Can supervise: YES
Cummins, A, Coddington, R, Fox, D & Symon, A 2019, 'Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework.', Women and birth : journal of the Australian College of Midwives.View/Download from: Publisher's site
PROBLEM:Midwifery-led continuity of care has well documented evidence of benefits for mothers and babies, however uptake of these models by Australian maternity services has been slow. BACKGROUND:It is estimated that only 10% of women have access to midwifery-led continuity of care in Australia. The Quality Maternal Newborn Care (QMNC) Framework has been developed as a way to implement and upscale health systems that meet the needs of childbearing women and their infants. The Framework can be used to explore the qualities of existing maternity services. AIM:We aimed to use the QMNC Framework to explore the qualities of midwifery-led continuity of care in two distinct settings in Australia with recommendations for replication of the model in similar settings. METHODS:Data were collected from services users and service providers via focus groups. Thematic analysis was used to develop initial findings that were then mapped back to the QMNC Framework. FINDINGS:Good quality care was facilitated by Fostering connection, Providing flexibility for women and midwives and Having a sense of choice and control. Barriers to the provision of quality care were: Contested care and Needing more preparation for unexpected outcomes. DISCUSSION:Midwifery-led continuity of carer models shift the power dynamic from a hierarchical one, to one of equality between women and midwives facilitating informed decision making. There are ongoing issues with collaboration between general practice, obstetrics and midwifery. Organisations have a responsibility to address the challenges of contested care and to prepare women for all possible outcomes to ensure women experience the best quality care as described in the framework. CONCLUSION:The QMNC Framework is a useful tool for exploring the facilitators and barriers to the widespread provision of midwifery-led continuity of care.
Jittitaworn, W, Fox, D, Catling, C & Homer, CSE 2019, 'Recognising the challenges of providing care for Thai pregnant adolescents: Healthcare professionals' views', Women and Birth.View/Download from: Publisher's site
© 2019 Australian College of Midwives 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.
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: UTS OPUS or Publisher's site
Hogan, R, Orr, F, Fox, D, Cummins, A & Foureur, M 2018, 'Developing nursing and midwifery students' capacity for coping with bullying and aggression in clinical settings: Students' evaluation of a learning resource.', Nurse education in practice, vol. 29, pp. 89-94.View/Download from: UTS OPUS or Publisher's site
An innovative blended learning resource for undergraduate nursing and midwifery students was developed in a large urban Australian university, following a number of concerning reports by students on their experiences of bullying and aggression in clinical settings. The blended learning resource included interactive online learning modules, comprising film clips of realistic clinical scenarios, related readings, and reflective questions, followed by in-class role-play practice of effective responses to bullying and aggression. On completion of the blended learning resource 210 participants completed an anonymous survey (65.2% response rate). Qualitative data was collected and a thematic analysis of the participants' responses revealed the following themes: 'Engaging with the blended learning resource'; 'Responding to bullying' and 'Responding to aggression'. We assert that developing nursing and midwifery students' capacity to effectively respond to aggression and bullying, using a self-paced blended learning resource, provides a solution to managing some of the demands of the clinical setting. The blended learning resource, whereby nursing and midwifery students were introduced to realistic portrayals of bullying and aggression in clinical settings, developed their repertoire of effective responding and coping skills for use in their professional practice.
Cummins, AM, Smith, R, Catling, C, Watts, N, Scarf, V, Fox, D & Gray, J 2018, 'Midwifery Graduate Attributes: A model for curriculum development and education.', Midwifery, vol. 61, pp. 66-69.View/Download from: UTS OPUS or Publisher's site
Models of midwifery education need to evolve to meet changing needs of the profession. This requires a constant process of review and re-evaluation of curricula. Courses that lead to midwifery registration must not only meet national and international standards, but many also commit to producing graduates who meet course-specific graduate attributes. These attributes differ between models of education and courses and are pivotal in providing clear direction for the development of higher level abilities in graduates. Visionary graduate attributes provide the opportunity to prepare graduates to function and flourish in a fast changing social and professional environment and to prepare them for a future that is largely unknown (Bowden et al., 2000).
The University of Technology Sydney (UTS) has embraced the concept of graduate attributes and all graduates are expected to demonstrate capability in both University and course-specific attributes. The UTS model of learning provides a framework for practice oriented learning that aligns graduate attributes and curriculum design. The model is focussed on three distinctive areas, practice oriented education situated in a global workplace through learning that is research inspired and integrated (UTS 2017). Each course offered by UTS has embedded graduate attributes that reflect the overall aim of the course. These provide important information for students, the public and future employers as to what personal, professional and intellectual attributes to expect from a graduate of that course.
Commencing in 2012, the midwifery team undertook a project to develop visionary attributes for midwifery graduates and this paper describes and discusses the development and implementation process of the graduate attributes model.
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: UTS OPUS or 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.
Hogan, R, Fox, D & Barratt-See, G 2017, 'Peer to peer mentoring: Outcomes of third-year midwifery students mentoring first-year students', WOMEN AND BIRTH, vol. 30, no. 3, pp. 206-213.View/Download from: UTS OPUS or Publisher's site
Catling, C, Hogan, R, Fox, D, Cummins, A, Kelly, M & Sheehan, A 2016, 'Simulation workshops with first year midwifery students.', Nurse Education in Practice, vol. 17, pp. 109-115.View/Download from: UTS OPUS or Publisher's site
Simulated teaching methods enable a safe learning environment that are structured, constructive and reflective. We prepared a 2-day simulation project to help prepare students for their first clinical practice. A quasi-experimental pre-test - post-test design was conducted. Qualitative data from the open-ended survey questions were analysed using content analysis. Confidence intervals and p-values were calculated to demonstrate the changes in participants' levels of understanding/ability or confidence in clinical midwifery skills included in the simulation. 71 midwifery students participated. Students rated their understanding, confidence, and abilities as higher after the simulation workshop, and higher still after their clinical experience. There were five main themes arising from the qualitative data: having a learning experience, building confidence, identifying learning needs, developing communication skills and putting skills into practise. First year midwifery students felt well prepared for the clinical workplace following the simulation workshops. Self-rated understanding, confidence and abilities in clinical midwifery skills were significantly higher following consolidation during clinical placement. Longitudinal studies on the relationship between simulation activities and student's overall clinical experience, their intentions to remain in midwifery, and facility feedback, would be desirable.
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: UTS OPUS or 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.
Fox, D, Lina, C, Kelly, ERT, Raes, A, Rooslee, SI, Keing, PS & Seng, CY 2013, 'One to one midwifery in Singapore: The first 100 births', British Journal of Midwifery, vol. 21, no. 10, pp. 701-707.View/Download from: UTS OPUS or Publisher's site
The Enhanced Midwifery Maternity Care (EMMa Care) programme at the National University Hospital in Singapore was implemented in 2011 to provide women with primary obstetric care in collaboration with one-to-one midwifery support. The continuity of care women are able to access from both an obstetrician and a midwife provides a unique opportunity for women and babies to benefit from both obstetric expertise and holistic midwifery care. This article describes the development of the programme, and the outcomes of the births of the first 100 women who booked. Sixty women were primiparous and 40 were multiparous. Birth outcome data demonstrated a caesarean rate of 20% and seven out of nine vaginal birth after caesarean (VBAC) attempts were successful (77.77% success rate). Of the women birthing vaginally, 81.33% did so without any pharmacological pain management; 58 women used water immersion in labour and 36 birthed their babies in water. There were no third or fourth degree perineal tears, no postpartum haemorrhages and the episiotomy rate was 4%. Apgar scores were above 7 at 5 minutes in all but one baby; five babies required phototherapy for hyperbilirubinemia and eight babies (including one set of twins) were admitted to the neonatal intensive care unit (NICU) for hypoglycaemia and/or prematurity. EMMa Care is associated with good maternal and neonatal outcomes. Caesarean section rates were lower than overall rates in the same hospital setting and use of pharmacological pain management was minimal.
Fox, D 2013, 'Diffusion of Innovation theory made easy—An introductory workshop', Women and Birth, vol. 26, pp. S42-S43.
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, vol. 26, no. 1, pp. S29-S29.View/Download from: Publisher's site
Fox, D, Sheehan, A & Homer, C 2017, 'Birthplace in Australia: Supporting woman centred care in homebirth transfer.', International Confederation of Midwives Congress, Toronto Canada.View/Download from: UTS OPUS
Fox, D, Sheehan, A & Homer, C 2017, 'Birthplace in Australia: Processes of referral and transfer from planned homebirth to hospital', 15th World Congress on Public Health, Melbourne.View/Download from: UTS OPUS
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.View/Download from: UTS OPUS
Fox, D, Denney-Wilson, E & Laws, R 2016, Breastfeeding content for pregnancy section of 'My Baby Now' app, using breastfeeding promotion as a strategy to reduce childhood overweight and obesity. Collaboration between Deakin University and UTS., Online.
Fox, D 2017, 'Transfer from planned homebirth to hospital: views and experiences of women, midwives and obstetricians'.
Recent evidence supports the safety of planned homebirth for low risk women when professional midwifery care and adequate collaborative arrangements for referral and transfer are in place. Much is known about rates of transfer, but little is known about the experiences of the women and caregivers involved.
The aim was to explore the views and experiences of women, midwives and obstetricians involved in the intrapartum transfer of women from planned homebirth to hospital in the Australian context.
Thirty-six semi-structured interviews were conducted with women, midwives and obstetricians. A constructivist grounded theory approach was taken to enable exploration of the social interactions and processes that occurred.
Four categories emerged from the analysis, 'Fostering relationships and reducing uncertainty', 'Transferring out of the comfort zone', 'Us and them' and 'Celebrating a successful transfer'. The grounded theory, 'Supporting woman centred care in homebirth transfer', was synthesised by integrating findings grounded in the data with theoretical codes gained from intergroup conflict theory.
Effective strategies of collaboration included mutual respect, supporting the midwife-woman partnership and regarding the transfer as a success of the system rather than a 'failed homebirth'. The goal of a 'healthy mother and a healthy baby' was ostensibly shared by women and caregivers, however, arriving at a common definition of a 'healthy mother and a healthy baby' was less straightforward, due to the different paradigms of childbearing that converged on the birthing room of a transferred woman.
From the perspectives of Australian law, healthcare policy and human rights, the woman is the only person with the authority to make informed decisions for the health and well-being of herself and her baby. Women's personal definitions of 'healthy' are made in the context of their individual parameters of risk and safety, encom...