Experiences of diabetes self-management: a focus group study among Australians with type 2 diabetes.

AIMS AND OBJECTIVES: The aim of this study was to explore the experiences and concerns of individuals with type 2 diabetes mellitus, in a predominantly low socio-economic setting. BACKGROUND: Currently, approximately 1 million Australians have diabetes and rates have more than doubled since 1989. Type 2 diabetes mellitus accounts for approximately 85% of diabetes cases. Risk factors include obesity, older age, low socio-economic status, sedentary lifestyle and ethnicity. Older individuals from low socio-economic backgrounds are particularly at risk of both developing and of mismanaging their condition. DESIGN: Exploratory qualitative design. METHODS: Focus groups were used to collect data from 22 individuals, aged 40 to more than 70 years, with type 2 diabetes mellitus, who were attending local health services for their diabetes care. Focus groups ranged in size from four to eight individuals and all were recorded, transcribed and analysed. Data were analysed using a thematic analysis approach. RESULTS: Participants described their experiences of managing their diabetes as emotionally, physically and socially challenging. Data analysis revealed four main themes including: (1) diabetes the silent disease; (2) a personal journey (3) the work of managing diabetes; and (4) access to resources and services. Throughout, participants highlighted the impact of diabetes on the family, and the importance of family members in providing support and encouragement to assist their self-management efforts. CONCLUSIONS: Participants in this study were generally satisfied with their diabetes care but identified a need for clear simple instruction immediately post-diagnosis, followed by a need for additional informal information when they had gained some understanding of their condition. RELEVANCE TO CLINICAL PRACTICE: Findings reveal a number of unmet information and support needs for individuals with type 2 diabetes mellitus. In particular, it is important for healthcare professionals and family members to recognise the significant emotional burden that diabetes imposes, and the type and quantity of information individuals with diabetes prefer. It is also important to consider levels of health literacy in the community when developing diabetes-related information or programmes.

Contraception knowledge and attitudes: truths and myths among African Australian teenage mothers in Greater Melbourne, Australia.

AIMS AND OBJECTIVES: To discuss the contraception knowledge, attitudes and beliefs of African Australian teenagers and women with a refugee background in Melbourne. BACKGROUND: The numbers of African Australian persons continue to increase, with a significant proportion being refugee women and children. Attitudes and behaviours towards contraception in this group continue to be influenced by culture, family and beliefs. DESIGN: This study is based on qualitative research that was underpinned by intersectionality theory, cultural competency and phenomenology. PARTICIPANTS: Sixteen teenagers and women who had experienced teenage pregnancy in Greater Melbourne, Australia, were interviewed. METHODS: In-depth interviews were conducted with the sixteen African Australian teenagers and women. Following data collection, data were transcribed verbatim, and coded, and key themes identified and analysed using thematic analysis. RESULTS: Knowledge of contraception among this group of migrants was low and filled with myths. Attitudes towards contraception use were insufficient and influenced by beliefs and external factors such as partner, family and community attitudes towards contraception. Migration status and other instabilities in the lives of these participants all intersected to shape their health beliefs and contraception decision-making. CONCLUSIONS: Refugee teenage mothers' knowledge of contraception was low and their attitude towards contraceptive use was poor. Myths and external factors continued to influence teenagers' and women's attitudes towards contraceptives. The events and life experiences of African Australian teenagers/women, culture, and family and community influences should be taken into consideration when providing healthcare services and sexual health education to this migrant group. RELEVANCE TO CLINICAL PRACTICE: Service providers should consider the multiple intersections in the lives of these women when delivering healthcare services and information to them.

Diabetes nurse educators' experiences of providing care for women, with gestational diabetes mellitus, from disadvantaged backgrounds.

AIMS AND OBJECTIVES: To explore diabetes nurse educators' experiences of providing care for women, with gestational diabetes mellitus, from disadvantaged backgrounds and to gather information which would assist with the development of an educational programme that would support both women and diabetes educators. BACKGROUND: Rates of gestational diabetes mellitus have increased dramatically in recent years. This is concerning as gestational diabetes mellitus is linked to poorer pregnancy outcomes including hypertension, stillbirth, and nursery admission. Poorest outcomes occur among disadvantaged women. gestational diabetes mellitus is also associated with maternal type 2 diabetes and with child obesity and type 2 diabetes among offspring. Effective self-management of gestational diabetes mellitus reduces these risks. Diabetes nurse educators provide most education and support for gestational diabetes mellitus self-management. DESIGN: An interpretative phenomenological analysis approach, as espoused by Smith and Osborn (Qualitative Psychology: A Practical Guide to Research Methods, 2008, Sage, London, 51), provided the framework for this study. METHODS: The views of six diabetes educators were explored through in-depth interviewing. Interviews were transcribed verbatim and analysed according to steps outlined by Smith and Osborn (Qualitative Psychology: A Practical Guide to Research Methods, 2008, Sage, London, 51). RESULTS: Three themes emerged from the data: (1) working in a suboptimal environment, (2) working to address the difficulties and (3) looking to the future. Throughout, the diabetes nurse educators sought opportunities to connect with women in their care and to make the educational content understandable and meaningful. CONCLUSIONS: Low literacy among disadvantaged women has a significant impact on their understanding of gestational diabetes mellitus information. In turn, catering for women with low literacy contributes to increased workloads for diabetes nurse educators, making them vulnerable to burnout. RELEVANCE TO CLINICAL PRACTICE: There is a need for targeted educational programmes for women with low literacy. Resources should be literacy appropriate, with photographs and simple text, and include culturally appropriate foods and information. This approach should lead to an improvement in the women's uptake of gestational diabetes mellitus information and may lead to a lessening of the workload burden for diabetes nurse educators.

Very advanced maternal age and morbidity in Victoria, Australia: a population based study.

BACKGROUND: In Australia, approximately 0.1% of births occur to women 45 years or older and this rate has been increasing in recent years. There are however, few population based studies examining perinatal outcomes among this age group. The aim of this study was to determine the maternal and perinatal outcomes of pregnancies in women aged 45 years or older compared to women aged 30-34 years. METHODS: Data on births at 20 or more weeks' gestation were obtained from the Victorian Perinatal Data Collection for the years 2005 and 2006. We examined selected maternal and perinatal outcomes for women of very advanced maternal age (VAMA) aged 45 years or older (n = 217) and compared them to women aged 30-34 years (n = 48,909). Data were summarised using numbers and percentages. Categorical data were analysed by Chi-square tests and Fisher's exact test. Comparisons are presented using unadjusted odds ratios, 95 percent confidence intervals (CIs) and p-values. RESULTS: Women aged 45 years and older had higher odds of gestational diabetes (OR 2.05; 95% CI 1.3-3.3); antepartum haemorrhage (OR 1.89; 95% CI 1.01-3.5), and placenta praevia (OR 4.88; 95% CI 2.4-9.5). The older age-group also had higher odds of preterm birth between 32-36 weeks (OR 2.61; 95% CI 1.8-3.8); low birth-weight (<2,500 gr) (OR 2.22; 95% CI 1.5-3.3) and small for gestational age (OR 1.53; 95% CI 1.0-2.3). Stratified analysis revealed that VAMA was most strongly associated with caesarean section in primiparous women (OR 8.24; 95% CI 4.5, 15.4) and those using ART (OR 5.75; 95% CI 2.5, 13.3), but the relationship persisted regardless of parity, ART use and plurality. Low birthweight was associated with VAMA only in first births (OR 3.90; 95% CI 2.3, 6.6), while preterm birth was more common in older women for both first (OR 3.13; 95% CI 1.8, 5.3) and subsequent (OR 2.08; 95% CI 1.2, 3.5) births, and for those having singleton births (OR 2.11; 95% CI 1.3, 3.4), and those who did not use ART (OR 2.10; 95% CI 1.3, 3.4). Preterm birth was very common in multiple births and following ART use, regardless of maternal age. CONCLUSIONS: This study demonstrates that women aged 45 years and older, in Victoria, Australia, have higher rates of pregnancy and perinatal complications, compared to women aged 30-34 years.

Gestational diabetes mellitus among women born in South East Asia: a review of the evidence.

OBJECTIVE: The aim of this paper was to examine rates of gestational diabetes mellitus (GDM) among women born in South East Asia, now residing in a developed country DATA SOURCES: Established health databases including: SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001-2011. STUDY SELECTION: Studies that examined GDM among women born in South East Asia (SEA) were sought. Keywords included gestational diabetes and a search term for Asian ethnicity (Asian, Asia, race, ethnic, and ethnicity). Further searches were based on citations and references found in located articles. Of 53 retrieved publications, five met inclusion criteria. DATA EXTRACTION: Data were extracted and organised under the following headings: GDM rates among women born in SEA; screening for GDM; and characteristics of GDM risk for SEA born women. Study quality was assessed by using the CASP (Critical Appraisal Skills Programme) guidelines. DATA SYNTHESIS: This review produced three main findings: (1) compared to combined Asian groups, GDM rates were lower among SEA women; (2) compared to other Asian sub-groups, GDM rates among SEA women were in the intermediate range; and (3) SEA born women demonstrated consistently higher rates of GDM than women from the same ethnic background who were born in countries such as the US, UK or Australia. CONCLUSIONS: From this review, it was clear that a 'one size fits all' approach to Asian ethnicity was not useful for estimating GDM rates among SEA women. There was also considerable difference among women of SEA ethnicity born in South East Asia, compared to women of the same ethnic background born in developed countries. Future research should explore the unique characteristics of GDM risk for these women. Such information is necessary for the development of strategies for the prevention and treatment of GDM among SEA women.

Women's experiences of gestational diabetes self-management: a qualitative study.

OBJECTIVE: to explore women's experiences of self-managing their gestational diabetes. DESIGN AND PARTICIPANTS: the study design was informed by interpretive phenomenological analysis. Data was collected using semi-structured interviews and one focus group. Participants included 15 women with a diagnosis of gestational diabetes who had experienced self-management of their condition. RESULTS: incremental adjustment occurred over 4 discrete themes, including: (1) the shock of diagnosis; (2) coming to terms with GDM; (3) working it out/learning new strategies; (4) looking to the future. Each adjustment phase was underpinned by the fifth theme (5) having a supportive environment. Throughout, participants reported that thinking about the baby was a powerful motivator for adherence to gestational diabetes management regimens. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study has shown that women undergo a process of adjustment following GDM diagnosis as they learn to self-manage their condition. The process is largely facilitated by the women's interest in maximising fetal health which may make them receptive to interventions to improve GDM control and to prevent type 2 diabetes in the future.

'A good midwife stands out': 3rd year midwifery students' views.

BACKGROUND: the midwifery workforce in Australia is ageing and predominantly part-time. There is considerable interest in the induction and retention of new midwives in the profession. OBJECTIVE: this study was undertaken to explore 3rd year students' views of the good midwife. It was anticipated that student views would show evidence of early transition and socialisation into the profession. DESIGN: qualitative thematic analysis. SETTING: Melbourne, Australia PARTICIPANTS: all completing midwifery students, in 2010, were invited to participate (n=31). FINDINGS: three broad themes emerged from the analysis: (1) a skilled practitioner; (2) a caring and compassionate individual; and (3) beyond the call of duty: passion and enthusiasm for midwifery. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: it was evident that 3rd year students' views of the good midwife were becoming aligned with the views of qualified midwives. Students also acknowledged the importance of safe practice at the same time as supporting women to make decisions. However, their intense passion and enthusiasm for midwifery practice may make them vulnerable to disappointment with the profession.

Maternal age ≥45 years and maternal and perinatal outcomes: a review of the evidence.

OBJECTIVE: to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries. BACKGROUND: this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women. METHODS: established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001-2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria. DATA EXTRACTION: data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines. FINDINGS: this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50-65 years), for healthy women who had been screened to exclude pre-existing disease. KEY CONCLUSIONS: although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.

Women's experiences of factors that facilitate or inhibit gestational diabetes self-management.

BACKGROUND: Gestational diabetes rates have increased dramatically in the past two decades and this pattern of increase appears to relate primarily to the obesity epidemic, older maternal age and migration from world areas of high GDM risk. Women from disadvantaged and migrant backgrounds are most at risk of developing and of mismanaging this condition. The aim of the study was to explore the factors that facilitated or inhibited gestational diabetes self-management among women in a socially deprived area. METHODS: Fifteen pregnant women, with a diagnosis of gestational diabetes, were purposively recruited for this study. Qualitative semi structured interviews and 1 focus group were conducted when participants were approximately 28-38 weeks gestation. The study's theoretical framework was based on interpretative phenomenology and data was analysed using a thematic analysis approach. RESULTS: Women in this study identified a number of factors that complicated their task of GDM self-management. Barriers included: (1) time pressures; (2) physical constraints; (3) social constraints; (4) limited comprehension of requirements, and (5) insulin as an easier option. Factors facilitating GDM self-management included: thinking about the baby and psychological support from partners and families. CONCLUSION: Women from low socio economic and migrant backgrounds often struggle to comprehend GDM self-management requirements. To improve adherence to management plans, these women require educational and supportive services that are culturally appropriate and aimed at a low level of literacy.

Advanced maternal age and obstetric morbidity for women giving birth in Victoria, Australia: A population-based study.

BACKGROUND: As the proportions of older women giving birth increase, there is a growing body of evidence on the increased risks of poorer maternal and perinatal outcomes for this group. However, the associations are not completely understood. This study aimed to establish the prevalence of selected maternal morbidities and examine whether advanced maternal age is associated with a higher risk of morbidity for women giving birth in Victoria. METHOD: Data on all births over 20 weeks‧ gestation for 2005 and 2006 were obtained from the Victorian Perinatal Data Collection. Unadjusted and adjusted analyses were undertaken using logistic regression to examine and quantify the association between advanced maternal age (35 years and older) and selected obstetric morbidities and complications. RESULTS: There was evidence of an association between older maternal age and selected morbidities and complications. Older nulliparous women were at highest odds of gestational diabetes (AdjOR, 1.83; 95% CI, 1.67-2.02), placenta praevia (AdjOR, 2.02; 95% CI, 1.68-2.44), multiple birth (AdjOR, 1.80; 95% CI, 1.58-2.06) and caesarean delivery (AdjOR, 1.93; 95% CI, 1.84-2.02). Older multiparous women were at highest odds of gestational diabetes (AdjOR, 2.01; 95% CI, 1.88-2.15) and placenta praevia (AdjOR, 2.11; 95% CI, 1.83-2.44). CONCLUSIONS: Older women giving birth in Victoria are at an increased risk of a range of obstetric morbidities. Delayed childbearing for an increasing number of women has societal and public health ramifications and will potentially place greater demand on healthcare services.

Experiences of pregnant women attending a lullaby programme in Limerick, Ireland: a qualitative study.

OBJECTIVE: to explore women's experience of singing lullabies in pregnancy and their understanding of possible benefits for themselves and their infants. DESIGN AND PARTICIPANTS: over four group sessions with musicians, six pregnant women, all expecting their first baby, learnt to sing three lullabies. Qualitative semi-structured interviews were conducted approximately three months after the birth to capture the women's experiences. Participants were recruited at antenatal classes at a metropolitan maternity hospital in Ireland. FINDINGS: The women enjoyed participation in the lullaby project and all felt it benefited them and their babies. Themes uncovered included: (1) beyond words: music and the articulation of deep emotion; (2) a balm for the soul: the power and pleasure of beautiful music; and (3) music and the facilitation of infant development. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: Singing lullabies in pregnancy had a soothing and calming effect and was a pleasant experience for participants. It was also an emotional experience and appeared to facilitate the expression of difficult emotion such as fear and anxiety. This effect is likely to have a significant and positive impact on well-being for pregnant women and as such warrants further exploration.

Maternal age, ethnicity and gestational diabetes mellitus.

BACKGROUND: in Australia, and globally, rates for gestational diabetes mellitus (GDM) have risen dramatically in recent decades. This is of concern as GDM is associated with adverse pregnancy outcomes and additional health-care costs. Factors linked to increasing incidence include older maternal age and non-Caucasian ethnicity. However, as yet, there is no clear consensus on the magnitude of effect associated with these factors in combination. This study therefore investigated the effect of maternal age and country/region of birth on GDM incidence. METHODS: all women who gave birth in Victoria, Australia in 2005 and 2006 (n=133,359) were included in this population-based cross-sectional study. Stratified cross-tabulations were conducted to examine the incidence of GDM by maternal age group and country/region of birth. Primiparous women were further analysed separately from parous women. The proportion of women with GDM was reported, along with the χ(2) for linear trend. FINDINGS: whilst women born outside Australia constituted just 24.6% of women giving birth during the study period, they accounted for 41.4% of GDM cases. The highest GDM incidence was seen among Asian women at 11.5%, compared with Australian born women at 3.7%. There was strong evidence that women born in all regions except North America were increasingly likely to develop GDM in pregnancies at older ages (p<0.001).On examining age related GDM trends by maternal region of birth, higher rates were seen across all regions studied but were most marked among women born in Asia and the Middle East. CONCLUSIONS: older maternal age and non-Australian birth increased a woman's risk of developing GDM and this increase was most evident among Asian women. As GDM is associated with adverse maternal and infant outcomes, it is important to explore ways of preventing GDM, and to put in place strategies to effectively manage GDM during pregnancy and to reduce the later risk of developing type 2 diabetes. Pregnancy presents midwives with a unique opportunity to provide education and to encourage dietary and behavioural modifications as women have repeated contact with the health system during this time.

The Limerick Lullaby project: an intervention to relieve prenatal stress.

BACKGROUND: stress during pregnancy is common and has been linked to a range of poorer maternal and infant outcomes. Treatment options are few, however, due to difficulties of diagnosis and concerns about the impact of medication on the developing fetus. Singing is an activity with stress reducing and other benefits that may be worth exploring. The aim of this study was to explore the impact of singing lullabies during pregnancy. METHODS: participants were recruited at antenatal classes at a metropolitan maternity hospital in Ireland. Six pregnant women participated and learnt to sing three lullabies over four group sessions with musicians. Qualitative in depth interviews were conducted approximately three months later to capture the women's experiences. KEY FINDINGS: participants unanimously reported a sense of satisfaction with their participation and all would recommend the programme to a friend. Findings suggest that learning to sing lullabies in pregnancy benefited women in terms of relaxation, in feeling closer to their infants, in connecting with other pregnant women and in providing an additional tool for communication in the early newborn period. Some women described profound feelings of love and connection with the unborn infant while singing the lullabies. IMPLICATIONS FOR PRACTICE: the principal value of this intervention is that it is non-pharmacological and easy to implement. At the same time, it appears to be an enjoyable exercise for pregnant women and to have an effect on reducing maternal stress and encouraging infant attachment.

Concerns among first year midwifery students: towards addressing attrition rates.

Since 2000, there has been a shift to undergraduate midwifery education in Australia. Midwifery students are generally highly motivated, however attrition rates remain high among first-year students. This study was undertaken in one Australian University against a background of high course demand and high student attrition. Thirty-two first-year midwifery students completed a demographic questionnaire and wrote a reflection in response to the question: What if anything, would make your experience as a first year student better? Data were subjected to thematic content analysis. Findings indicated a need for: greater opportunities to prepare; for more time to study; for greater student supports; and outlined difficulties such as financial and childcare. In conclusion, undergraduate midwifery courses and local conditions vary among institutions. Student feedback is a useful way of identifying local concerns that may impact on student completion rates. This is a necessary first step to the provision of meaningful student support.

Older maternal age and intervention in labor: a population-based study comparing older and younger first-time mothers in Victoria, Australia.

BACKGROUND: In Australia, birth rates for women aged 35 years or more are significant and increasing and a considerable percentage are first births. This study investigated the effect of maternal age on interventions in labor and birth for primiparous women aged 35 to 44 years compared with primiparous women aged 25 to 29 years. METHODS: All primiparous women who gave birth in Victoria, Australia, in 2005 and 2006 (n = 57,426) were included in this population-based cross-sectional study. Women were stratified by admission status (private/public). Main outcome measures were induction of labor, augmentation of labor, use of epidural analgesia, and method of birth. Multivariate logistic regression was used to explore the relationship between maternal age and cesarean adjusted for confounders. RESULTS: Older women were more likely to give birth by cesarean section whether admitted as public or private patients. For private patients, total cesarean rates were 31.8 percent (25-29 yr), 46.0 percent (35-39 yr), and 60.0 percent (40-44 yr; p < 0.001) compared with 27.5, 41.6, and 53.4 percent for public patients (p < 0.001). Older women who experienced labor were more likely to have an instrumental vaginal birth or an emergency cesarean section than younger women. Both were more common in women admitted as private patients. Age-related trends were also seen for induction of labor and use of epidural analgesia. Rates were higher for private patients. Rates of induction were (37.8, 40.2, and 42.5%) for private patients compared with (32.1, 36.7, and 40.1%) for public patients and rates for epidural were (45.3, 49.9, and 48.1%) among private patients compared with (33.3, 38.8, and 39.3%) among public patients. CONCLUSIONS: Interventions in labor and birth increased with maternal age, and this effect was seen particularly for cesarean section among women admitted privately. These findings were not fully explained by the complications we considered.

Advanced maternal age and adverse perinatal outcome: a review of the evidence.

OBJECTIVE: To examine the evidence in relation to advanced maternal age (35-39 years), physiological risk and adverse perinatal outcome (stillbirth, low birth weight, preterm birth) in high-income countries. BACKGROUND: This review was conducted against a background of increasing maternal age (>35 years) and concerns for fetal and maternal welfare among this group. Consequent to these concerns, increasing trends of birth intervention such as caesarean section and instrumental birth are seen. Although evidence justifies a high rate of intervention among women aged more than 40 years, the evidence for such intervention in women aged 35-39 years is sketchy and often contradictory. METHODS: A systematic review was conducted of studies in English, that were published between 2000 and 2010. Studies were included if they had extractable data on maternal age (35-39 years) and perinatal outcomes. Of 102 retrieved publications, nine met these criteria. FINDINGS: Evidence from this review suggests that rates of adverse perinatal outcome, such as stillbirth, are linked to maternal age 35-39 years. However, rates of increase are modest until 40 years of age or more. The impact of changing maternal socio demographics appears to be of importance but is not yet well understood. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although risk and rates of adverse perinatal outcome are increased among women aged 35-39 years, midwives and women should also be aware that perinatal outcomes are generally favourable for this group. There is also some suggestion in the literature that social advantage may ameliorate some of the effect of advanced maternal age on perinatal outcome. Further research is required to evaluate the soundness and strength of this association.

The good midwife: commencing students' views.

OBJECTIVE: to explore commencing students' views of the good midwife. This study was set against a background of high course attrition and concerns that discordant students' views of midwifery practice may have been associated with course attrition. DESIGN: qualitative thematic analysis. SETTING: Melbourne, Australia. PARTICIPANTS: all commencing midwifery students, in 2008, were invited to participate (n = 41). MEASUREMENTS AND FINDINGS: students spoke of a series of key attributes they felt were important to the role of the midwife. Most fell into the affective domain and four themes were identified: personal qualities and attitudes; a belief in women and natural birth; compatible work ethic; and the possession of additional attributes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: commencing students showed a clear understanding of the affective attributes required of a good midwife but a lesser understanding of requirements of knowledge and competence. A small number of students felt that they were already equipped to advise pregnant women, despite their early stage in the course. This is an issue that needs to be addressed.

Undertaking midwifery studies: commencing students' views.

OBJECTIVE: to explore the motivations and beliefs of commencing midwifery students against a background of high course demand and high student attrition. DESIGN: a qualitative analysis of student reflective essays. SETTING: Melbourne, Australia. PARTICIPANTS: all commencing midwifery students, in 2008, were invited to participate (n = 41). MEASUREMENTS AND FINDINGS: three primary motivations for choosing midwifery were identified, including: notions of altruism (wanting to help), a fascination with pregnancy and birth, and a view of midwifery as a personally satisfying career. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Bachelor of Midwifery programmes attract students with idealised views about midwifery practice. Such views may lead to student disillusionment, tensions with educators and clinicians, and higher rates of student attrition. Students need greater support to examine their views about midwifery practice. More meaningful support may assist the students' successful socialisation into clinical practice.

Attitudes towards gestational diabetes among a multiethnic cohort in Australia.

AIMS: This study aimed to examine the attitudes and beliefs towards gestational diabetes of a multiethnic sample of pregnant women with gestational diabetes. BACKGROUND: Women from non-Caucasian background are disproportionately represented in gestational diabetes statistics. This is of particular importance in multicultural Australia, where increasing numbers of non-Caucasian women give birth. DESIGN: Cross-sectional survey. METHODS: The Diabetes Attitude Scale, version 3 was administered to 200 women with gestational diabetes from Vietnamese, Indian, Filipino and Caucasian backgrounds. RESULTS: A total of 143 questionnaires were returned indicating a response rate of 71·5%. There were significant between group differences in terms of educational level (p = 0·001) and English fluency (p = 0·001). Lower educational level, though not English language fluency, was associated with poorer appreciation of gestational diabetes as a serious condition and also with a lower valuing of tight glucose control. This effect was seen irrespective of ethnic group. Indian and Vietnamese women indicated a lower valuing of patient autonomy and also reported less negative psychological effects than Caucasian and Filipino women. CONCLUSIONS: Women from non-Caucasian ethnicities may be at risk of poorer self-management of gestational diabetes related to lower education, lower health literacy and a lower appreciation of gestational diabetes as a serious condition. RELEVANCE TO CLINICAL PRACTICE: Nurses and midwives provide information and advice to women with gestational diabetes. Knowledge about factors that impact on attitude towards gestational diabetes among multiethnic populations is important for developing educational programmes to address their needs.