of use," "perception and self-reported evaluation," and "referral and information sources." Conclusions: This review highlights four research gaps in the literature, a lack of: large representative samples; in-depth understanding of user experiences and risk perceptions; research comparing consumption patterns across cultures and over time; and work exploring the nature of the therapeutic encounter with complementary practitioners in this area of women's health care.
Homer, CS 2011, 'Obstetric emergencies' in Curtis, K, Ramsden, C & Friendship, J (eds), Emergency and Trauma Care for Nurses and Paramedics, Elsevier, Sydney, pp. 841-860.
Brodie, P & Homer, C 2009, 'Transforming the culture of a maternity service' in Birth Models That Work, pp. 187-212.
Brodie, PM & Homer, CS 2009, 'Transforming the Culture of a Maternity Service: St George Hospital, Sydney, Australia' in Davis-FLoyd, R, Barclay, L, Daviss, BA & Tritten, J (eds), Birth Models That Work, University of California Press, London, UK, pp. 187-212.
Homer, CS, Brodie, PM & Leap, N 2008, 'Getting started: What is midwifery continuity of care? (Chapter 1)' in Homer, C, Brodie, P & Leap, N (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 1-24.
Homer, CS, Brodie, PM & Leap, N 2008, 'Midwifery continuity of care for specific communities (Chapter 10)' in Homer, C, Brodie, P & Leap, N (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 181-194.
Homer, CS, Brodie, PM & Leap, N 2008, 'Midwifery continuity of care: The future (Chapter 12)' in Homer, C, Brodie, P & Leap, N (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, Australia, pp. 215-219.
Leap, N, Homer, CS & Brodie, PM 2008, 'Introducing continuity of care in mainstream maternity services: Building blocks for success (Chapter 4)' in Homer, C, Brodie, P & Leap, N (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 67-88.
Sandall, J, Page, LA, Homer, CS & Leap, N 2008, 'Midwifery continuity of care: What is the evidence? (Chapter 2)' in Homer, C, Brodie, P & Leap, N (eds), Midwifery continuity of care: A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 25-46.
Brodie, PM, Davis, GK & Homer, CS 2008, 'Effective collaboration with medical colleagues: making it happen' in Homer, Brodie & Leap (eds), Midwifery Continuity of Care A practical guide, Churchill Livingstone Elsevier, Sydney, pp. 89-106.
Homer, CS 2006, 'Challenges to Women's Health' in Pairman, S, Pincombe, J, Thorogood, C & Tracy, S (eds), Midwifery: Preparation for practice, Elsevier, Sydney, pp. 115-137.
Homer, CS 2005, 'Laying the foundation: the STOMP study' in Midwifery and Public Health: future directions, new opportunities, Churchill Livingstone, Philadelphia, USA, pp. 129-152.
Yu, S, Fiebig, DG, Viney, R, Scarf, V & Homer, C 2019, 'Private Provider Incentives in Health Care: The Case of Birth Interventions', iHEA 2019 Congress: New Heights in Health Economics, Basel, Switzerland.
Jittitaworn, W, Catling, C, Fox, D & Homer, C 2018, 'The challenges of improving perinatal outcomes for Thai adolescent pregnant women: views of health professionals', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S34-S34.View/Download from: Publisher's site
Murray-Parahi, P, Catling, C & Homer, C 2018, 'A new career pathway for new graduate midwives: Barriers or opportunities?', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S21-S21.View/Download from: Publisher's site
Scarf, V, Viney, R, Cheah, S & Homer, C 2018, 'Estimated costs associated with birth at home, in a birth centre or in a hospital: a micro-costing', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S51-S52.View/Download from: Publisher's site
Coddington, R, Homer, CSE & Catling, C 2017, 'From 'homebirth sceptics' to 'homebirth champions': The influence of Australian publicly-funded homebirth programs on care provider's attitudes', Women and Birth, Elsevier, pp. 16-16.View/Download from: Publisher's site
Scarf, V, Cheah, S, Homer, CSE & Viney, R 2017, 'How can the cost of giving birth be estimated by tracing the birth trajectory of women with healthy pregnancies?', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. 27-27.View/Download from: Publisher's site
Fox, D, Sheehan, A & Homer, C 2016, 'Birthplace in Australia: Qualitative perspectives on intrapartum transfer from planned homebirth to hospital', Canadian Association of Midwives 16th Annual Conference, Victoria, British Columbia, Canada.
Mangos, G, Xu, L, Henry, A, Roberts, L, Homer, CS, Craig, M, Harvey, S, Davis, G & Brown, M 2016, 'Blood Pressure in Women Six Months After Normal and Hypertensive Pregnancies - the P4 Study', Nephrology, 15th Asian Pacific Congress of Nephrology (APCN) and 52nd ANZSN ASM, Wiley: 12 months, pp. 48-48.
Fox, D, Sheehan, A & Homer, CSE 2015, 'Birthplace in Australia: Midwives' experiences of intrapartum homebirth transfer', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S15-S15.View/Download from: Publisher's site
Dawson, A, Turkmani, S, Varol, N, Sullivan, E & Homer, C 2015, 'Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia', Super Midwives - Making a Difference, Australian College of Midwives, 19th Biennial Conference, Gold Coast, Australia.View/Download from: Publisher's site
Catling, C, Coddington, R, Foureur, M & Homer, CSE 2014, 'Publicly-funded homebirth in Australia: outcomes over 6 years', International Confederation of Midwives 30th Triennial Conference, Prague, Czech Republic.
Progress towards MDG5 cannot be achieved without midwives and midwifery organisations coming together to support midwifery education, regulation and professional association efforts in low and middle income countries. Capacity building is critical to scaling up the midwifery workforce and improving maternal and child health. A number of symposia have sought to develop ways to build midwifery capacity through collaboration. This includes the 2010 meeting of the Global Advisory Group for Nursing and Midwifery Development that focused on developing policy and technical guidance in key areas including inter-professional collaboration. Other forums have emphasised partnership through pairing organizations (twinning), networking as well as bilateral and global collaboration. However, despite considerable effort towards building midwifery capacity through collaboration there is little high level evidence about the effectiveness of such strategies.
The aim of this paper is to provide an overview of approaches to collaboration documented in peer-reviewed research papers that were examined as part of a meta-synthesis study. We will discuss the complexities of collaborative efforts between midwifery organizations from different nations and describe a framework to guide practice. The presentation will present experiences of international midwifery collaboration from the literature that have sought to build capacity through the provision of tools, training midwives to develop appropriate clinical or research skills, building adequate numbers of skilled midwives, supervisor networks and incentives, establishing appropriately managed facilities as well as systems to facilitate effective decision making, information gathering and accountable midwifery care. We will examine these efforts in the light of social theory, including power relations, concepts of reciprocity and empowerment. This paper will present an innovative framework for the design and evaluation of midwifery coll...
Fox, D, Sheehan, A & Homer, C 2013, 'Views and experiences of women planning a home birth who subsequently require transfer to hospital: A meta-synthesis of the qualitative literature', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S29-S29.View/Download from: Publisher's site
Catling, C, Coddington, R, Foureur, M & Homer, CSE 2013, 'Maternal and neonatal outcomes from publicly-funded homebirth models in Australia', Australian College of Midwives 18th Biennial Conference, 'Life, Art and Science in Midwifery, Australian College of Midwives Biennial Conference, Hobart.
Catling, C, Coddington, R, Foureur, M & Homer, CSE 2013, 'Publicly-funded homebirth in Australia: outcomes over 6 years', Perinatal Society of Australia and New Zealand 17th Annual Congress 'Controversies in perinatal care, Adelaide.
Hartz, D, Hall, B, Allen, J, Lainchbury, A, Forti, A, Kildea, S, Tracy, M, Foureur, M, Homer, C & Tracy, S 2013, 'The M@NGO Trial: Does caseload midwifery reduce caesarean section operation rates?', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S8-S9.View/Download from: Publisher's site
Homer, CS 2013, 'Connections, Continuity and Community: Models of Care for Aboriginal and Torres Strait Islander Women', PSANZ 2013 17th Annual Congress, Wiley Blackwell, Adelaide.
Dawson, A, Homer, C, Brodie, P, Rumsey, M & Copeland, F 2013, 'We kam longwe so far: Building Midwifery Capacity in Papua New Guinea. Innovative approaches for women's health. Are the current initiatives adequate?', Pacific Society of Reproductive Health Biennial Conference, Honiara, The Solomon Islands.
In early 2012, the AusAID funded WHO PNG Maternal and Child Health Initiative (MCHI) was established to improve maternal health outcomes in Papua New Guinea in close partnership with the PNG National Department of Health. The WHO Collaborating Centre at UTS is subcontracted by WHO PNG to deliver a range of activities focused on improving the standard of midwifery clinical teaching and practice in four teaching sites. This has included the placement of 8 clinical midwifery facilitators to work alongside PNG midwifery educators, 2 obstetricians providing clinical care and education in rural areas, the provision of learning resources and training and education and capacity building workshops. Two obstetricians were also placed in two rural hospitals to assist in the delivery of obstetric care and training.
Multiple data collection tools are being used to collect both qualitative and qualitative data. These include In-country visits where interviews and focus groups were conducted with various stakeholders. Additionally surveys and reports were collected from educators, students, and faculty staff to the contribution that this capacity building initiative is making to the strengthening of teaching and learning and regulation.
The findings are currently being presented to WHO PNG and AusAID as part of a Mid Term Review. The findings will be presented at the PSRH Conference.
The MCHI is a new, and solid beginning towards the scale up of midwifery in PNG but only through on-going investment and development can the impact that can be made by midwives at population level be fully realized.
Homer, CS, Rumsey, M, Brodie, PM, Dawson, A, Copeland, FH & Daly, J 2013, 'Helping build foundations for improved maternal health in PNG', International Council of Nurses 25th Quadrennial Congress, Melbourne.
Dawson, A, Ith, P & Homer, C 2012, 'Quality of maternity care practices of skilled birth attendants during labour, birth and the immediate postpartum period in Cambodia', International Confederation of Midwives Asia Pacific Regional Conference, Hanoi, Viet Nam.
The proportion of births attended by skilled birth attendants (SBAs) has been used as a proxy indicator to monitor progress towards achievement of Millennium Development Goal five which aims to reduce maternal mortality by three quarters by 2015. However, there has been little emphasis on examining the provision of quality of maternity care practices in Cambodia. The objective of this study was to seek to understand SBAs' perceptions and practices and the factors affecting their practice during labour, birth and the immediate postpartum.
A qualitative design was employed using in-depth interviews and focus group discussions with midwives, nurses-midwives and doctors with midwifery skills in two health centres and three referral hospitals in one province of Cambodia. Data were analysed using a thematic approach.
SBA practice is not always consistent with evidence-based standards known to reduce morbidity and mortality. Eight inter-related themes emerged which described patterns of SBA practice.. These were: skills in the care of labouring women; provision of support in labour; interventions in the second stage of labour; management of the third stage of labour; lack of policy and authority; fear of litigation; workload and lack of human resources; and, financial incentives and socioeconomic influences.
A gap exists between evidence-based standards and current SBA practice during labour, birth and the immediate postpartum care. This is largely driven by the lack of a supportive working environment. The findings of this research provide maternal health services, workforce planners and policy makers with valuable information to improve maternal health. Recommendations for decision makers are made that maybe transferrable to other developing country contexts.
Smith, RM, Homer, AK, Homer, DJ & Homer, CS 2010, 'Harper's story: Teaching midwifery students about stillbirth', Journal of Paediatrics and Child Health, ISA and ISPID Joint Conference, Blackwell Publishing, Sydney, Australia, pp. 7-7.
Davis, DL, Homer, CS, 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.
Hoang, DB, Lawrence, EM, Ahmad, N, Balasubramanian Appiah, V, Homer, CS, Foureur, M & Leap, N 2008, 'Assistive Care Loop with Electronic Maternity Records', 2008 10th IEEE International Conference on e-Health Networking, Applications and Services, International Conference on e-Health Networking, Applications and Services, IEEE, Biopolis, Singapore, pp. 118-123.View/Download from: Publisher's site
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.
Rumsey, M, thiessen, J & homer, C WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2016, RHTU Monitoring and Evaluation Final Report 2015, Sydney.
Rumsey, M, thiessen, J & homer, C WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2016, RHTU: Report on the Knowledge, Attitude, Practice of EOC and EmOC Participants and Observers.
thiessen, J, rumsey, M & homer, C WHO Collaborating Cetnre for Nursing, Midwifery and Health Development. 2016, Reproductive Health Training Unit (RHTU) summary of Monitoring and Evaluation Annual Report 2015.
Homer, C, Neill, A & Rumsey, M WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, Midwifery Education in Papua New Guinea: A Discussion Paper.
Moores, A, Catling, C, West, F, Neill, A, Rumsey, M & Homer, C WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, What Motivates Midwifery Students to Study Midwifery in Papua New Guinea?.
Rumsey, M, Brodie, P, Copeland, F, Neill, A & Homer, C WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, Midwifery Capacity Building in Papua New Guinea: Key Achievements and Ways Forward.
Rumsey, M, Catling, C & Homer, C WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, Health System Strengthening in PNG: Past, Present and Future Challenges.
Rumsey, M, moores, A, homer, C, dawson, A & west, F WHO Colloborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, Midwifery graduates in Papua New Guinea (2012-2013).
rumsey, M, Neill, A & Homer, C WHO Collaborating Centre for Nursing, Midwifery and and Health Development, Univeristy of Technology Sydney 2015, Papua New Guinea - Maternal and Child Health Initiative Phase II.
Rumsey, M, thiessen, J & homer, C WHO Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology, Sydney 2015, Reproductive health training unit (RHTU) summary of monitoring and evaluation annual report 2014, Sydney.
Rumsey, M, Neill, A, Homer, C & Karan, P WHO CC UTS 2014, UTS World Health Organization Collaborating Centre for Nursing, Midwifery & Health Development - Phase 1: final report - PNG maternal and child health initiative (MCHI), pp. 1-58, Sydney, Australia.
Rumsey, M, Neill, A, Homer, C & Copeland, F World Health Organization – Western Pacific Region 2013, WHO/AusAID Collaboration in PNG for the project, "Capacity building in Midwifery Education and Practice in PNG" - Final Status Report, pp. 1-138, Boroko, Papua New Guinea.
Sandall, J, Homer, CS, Sadler, E, Rudisill, C, Bbourgeault, IL, Bewley, S, Nelson, P, Cowie, L, Cooper, C & Curry, N The King's Fund 2011, Staffing in Maternity Units, pp. 1-53, London, UK.
This report was commissioned by The King's Fund to answer a fundamental question: Can the safety of maternity services be improved by more effectively deploying existing staffi ng resources? There is much debate at present about staffing levels in maternity. The independent inquiry into the safety of maternity services commissioned by The King's Fund suggested that, while staffing levels are important, employing more staff may not necessarily improve safety. The inquiry found that the effective deployment of the right staff doing the right thing at the right time in the right place is the key to improvement (The King's Fund 2008, p 48). Current financial pressures mean that it is unrealistic to expect significant increases in numbers of staff. As such, maternity services - and the National Health Service (NHS) as a whole - will need to focus on developing new ways of working in order to maintain, and increase, levels of safety and quality within the resources available.