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August 17, 2022
  • THE MAGAZINE OF THE NSW NURSES AND MIDWIVES’ ASSOCIATION
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Midwifery

Kangaroo care with dads helps with critically-ill babies: study 

July 22, 2022 by Rayan Calimlim Leave a Comment

New research out of the University of South Australia (UniSA) examining how fathers’ bond with their premature babies in neonatal intensive care units (NICU) has confirmed the benefits of skin-to-skin contact for critically-ill term babies.  

Researchers documented the experiences of fathers holding their premature babies against their bare chest in a pouch-like position, which is known as kangaroo care. The method mimics how a joey finds warmth, comfort and sense of security inside it’s mother pouch and close to the mother’s heartbeat. 

Practiced in neo-natal wards globally, the kangaroo care method, sees mothers holding their newborn babies against their bare skin, aiding in the neurodevelopment of the infant and helping build a bond between mother and child.   

Previous research has shown that skin-to-skin contact activates nerve receptors in mammals, sparking certain hormones which reduce pain and stress for both baby and parent. 

While the benefits of kangaroo care practiced between mothers and infants has been recognised, there has been little research to date into whether the same benefits can be found when kangaroo care is practiced by fathers.  

Registered nurse and UniSA Masters candidate, Sophia Dong, says that while mothers are considered the dominant kangaroo care providers, traditional family structures have changed in recent decades and fathers have long been overlooked.  

“We know that kangaroo care provides a variety of benefits for pre-term, low birth weight infants, including lowering mortality rates, reduced infections, higher rates of breast feeding, calmer babies and enhancing bonding,” Dong said. 

Father’s who took part in the study reported having a ‘silent language of love and connection’ with their infant when they adopted the kangaroo care model.  

“The fathers described the NICU environment as ‘overwhelming’ initially causing them to feel anxious and powerless, but the close contact with their baby through kangaroo care fostered strong bonds with their infants. This in turn relaxed them and built their confidence,” Dong said.   

Midwives matter, alongside mothers and babies in their care

May 5, 2022 by Rayan Calimlim Leave a Comment

As midwives, nurses and other health professionals pause to recognise International Day of the Midwife, many midwives across NSW are grappling with the challenges they face without safe staffing ratios.

The NSW Nurses and Midwives’ Association (NSWNMA) wants the NSW government to introduce a ratio of one midwife to three mothers and their babies on postnatal maternity wards, a full review of the Birthrate Plus staffing system, and for extra Clinical Midwifery Educators to be employed.

NSWNMA General Secretary and former midwife, Brett Holmes, said while midwives and their profession deserved to be celebrated today, they were also confronted by significant hurdles.

“This is an important day to recognise the critical work of midwives who assist mothers in the safe delivery of their children. It’s a challenging profession but it’s also extremely rewarding,” said Mr Holmes.

“There’s no denying we have a midwifery shortage in NSW. This is undoubtedly adding to the strain and growing workload of midwives, who are attempting to safely support parents and babies at a crucial point in their lives.

NSWNMA Assistant General Secretary, Shaye Candish, said it was imperative mothers and babies were afforded access to quality midwifery care in all facilities across the state.

“On behalf of members, we’re continuing to fight for the correct number of midwives on shift, so they can deliver safe care to mothers and their babies,” said Ms Candish.

“Highly skilled, professional midwives are flat-out trying to work in a broken health system and we’re seeing them reduce their hours or move interstate where conditions and pay is better.”

Honouring International Day of the Midwife alongside colleagues, NSWNMA Macarthur Branch president and midwife of more than 20 years, Nichole Flegg, said the challenges midwives face were very real.

“There’s been no reprieve in maternity, despite many occasions of highlighting the need for more midwives and a better skill mix of staff who support us,” said Ms Flegg.

“We absolutely love the role we play helping to deliver babies and supporting their parents, but it’s tough and morale is low. Experienced midwives are leaving because our working conditions are unsustainable. The stress on senior midwifery staff is next level.”

NSWNMA Wagga Wagga Base Hospital Branch vice president and midwife, Karen Hart, agreed the additional strain on midwives was taking a toll and safe staffing ratios were desperately needed in maternity.

“There’s no sugar-coating how difficult our workloads are or how devastated we feel that our concerns haven’t been addressed. We need maternity ratios to provide safe care,” said Ms Hart.

“This has been going on for too long. Without minimum staffing ratios, more clinical midwifery educators and better conditions for midwives in regional areas, we’ll continue to see more midwives walking away.”

The NSWNMA is continuing to urge the NSW government to implement nursing and midwifery staffing ratios on every shift, not just on average, in all NSW public hospitals.

Group Clinical Supervision for midwives

May 18, 2021 by Rayan Calimlim Leave a Comment

Midwives are leaving the profession, many of them at the beginning of their careers. A new trial of group clinical supervision is underway in Australia to see if it makes a difference to burnout, perception of workplace culture and midwives’ intention to leave.

Midwives are pivotal to the wellbeing of women and their babies. Indeed, there is an urgent global call to upscale midwifery to address the rates of women and babies who are injured or die in childbirth. However, in Australia, similar to other high-income countries, there is another type of crisis occurring that we can no longer ignore – midwives in significant numbers are leaving the profession.

Many midwives are feeling demoralised, disempowered, and overwhelmed. Some of the reasons for this are an over-medicalisation of the workplace, a lack of autonomy and under-staffing, like in this recent article. These factors are leaving midwives emotionally fragile and feeling unsupported by their managers (Catling & Rossiter, 2020; Hunter et al, 2018; Pezaro et al. 2016).

Blogs such as ‘midwife diaries’[1] are heartbreaking to read and confirm the results of the Work, Health and Emotional Lives of Midwives (WHELM) study (Hunter et al, 2018). The WHELM study surveyed the wellbeing of nearly 2000 midwives in the UK and found significant levels of emotional distress, burnout, stress, anxiety, and depression. Two thirds of participants stated that they had thought about leaving their profession in the last six months, and alarmingly, early career midwives were over-represented in those leaving (Harvie et al, 2019).

Australian research echoes findings about midwives who have left the profession (Matthews, 2021), along with similar findings about work-related distress (Creedy et al, 2017; Catling & Rossiter, 2020). A Royal College of Midwives document Why midwives leave – revisited (2016) reported that 88% of midwives who had left the profession might consider returning if there were appropriate staffing levels. Eighty percent of midwives said they would return if their workplace culture was changed for the better, although this report did not outline what a positive workplace culture was.

Positive workplace culture

We suggest the following list (although not exhaustive) highlights some important things that midwives want from maternity services:

  • fully staffed ward/unit with adequate resources for staff to do their jobs;
  • visible managers who provide support to their staff to excel and flourish
  • support to engage in educational opportunities, support to attend conferences / seminars / complete higher degrees
  • emotional support following adverse events
  • timely feedback and assistance with relationships in the workplace including zero tolerance for bullying behaviour
  • autonomy in practice with multi-disciplinary assistance when indicated
  • opportunity to work in midwifery continuity of care

In essence, a positive workplace culture would have trust in, and collegiality with, work colleagues and knowledge that your work with women was high-quality and valuable.

How can we support midwives?

Clinical supervision is a well-known supportive strategy that has been used in many health disciplines to help promote staff professional development and health and wellbeing. Transforming Maternity Care Collaborative’s (see transformingmaternity.org.au) Director of Workforce, Associate Professor Christine Catling, gained a National Health and Medical Research Council investigator grant over the next 5 years to investigate whether group clinical supervision makes a difference to Australian midwives and the midwifery workplace culture. We know Clinical Supervision reduces burnout from observational studies, but it has not been studied extensively and experimentally before in the midwifery discipline. For more information on what Clinical Supervision is please go to the Australian Clinical Supervision Association site here.

The trial of group clinical supervision

The cluster randomised controlled trial (for maternity units in Greater Sydney) will involve 12 maternity sites (the ‘clusters’). Each cluster will be randomised to either receive the intervention (group clinical supervision) or not.

The trial will measure midwifery burnout rates (using the Copenhagen Burnout Inventory), the perceptions of their workplace culture (using the Australian Midwifery Workplace Culture (AMWoC) tool, and intentions to leave the profession. For the intervention sites, the efficacy of the clinical supervision will be measured through using the Clinical Supervision Evaluation Questionnaire (CSEQ) (Horton, 2008).

The results of this 5-year study are forthcoming. This year the research team will conduct a review of all available research evidence (both qualitative and quantitative) on group clinical supervision. In the meantime pending the study results, midwives and managers of maternity units could think about their workplace culture and what aspects to focus on to build an environment where staff want to work in, feel supported and safe.

Christine Catling PHD, Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney.

This article is reproduced from the TMCC blog with permission from the author.


References

Catling, C. & Rossiter, C. 2020, Midwifery workplace culture in Australia: A national survey of midwives, Women and Birth, 33(5) 464-472.

Creedy, DK., Sidebotham, M., Gamble, J., Pallant, J. & Fenwick, J. (2017) Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey, BMC pregnancy and childbirth 17 (1), 1-8.

Harvie K., Sidebotham, M. & Fenwick. J. 2019, Australian midwives’ intentions to leave the profession and the reasons why, Women and Birth, 32(6) e584-e593.

Horton S, de Lourdes Drachler M, Fuller A, de Carvalho Leite JC. (2008). Development and preliminary validation of a measure for assessing staff perspectives on the quality of clinical group supervision. Int J Lang Commun Disord. 43:126–34.

Hunter B, Henley J, Fenwick J et al (2018). Work, Health and Emotional Lives of Midwives in the United Kingdom: The UK WHELM study. School of healthcare Sciences, Cardiff University.

Matthews, R. (2021). Impact of Stage of Career on Burnout and Experience of Work for Midwives and Neonatal Nurses Working in a Tertiary Service, conference presentation, PSANZ Congress, 2021.

Pezaro, S., Clyne, W., Turner, A., Fulton, E. & Gerada, C. 2016, ‘Midwives Overboard!’ Inside their hearts are breaking, their makeup may be flaking but their smile still stays on, Women and Birth, 29(3) June e59-e66.

Royal College of Midwives, 2016, Why midwives leave – revisited. RCM, London.

[1] Blogs such as https://midwifediaries.com/whlem-study/

Midwives are delivering above and beyond

May 5, 2021 by Rayan Calimlim Leave a Comment

Despite a challenging pandemic enveloping our globe, midwives have continued their selfless roles delivering thousands of babies around the clock, while also campaigning for safe staffing ratios in NSW.

On International Day of the Midwife (5 May), the NSW Nurses and Midwives’ Association (NSWNMA) is honouring the resilience of its midwifery members and their determination to support mothers and babies, despite the tough working conditions.

NSWNMA President and midwife, O’Bray Smith, said on International Day of the Midwife it was important to thank midwives for keeping mothers and babies safe, and to support their calls for midwife-to-mother ratios across NSW.

“Day in day out, you are giving every single part of you to the women and babies in your care so there is nothing left. We see you and we are so grateful,” said Ms Smith.

“When you go home at the end of a shift with the faces of the mothers and babies you looked after etched into your minds, concerned about what’s going to happen to them on the next shift because it’s short-staffed, or distressed and devastated by what’s just happened to them on your shift.

“You need to tell your stories to those people who can legislate ratios – make them hear you.”

NSWNMA General Secretary, Brett Holmes, said the efforts of midwives during public health crisis had not wavered and it was time the NSW government honoured their commitment to the community.

“Midwives did not shy away from the multiple challenges this pandemic has thrown at them, or their support of the mothers and babies in their care,” said Mr Holmes.

“We’ve exposed some pretty horrendous under-staffing that’s occurring in maternity services across our public hospitals and there’s plenty of examples where more improvements are needed.

“Not only do we need more midwives and for newborns to be counted in patient numbers, we also need increased clinical support and respectful pay rates to encourage midwives to stay in the profession.”

NSWNMA Assistant General Secretary, Judith Kiejda, said midwives are extraordinary at performing under pressure and are constantly putting mothers and babies first.

“Midwifery is a physically demanding role, from support during a delivery to helping mums with breastfeeding, midwives are instrumental in the care journey,” Ms Kiejda said.

“Unfortunately, we’re seeing too many burn out because they’re constantly short-staffed or working overtime. It’s not sustainable and our government is accountable.”

The NSWNMA is currently seeking staffing improvements to maternity services and fair pay for midwives in NSW public hospitals.

Push to overhaul maternity staffing

April 7, 2021 by Rayan Calimlim Leave a Comment

The NSWNMA award claim for 2021 seeks to overhaul maternity unit staffing with minimum ratios for postnatal wards and updates and improvements to the Birthrate Plus® tool used to calculate required numbers of midwives.

Campbelltown Hospital midwife Rachel Lown, a member of the NSWNMA’s Macarthur branch, says Birthrate Plus® has some major flaws.

“It does not count babies as patients and fails to take into account the increasing acuity of mothers,” she says.

“We do about 4000 births a year and the acuity of women has increased, so we are taking on many more high-risk cases, which are not factored into your workload.

“For example, I’ve had three ladies immediately after they returned from recovery from caesarean section. Having three post-op women and their babies to look after is very full on.

Rachel says management undertook a major recruitment drive in 2019, which led to a temporary improvement in staffing and workloads.

“However, so many staff have decided to go elsewhere because Campbelltown is so hectic.

“Our main issue isn’t finding staff, it’s retaining staff.”

She says Birthrate Plus® does not adequately provide for “like for like” replacement of staff who are on long-term leave or have taken managerial positions or retired.

“Some of our senior people have been replaced by very junior staff.

Rachel says nurses and mid-wives need a fair pay increase after only getting 0.3 per cent last year, when they had to cope with increased workloads due to bushfires followed by the pandemic.

Regarding the union’s claim for free parking for hospital staff, Rachel believes it’s unfair to make hospital staff pay for parking.

“We should get it for free. It’s the least the government could do for those who serve their communities.”

Heroic efforts of Lismore midwives’ honoured

March 24, 2021 by Rayan Calimlim Leave a Comment

The courage of two local midwives who bravely put mothers and babies’ lives before their own as a severe storm lashed Lismore Base Hospital almost six years ago, has been recognised in today’s Australian Bravery Decorations.

When scaffolding collapsed onto a temporary maternity building in late November 2015, Leanne Chamberlain and Mary-Ann Hyde, leapt into action to shield five mothers and newborns from debris as the ceiling fell in.

Despite being injured, the two NSW Nurses and Midwives’ Association (NSWNMA) members responded to the calls of distressed mothers, moved everyone to safety inside the ward and continued to care for them until emergency services arrived.

NSWNMA General Secretary, Brett Holmes, said today’s ‘Commendation for Brave Conduct’ awarded to Leanne and Mary-Ann was apt recognition for the lengths both midwives went to.

“Both of these midwives went well above and beyond what would normally have been expected of any nurse or midwife in such difficult circumstances,” said Mr Holmes.

“The fact that Leanne immediately threw herself across one mother and baby to shield them from the falling debris is remarkable. Leanne ignored her own injuries and put the safety of her patients first.

“Mary-Ann’s efforts during the crisis were incredible. Surrounded by debris and water, she managed to wade through it and slide across a fallen wall to reach the mothers and babies and support Leanne.”

NSWNMA Assistant General Secretary, Judith Kiejda, said the agility of the two women in such trying circumstances was extraordinary.

“It takes enormous courage, in a situation of heightened danger, to not hesitate when a ceiling is collapsing around you and you’re battling all the elements of a severe storm cell,” said Ms Kiejda.

“No one heads into a shift thinking they’ll be performing the heroics these two midwives delivered so courageously. It was beyond belief and they conducted themselves selflessly.”

The NSWNMA and its Lismore Base Hospital Branch nominated both members for the bravery awards with input from local authorities.

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The Lamp is the magazine of the NSW Nurses and Midwives’ Association. It is published bi-monthly and mailed to every member of the Association.

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