'It was horrible to watch, horrible to be a part of': Midwives' perspectives of obstetric violence.

BACKGROUND: Obstetric violence, including unconsented interventions, coercion and disrespect, violates human rights; impacting the physical and psychosocial health of women. The perspective and experience of midwives related to obstetric violence have been explored in low and middle-income countries, with limited research into the experience of midwives in high income nations. AIM: To explore Australian midwives' perspectives of obstetric violence. METHODS: Thematic analysis of qualitative in-depth interviews with 15 midwives experienced in supporting women during birth. Critical feminist theory underpinned each stage of the research. FINDINGS: Interviews with 15 Australian midwives from diverse care settings were analysed thematically. Four key themes were developed from the data: 'the operationalisation of obstetric violence', 'the impact of obstetric violence' 'the historical and situational context' and 'hope for the future'. Midwives considered entrenched patriarchal structures and gender inequity as fundamental to the occurrence of obstetric violence. This societal scaffold is intensified within health care systems where power imbalances facilitate maternal mistreatment through coercion and grooming women for compliance in the antenatal period. Fragmented care models expose women to mistreatment with continuity models being protective only to a point. Midwives experience their own trauma, as a result of what they have witnessed, and due to the lack of support they receive when advocating for women. CONCLUSIONS: Obstetric violence occurs in Australian maternity systems with unconsented interventions, overmedicalisation, coercion, and disrespect observed by midwives. Care-related trauma impacts on the mental health of midwives, raising workforce concerns for policy makers, consumer advocates and professional bodies.

Model of care matters: An integrative review.

BACKGROUND: Pregnant women are entitled to quality care during pregnancy. Some health districts offer a variety of maternity care models but, not all women are aware of what is available and there is limited research on the experiences of women within their chosen or allocated model of care. AIM: The aim of this integrative review is to explore the available literature on women's experiences of the model of care accessed during pregnancy. METHOD: A database search of CINAHL, MEDLINE, SCOPUS, OVID, JBI and Cochrane Database was conducted to identify original research articles published in English between 2011 and 2021. In total, 20 articles met the inclusion criteria. FINDINGS: The included papers came from nine different countries and reported on eight different models of care. Following analysis of the articles one overarching theme 'Model of care matters', and six sub themes were identified: 1.'Choosing a model', 2.'Learning about pregnancy and birth', 3.'Being known', 4.'Making social and emotional connections', 5.'Receiving enabling or disabling care' and 6.'Integrated care is best'. Some women disclosed that they had no choice in the model they were allocated, while others stated they were not provided with information about all available models of care. CONCLUSION: A lack of integrated care between medical and midwifery models led to feelings of dissatisfaction and distress during pregnancy. Positive experiences were reported when women developed a connection with the care provider. The development of a well-informed decision aid could alleviate deficits of information, and clarify the subtle differences that occur within various models.

Emergency scenarios in maternity: An exploratory study of a midwifery and medical student simulation-based learning collaboration.

BACKGROUND AND PROBLEM: In Australia, interprofessional education has been embedded into pre-registration course accreditation standards. Little is known about Australian midwifery and medical students experiences of interprofessional learning when the focus is on emergency scenarios during birth. AIM: This study aimed to evaluate student experience of Interprofessional Simulation-Based Learning workshops focused on emergency scenarios with midwifery and medical students. METHODS: This was a descriptive, exploratory study of an educational activity designed to enhance inter-professional and collaborative learning between Bachelor of Midwifery students and Bachelor of Medicine students at a Simulation Centre in Sydney, Australia. A pre and post survey design enabled data collection before and after the 6-h simulation-based workshop. FINDINGS: A total of 45 students attended two interprofessional simulation learning days, 14 were midwifery students and 31 medical students. Students disclosed a level of apprehension in the pre workshop survey and ambivalence towards the values of collaborative simulation-based learning. Following the workshop students reported that the workshop enhanced their ability to work collaboratively in practice. Both student cohorts commented on a perceived power imbalance and a sense of each profession having to 'prove' their knowledge levels. Students stated that learning to work together in a safe environment allowed them to develop an appreciation for each other's scope of practice and responsibilities in an emergency situation. CONCLUSION: This form of collaborative learning has the potential to improve new graduate experience in the workplace, especially during emergency situations, and ultimately improve care for women and babies.

"Paper, face-to-face and on my mobile please": A survey of women's preferred methods of receiving antenatal education.

BACKGROUND: Antenatal education prepares women for childbirth and can be delivered face-to-face, in hard-copy and electronically. Smartphones allow access to online learning and internet searching is common among pregnant women. It is unclear which mode of health information delivery women prefer. AIM: This study aimed to investigate how women at one Local Health District (LHD) preferred to receive health information during pregnancy and the early postnatal period. METHODS: We developed a survey to gather data on women's preferences for educational information. Women who were discharged from one LHD, in NSW Australia, were invited, in 2019, to participate in a simple 14 question survey, either online or in hard copy format. FINDINGS: In total, 685 women completed the survey which represented a 40% response rate over a period of two months. The survey revealed women commonly used smart phones, or other devices, to source information. Despite this, most women preferred to receive antenatal education via non-electronic methods. Of note many participants felt underprepared for the post-birth period. The method of survey completion, whether hardcopy or online, aligned with individuals' preferences for information delivery. CONCLUSION: Non-electronic methods of education delivery were the preferred method for most women, and this was consistent across all educational, cultural and socioeconomic levels. Women sought information online, or through apps, but these options did not always meet their knowledge needs, especially regarding the postnatal period. We recommend that hospitals continue to provide information in a variety of modes, as exclusively electronic methods may marginalise groups of women.

Breastfeeding support at an Australian Breastfeeding Association drop-in service: a descriptive survey.

BACKGROUND: In Australia, during the early establishment phase of breastfeeding, women can access telephone peer support counselling provided by the Australian Breastfeeding Association (ABA) however options for face-to-face peer support are limited. The known factors which improve ongoing and exclusive breastfeeding include face-to-face support, peer and/or professional support, and trained personnel. This study aimed to examine women's experiences of accessing one breastfeeding drop-in peer support service provided by trained peer support volunteer counsellors from the ABA. METHODS: Women who accessed the service were invited, in 2014, to participate in an anonymous online survey which collected both quantitative and qualitative data. Participants were asked about their experiences of breastfeeding support, as well as their experiences of the drop-in service. In total, 53 women completed the online survey, and subsequent analysis generated descriptive statistics and qualitative themes. RESULTS: Responses to the survey revealed that women attended the drop-in service with infants ranging in age from less than 1 week through to 12 months of age. Most women reported attending with infants aged 0-8 weeks of age (72%). The predominant presenting problems identified were sore/damaged nipples, difficulties with infant latching to the breast, or concerns about using nipple shields. Analysis of the open text qualitative responses revealed one overarching theme 'Support to continue breastfeeding' and four subthemes: 'feeling listened to and not judged'; 'emotional support and confidence building'; 'the importance of face-to-face, practical support'; and 'the need for ongoing, free access'. DISCUSSION: In this study many women were seeking support for ongoing breastfeeding difficulties. Health professionals who had limited breastfeeding knowledge and skills were identified as most unhelpful in providing support with ongoing breastfeeding difficulties. Women valued having access to trained peer counsellors, who had the capacity to provide non-judgemental, face-to-face support; who could sit through a feed; in a space that was 'safe'; and who could enhance a woman's confidence with breastfeeding over the course of her full breastfeeding journey. CONCLUSIONS: Reactive peer support, provided in response to need, at an Australian Breastfeeding Association drop-in service, was described by participants as pivotal to enabling their ongoing breastfeeding.