December 2, 2020

Midwifery

Dire situation forces Blacktown midwives to speak out

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Traumatised and fatigued midwives at Blacktown Hospital are in desperate need of relief from unsafe staffing levels, which are putting patient safety and their professional registration at risk.

Following multiple infant fatalities over the past 18 months and ongoing staffing concerns, the midwives have given Western Sydney Local Health District 48 hours to address their concerns.

NSW Nurses and Midwives’ Association (NSWNMA) General Secretary, Brett Holmes, said Health Minister Brad Hazzard needs to urgently intervene in the matter.

“The situation is dire and many of these midwives no longer feel supported, despite repeatedly raising their concerns with hospital management,” said Mr Holmes.

“Since 2015, births at Blacktown Hospital have increased 52%, while staffing has only risen 11%.

“Year on year, the number of babies delivered at the hospital has continued to grow, with around 4,100 projected births this year.

“Currently, they’re averaging 11.5 births every 24 hours at Blacktown, with often only seven midwives rostered per shift. Meanwhile, at Westmead Hospital, midwives are assisting with an average 13.7 deliveries in 24 hours, yet they have ten midwives rostered per shift.

“For the past two years, our members at Blacktown Hospital have been battling short staffing and workloads issues which were only exacerbated after they relocated to a new, larger birthing unit as part of the hospital’s redevelopment.

“Due to obstetrician shortages, midwives are being trained to take on more roles, increasing their workloads each shift. On a regular basis, they’re also prevented from leaving work early if they miss meal breaks.

“Midwives are often being rostered for multiple day and night shifts of up to 64 hours over seven days, despite 56 hours being the maximum.

“Not only are they burning out with fatigue, many of the midwives have been traumatised by tragic deaths and believe the staffing issue has become untenable, putting their professional registrations at risk.”

Mr Holmes said the conditions were unsafe for midwives and patients, increasing the risk of further tragic outcomes.

One midwife described how many of them were struggling with the lack of support: “But most of us stay because we love what we do. We are passionate about our women and their babies. We are dedicated to them and their needs.”

Members of the NSWNMA’s Blacktown Hospital Branch are seeking urgent additional staffing while the Local Health District carries out a review of BirthRate Plus, the model used to determine staffing levels across maternity services.

They’re also requesting an immediate review of the hospital’s maternity services and calling for all existing vacancies to be filled.

Midwife elected to NZ Parliament in Labour Landslide 

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A midwifery lecturer has been elected for Labour in a safe conservative seat following Jacinda Ardern’s landslide victory in New Zealand.  

Sarah Pallett has been elected to the Christchurch-based seat of Ilam, defeating National Party deputy leader Gerry Brownlee in a surprise victory. 

Pallett was a midwifery and union activist at Ara Institute of Canterbury prior to her election. She had also worked as a rural midwife and at the Christchurch Women’s Hospital for ten years. 

Brownlee had held the seat since 1996, and entered the race with a 25% advantage over his Labour counterpart from the 2017 election.  

In finding out the result, Pallett said she was “so excited [and] absolutely blown away”.  

“I think it shows that Ilam was ready for a new MP,” she said.  

“Working in healthcare, I am uniquely placed to understand the opportunities and challenges in the area”. 

Illawarra Shoalhaven LHD to partner Birthing on Country

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Studies have shown Aboriginal-centred care can reduce preterm births by 50 per cent.

The Birthing on Country program is preparing to sign a statement of commitment with the Illawarra Shoalhaven Local Health District (ISLHD).

Birthing on Country is a model of care provided to Aboriginal women and their families. It offers wrap-around maternity support in the community and in hospital by providing intrapartum birth care and then postnatal care for up to six weeks.

The program has been running at Waminda, a women’s health and welfare service on the New South Wales South Coast since 2018.

“It is giving us ownership of our health and birthing babies on country in a place that they feel safe and there is no judgement,” said Melanie Briggs, a senior midwife at the centre.

“Then they can have beautiful, healthy, chunky babies and be able to practise culture and community care and be looked after aunties and elders and mums.”

ISLHD chief executive Margot Mains said it would provide greater maternity care options that were safe and respectful of culture and spirituality.

“This includes the implementation of a long-term plan of action, targeted at addressing the maternal and perinatal gap in health outcomes for Aboriginal and Torres Strait Islander mothers and their babies,” she said.

During COVID-19, women are opting for ‘freebirthing’ if homebirths aren’t available. And that’s a worry

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The pandemic is prompting some Australian pregnant women to give birth at home without a midwife or registered health provider, according to a survey out this week. Another new survey helps explain why.

The number of women who say they have either had or were thinking about “freebirthing” is concerning, due to the increased risk to mothers and babies when unrecognised complications arise or emergencies occur.

So we need to support women to choose where they give birth, or they may be forced to choose this riskier option.

How many women are changing their birth plans?

The evidence to date indicates the risk of COVID-19 for pregnant women and babies is not as high as other groups. But women have understandably been concerned.

This has led to a spike in inquiries from women wanting to change where they give birth. We see this trend, from hospital to home, in Australia and overseas.

For instance, in Victoria a publicly funded homebirth program tripled the number of homebirths provided from March to May compared to the previous year.

Now, a national survey the Australian College of Midwives conducted during the peak of the COVID-19 pandemic provides further evidence.

Out of 2,750 responses from women about their experience of maternity care,
26% reconsidered where they wanted to give birth and who provided their care.

Reasons ranged from fear of contracting COVID-19 in hospital to restrictions on support people allowed in hospital for pregnancy, birth and postnatal care.

Most of those who reconsidered their maternity care looked for a homebirth option. But of those who wanted a home birth, 60% couldn’t find a private midwife, and 39% found they were fully booked. Around 3% chose to freebirth.

Why do women choose to homebirth or freebirth?

We have just published the results of the largest survey in Australia examining why women choose to give birth at home. We conducted this survey before the COVID-19 pandemic, with 1,681 women responding.

Most women said they wanted to give birth at home with a midwife. But nearly half said they would consider a freebirth or finding an unregulated birth worker if they could not have a midwife. One in ten women had a freebirth.

Reasons for wanting to give birth at home included wanting to avoid medical interventions, such as induction of labour or episiotomy, or to avoid feeling pressured to have them, rather than being supported to have the birth they wanted.

Many of the women who responded to the survey described their previous hospital experience as traumatic (32%) or were diagnosed with post-traumatic stress disorder (6%).

Are homebirths safe?

In Australia only 0.3% of women are able to access a homebirth attended by a midwife.

This contrasts with other countries such as the Netherlands (12.7%) UK (2.1%), Canada (2%) and New Zealand (3.4%) where this birth option is funded and supported for low risk women by government and key obstetric colleges, such as those in the UK and Canada.

In Australia the obstetric college RANZCOG advises against homebirth.

Yet reviews published in 2018, 2019 and 2020 find strong evidence for the safety of a homebirth for low risk women with a midwife attending.

Why aren’t there more homebirths in Australia?

There are many reasons for the lack of support for homebirths in Australia. These include medical opposition, lack of insurance for private midwives to attend a homebirth and lack of Medicare funding.

Women who live within 20-30 minutes of one of the 17 publicly funded homebirth programs (run out of public hospitals) and remain low risk, can birth at home. But these programs are oversubscribed and inaccessible to many women, especially in non metropolitan areas.

Others will try to find one of around 200 private midwives nationwide, who are not already fully booked, to care for them. They will pay up to A$6,000 for a private midwife to attend a homebirth, getting no Medicare rebate for the birth at home and little chance of private insurance rebates.

COVID-19 has escalated this demand for homebirth even further.

Here’s what we can do

We have written extensively about the reasons why women choose freebirth, and engage non regulated providers such as birth workers.

So we need to support women to choose where they give birth and not to be forced into less-safe options. Here’s what would make a difference:

  • make respectful care a reality for all women, to reduce birth trauma in the first place
  • support women’s access to their chosen place of birth and model of care
  • support midwifery care at home through funding and insuring midwifery care
  • offer more flexible, acceptable options for women experiencing risk factors during pregnancy and/or birth
  • get the policy, regulatory and educational framework right to enable safe and sustainable homebirth services.

Heather Sassine was the lead author of the study and undertook the survey as an honours student in the School of Nursing and Midwifery at Western Sydney University.The Conversation

Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Midwives can help detect domestic violence – here’s how

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One in six Australian women experience physical or sexual violence by someone they know at some point in their adult life. More than half (54%) of women living with abusive partners experience violence during pregnancy.

Domestic violence at any stage of life results in poorer health, reduced quality of life and higher use of health services. During pregnancy, violence also contributes to miscarriage, premature labour, low birth weight and a higher incidence of infant death.

Given that more than 300,000 women seek antenatal care each year, midwives are ideally placed to identify women experiencing violence and to provide immediate support and referrals to other agencies for emotional, financial and practical support.

But some midwives are reluctant to enquire about domestic violence, or lack the confidence and knowledge to do so effectively.

Violence in pregnancy

A history of violence before pregnancy is one of the strongest predictors of pregnancy violence. For these women, the frequency and intensity of violence often increases during pregnancy.

Pregnancy can also be a trigger for violence. A quarter of Australian women who have experienced partner violence were abused for the first time during pregnancy.

The period following birth is also a time of increased risk of domestic violence for women, as parental stress increases while caring for a newborn infant.

Worldwide, high levels of fear, control and sexual violence in intimate relationships result in women being unable to negotiate the use of contraception and prevent pregnancies.

A recent study in the United Kingdom found women in violent relationships were more likely than other women to terminate a pregnancy. They were three times as likely to conceal a termination from their partner.

A World Health Organisation study involving over 26,000 women across ten low- and middle-income countries concluded that if domestic violence could be reduced by 50%, rates of unintended pregnancy could be reduced by up to 18% and abortion rates by 40%.

What can midwives do?

Maternity services that offer care by the same midwife allow women to form a trusting relationship with their midwife throughout pregnancy, labour and after her child is born.

This relationship allows midwives to routinely enquire about the nature of a woman’s relationship, her sense of safety, available support and health education needs.

But our research team recently surveyed 152 Australian midwives and found a significant proportion were not equipped to talk to their clients about domestic violence.

Two-thirds of the midwives we surveyed didn’t know about the risks and signs of domestic violence. One-third didn’t know that younger women are at greater risk of DV. And around 25% incorrectly believed that perpetrators were violent because of alcohol or drug use.

Perhaps unsurprisingly, midwives who had some education or training about domestic violence achieved higher knowledge scores than midwives who had received no formal training.

We also interviewed 24 midwives working in a variety of maternity models of care in Australia. All the midwives believed that routine enquiry for domestic violence should occur. But most (21) felt unprepared and unsupported in this role.

Our interviewees reported a lack of ongoing education and training programs. They were unsure about how to respond to women’s disclosure of domestic violence.

Time for policy reform

Research from countries such as Canada and the United Kingdom also found a lack of knowledge to be an important barrier to the frequency of screening for physical, emotional and sexual abuse during pregnancy.

But a five-year study of midwives in Bristol, United Kingdom, shows this can be reversed. My colleagues and I found that training and supporting midwives to use sensitive questioning leads to an increase in knowledge and willingness to screen for domestic violence.

All the midwives surveyed reported that enquiring about domestic violence was now a fundamental part of their role. They women they care for are now more likely to disclose they’re in violent relationships.

Last week the Queensland Domestic Violence Task Force recommended improving services for pregnant women and their families, and ensuring that all midwives receive appropriate training.

It recommended asking all women attending ante-natal clinics about their exposure to domestic and family violence and providing appropriate referrals if domestic violence is disclosed.

To facilitate change in this area, we need to to develop better training, screening tools and practice protocols to assist midwives – not just in Queensland, but Australia-wide. This must include an awareness of the needs of ethnic and other minority groups and the development of appropriate inter-agency pathways.

Anyone at risk of family and domestic violence and/or sexual assault can seek help 24 hours a day, seven days a week, either online or by calling 1800 RESPECT (1800 737 732). Information is also available in 28 languages other than English.

Kathleen Baird, Senior Midwifery Lecturer, Griffith University and Debra K. Creedy, Professor of Perinatal Mental Health, , Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

20% of pregnant Australian women don’t receive the recommended mental health screening

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One-fifth of Australian women still don’t receive mental health checks both before and after the birth of their baby, our research published today has found. Although access to recommended perinatal mental health screening has more than tripled since 2000, thanks largely to government investment in perinatal mental health, our surveys show there is still some way to go before every mum gets the mental health screening needed.

Mental health issues are one of the most common complications of pregnancy. Up to 20% of women report anxiety or depression either during pregnancy or in the first year after their baby is born.

Maternal anxiety and depression are associated with problems including premature birth and low birth weight. They can also impact child development through effects on parenting practices and impaired bonding.

In 2019, the cost of perinatal depression and anxiety was estimated at A$877 million.Australia has invested substantially in perinatal mental health screening. From 2001 to 2005, BeyondBlue’s National Postnatal Depression Program screened 52,000 women and reached out to 200,000 families.

This was followed in 2008 by the National Action Plan for Perinatal Mental Health and the National Perinatal Depression Initiative in 2008-13, which supported universal screening and follow-up care, workforce training, and community mental health awareness programs.

National clinical practice guidelines on perinatal mental health care were introduced in 2011 and updated in 2017. In 2019 the federal government committed A$36 million to support the emotional health and well-being of Australian women and families.

Has it worked?

The lack of national government data collection on perinatal mental health screening makes it hard to tell whether this public health investment has paid off.

Our study, published in the Australian and New Zealand Journal of Public Health, is the first to track perinatal screening over time in a national sample. It included 7,566 mothers and 9384 children from the Australian Longitudinal Study on Women’s Health, which was started in 1996.

We asked mothers whether a health professional had asked them any questions about their emotional well-being, including completing a questionnaire. We mapped screening rates between 2000 and 2017 and compared them to policy initiatives and clinical practice guidelines.

We found the percentage of women being screened both during and after pregnancy has more than tripled since 2000, from 21.3% in 2000 to 79.3% in 2017. The percentage of women reporting they were not screened at all fell from 40.6% in 2000 to 1.7% in 2017.

Perinatal mental health screening rates and policy initiatives over time. The point marked ‘a’ is where the proportion of women who are not screened at all begins to decline; point ‘b’ is where recommended screening becomes most common.
Aust NZ J. Pub. Health, Author provided

Our data shows a clear improvement in access to mental health screening. There was a decline in the percentage of women who were only screened once, and an increase in the percentage who were screened both during and after pregnancy. Notably, this widespread transition from single to double screening (the point marked “b” in the graph above) coincided with the introduction of the Perinatal Mental Health National Action Plan and the National Perinatal Depression Initiative, suggesting these policies have delivered real improvements.

However, the timing of this transition differed by state. For example, it happened in 2008 in New South Wales, 2009 in Victoria, and 2010 in Queensland. This might be due to state-based differences in the previous policies and clinical practice, and readiness to implement national initiatives.

What is still to be done?

While our results show there’s been real improvement, it nevertheless remains the case that in 2017, one in five women didn’t receive the recommended mental health screening.

What’s more, women who had reported emotional distress were 23% less likely, and older mothers 35% less likely, to be screened both during and after pregnancy.

Screening is not yet universal – and it needs to be.

There are barriers to screening, including lack of time and potential over-diagnosis. Also, some women who screen positive for mental health problems might not engage in treatment. However, women who are asked about their current and past mental health are up to 16 times more likely to receive a referral for further support. We need to ask mothers about their mental health.

Clinical practice guidelines recommend screening for symptoms of anxiety and depression during pregnancy and during the first year after giving birth. This can be done by trained health professionals. Access to well-integrated and culturally safe care is essential.

Systematic national data collection is required if clinical best practice is to be monitored into the future. Perinatal mental health items have been developed as part of the National Maternity Data Development Project, and should be progressed as a priority.

Women have regular contact with the health system both before and after giving birth. This offers a great chance to identify women who need extra mental health support, and it is too important to be missed.The Conversation

Katrina Moss, Postdoctoral Research Fellow in maternal and child health, The University of Queensland; Gita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of Queensland, and Nicole Reilly, Postdoctoral research fellow, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.