Australian, Irish, and Swedish women's comfort levels when breastfeeding in public.

BACKGROUND: Despite a flux of global initiatives to increase and sustain breastfeeding rates, challenges persist. The decision to commence and sustain breastfeeding is influenced by multiple, complex factors. Feelings of social embarrassment, shame, fear of judgement, and lack of confidence when breastfeeding in public, compound women's decisions to breastfeed and may result in formula feeding or early cessation of breastfeeding. A greater understanding of where and how women feel most comfortable when breastfeeding in public can assist in designing interventions to support the initiation and continuation of breastfeeding. METHODS: A cross-sectional survey was conducted with women living in Australia (n = 10,910), Sweden (n = 1,520), and Ireland (n = 1,835), who were currently breastfeeding or who had breastfed within the previous two years. Our aim was to explore where, and how often women breastfeed in public and to compare their levels of comfort when breastfeeding in public. Data were collected in 2018 using an anonymous online survey over a four-week period in Ireland, Australia, and Sweden, and were analyzed using SPSS Version 25. RESULTS: Most respondents were highly educated, with over 70% in each country reporting having a university or college degree. Observing women breastfeeding in public was more commonly reported to be a weekly or daily occurrence in Sweden (24.5%) and Australia (28%), than in Ireland (13.3%). Women in the participating countries reported breastfeeding in public most commonly whenever their babies needed feeding. Very few women never or rarely breastfed publicly. Coffee shops/cafes, restaurants, and parks were the most popular locations. In all three countries, partners were reported to be very supportive of breastfeeding in public, which enhanced breastfeeding women's comfort levels. When asked to score out of a maximum comfort level of 10, women reported higher mean levels of comfort when breastfeeding in front of strangers (Ireland M = 7.33, Australia M = 6.58, Sweden M = 6.75) than with those known to them, particularly in front of their father-in-law (Ireland M = 5.44, Australia M = 5.76, Sweden M = 6.66 out of 10), who scored lowest in terms of women's comfort levels. CONCLUSION: This study offers important insights into the experiences and comfort levels of women breastfeeding in public. Limitations include the anonymous nature of the surveys, thus preventing follow-up, and variances in terminology used to describe locations across the three settings. Recommendations are made for research to determine the relationships between the frequency of breastfeeding in public and breastfeeding women's perceived comfort levels, the influence of family members' perceptions of breastfeeding in public and women's experiences, and the experience of women who feel uncomfortable while breastfeeding in public, with a view to developing support measures.

Women's perceptions of factors needed to encourage a culture of public breastfeeding: a cross-sectional study in Sweden, Ireland and Australia.

BACKGROUND: Breastfeeding in the public sphere is known to be experienced as a problem for many women. It has been shown to arouse negative feelings among the public, depending on the attitude of those in the immediate surroundings. This contributes to the fact that many women hesitate to breastfeed in public and prepare themselves for potential adverse comments. METHODS: An online survey was used for an international cross-sectional study including women living in Sweden (n = 1252), Australia (n = 7602) and Ireland (n = 1597). Women who had breastfed within the previous two years were invited to participate through Facebook. One key open-ended question was presented, inviting women to respond to: "What do you think is important or needed to encourage a breastfeeding culture where breastfeeding in public is seen as normal?" During 2018, data were collected during a four-week period. A thematic analysis of women's responses was conducted separately in each country and then comparison and negotiation occurred once similarities between themes and subthemes were confirmed. Frequencies of subthemes were then determined and compared between the three countries. RESULTS: Seven subthemes developed from the data; 'Make breastfeeding visible in society'; 'Healthcare professionals support and knowledge regarding breastfeeding'; 'Education of the public'; 'Inviting environment'; 'Zero tolerance to other's unwanted opinions'; 'Focusing on the needs and rights of the breastfeeding dyad'; and 'Desexualize breastfeeding and women's' bodies in society'. Subthemes were integrated under two themes; 'Active supportive interventions needed for breastfeeding' and 'The obvious right of breastfeeding women and children to take a seat in the public sphere'. CONCLUSION: The common experience that exists today regarding public breastfeeding requires change towards normalization. Further collaborative research is recommended to meet the expressed requirements from women who wish to breastfeed in public.

Relationship focused mother-infant groups: Preliminary evaluation of improvements in maternal mental health, parenting confidence, and parental reflective functioning.

We report on two preliminary evaluations of a group intervention, targeting vulnerable infants and their mothers within the first 6-months postpartum. The Mother-Baby Nurture® program aims to strengthen the developing infant-mother attachment relationship by increasing maternal mentalizing. These studies were undertaken with pre-post evaluations with the mothers of infants under 10-months of age. The mother-infant dyads participated in ten 2-h group sessions. Study one (N = 69 dyads) included self-reported maternal depression, anxiety, and parenting confidence. In study two (N = 27 dyads), parenting stress and reflective functioning were measured by self-report, and reflective functioning coded on the 5 min speech sample (completed by N = 22). Results from study one confirmed a decrease in depression (p < .001, d = .79) and anxiety (p < .001, d = .72) symptoms, and an increase in mothers' scores for parenting confidence (p < .001, d = -.98). Results from Study Two demonstrated a significant decrease in parenting stress (p < .001, d = .94) and significant improvement in measures of self-report reflective functioning (p = .007, .024; d = .56, .61). These findings are preliminary yet promising indications that this program could be effective in alleviating parenting stress, depression, and anxiety, and improving mother's reflective functioning and parenting confidence. Further research is needed, with a control group and long-term follow-up assessments.

Reportamos sobre dos evaluaciones preliminares de un grupo de intervención, con enfoque en infantes vulnerables y sus madres dentro de los primeros seis meses después del parto. El programa Naturaleza Mamá-Bebé® se propone fortalecer el desarrollo de la relación afectiva infante-madre por medio de incrementar el proceso de mentalización materna. Estos estudios se llevaron a cabo con evaluaciones anteriores y posteriores con las madres de infantes menores de 10 meses de edad. Las díadas madre-infante participaron en diez sesiones de grupo de 2 horas. El Estudio Uno (N=69 díadas) incluyó la auto reportada depresión materna, la ansiedad y la confianza en la crianza. En el Estudio Dos (N=27 díadas) se midieron el estrés de crianza y el funcionamiento con reflexión por medio de auto reportes, y el funcionamiento con reflexión se codificó en base a la Muestra de Cinco Minutos de Charla Oral (completada por N=22). Los resultados del Estudio Uno confirmaron una disminución en los síntomas de depresión (p<.001, d=0.79) y ansiedad (p<.001, d=0.72) y un aumento en los puntajes de las madres en cuanto a confianza en la crianza (p<.001, d=-0.98). Los resultados del Estudio Dos demostraron una significativa disminución en el estrés de crianza (p<.001, d = 0.94) y un significativo mejoramiento en las medidas de funcionamiento con reflexión auto reportadas (p=.007, .024; d=0.56, 0.61). Estos resultados son preliminares, pero aun así indicaciones prometedoras de que este programa pudiera ser eficaz para aliviar el estrés de crianza, la depresión y la ansiedad, y mejorar el funcionamiento con reflexión y confianza en la crianza de la madre. Se necesita una mayor investigación, con un grupo de control y medidas de evaluación a largo plazo.

Nous présentons deux évaluations préliminaires d'un groupe d'intervention ciblant des nourrissons vulnérables et leurs mères durant les six premiers mois postpartum. Le programme Mother-Baby Nurture® a pour but de renforcer la relation d'attachement infant-mère qui se développe en augmentant la mentalisation maternelle. Ces études ont été faites avec des évaluations pré-post avec les mères de nourrissons de 10 mois. Les dyades mère-bébé ont participé à dix séances de groupes, de heures chacune. La première étude (N=69 dyades) a inclus une dépression maternelle, de l'anxiété et la confiance de parentage, toutes auto-rapportées. Dans la deuxième étude (N=27 dyades), le stress de parentage et le fonctionnement de réflexion ont été mesurés par auto-déclaration, et le fonctionnement de réflexion a été codé à partir du de l'échantillon Five-Minute Speech Sample (complété par N=22). Les résultats de la première étude ont confirmé une décroissance de la dépression (p<,001, d=0,79) et des symptômes d'anxiété (p<,001, d=0,72) et une augmentation des scores des mères pour ce qui concerne la confiance de parentage (p<,001, d=-0,98). Les résultats de la deuxième étude ont révélé une décroissance importante du stress de parentage (p<,001, d = 0,94) et une amélioration importante dans les mesures de fonctionnement de réflexion auto-rapporté (p=,007, ,024; d=0,56, 0,61). Ces résultats sont préliminaires mais cependant ils s'avèrent présenter des indications prometteuses que ce programme pourrait être efficaces pour soulager et atténuer le stress de parentage, la dépression et l'anxiété, et améliorer le fonctionnement de réflexion des mères ainsi que leur confiance de parentage. De plus amples recherches sont nécessaires, avec un groupe de contrôle et des évaluations de suivi à long terme.

Using a scheduled caesarean birth plan: A cross-sectional exploration of women's perspectives.

PROBLEM: There is minimal evidence regarding the role or impact of birth plans from the perspective of women experiencing scheduled caesarean birth. BACKGROUND: Quality maternity care requires respect for women's preferences. Evidence suggests birth plans enable communication of women's preferences and may enhance agency when vaginal birth is intended, however there is limited evidence of how this translates in the perioperative environment where caesarean birth is the intended outcome. AIM: Explore the experiences and perspectives of women who had utilised a scheduled caesarean birth plan at an Australian tertiary maternity hospital. METHODS: A cross-sectional design was used; 294 participants completed the survey within two weeks post-birth. Descriptive statistics were used to analyse quantitative data, qualitative responses were analysed using content analysis. FINDINGS: Over half of the women requested lowering of the surgical-screen at birth, most requested immediate skin-to-skin with their babies; around two-thirds of these preferences were met. Use of a birth plan for scheduled caesarean section supported women's ability to communicate their desires and choices, enhancing agency and reinforcing the significance of the caesarean birth experience. Qualitative data revealed two main categories: Perceptions and experiences; and Recommendations for improvement, with corresponding sub-categories. DISCUSSION: Findings provide unique opportunities to consider the provision of woman-centred care within the highly technocratic perioperative environment. CONCLUSION: All women, regardless of birth mode, have a right to respectful maternity care that prioritises their wishes and agency. This study provides evidence for the positive utility of birth plans in caesarean birth, local adaptation is encouraged.

Maternity research priorities in country Western Australia: a Delphi study.

Objective Health research priorities are commonly identified and resourced by strategic leaders. The importance of recognising the expertise of clinician-researchers is being prioritised by a national funding shift towards applied research. There is a dearth of evidence regarding research priorities for maternity care in rural and remote health in Australia. This study aimed to develop an evidence-based consensus of maternity research priorities in regional, rural, and remote areas of Australia's largest rural health service (by land area) in Western Australia. Methods A three-phased Delphi method was selected to achieve an interdisciplinary, evidence-based consensus on maternity research priorities within Western Australian Country Health Service. Results Across three study phases, 432 participants responded. Representation was from seven regions and all stakeholder roles within the regions. Phase 1 included 173 responses yielding 53 concepts categorised under five domains. Phase 2 involved 161 participants who prioritised concepts under domains of (i) workforce and education; (ii) health equity; (iii) Aboriginal health; (iv) logistics and health systems; and (v) clinical. Phase 3 included 96 participants revealing 15 maternity research priorities with the top four ranked concepts: 'recruitment and retention of staff'; 'care for women and families with vulnerabilities', 'models of care offering continuity' and 'systems efficiencies'. Conclusions The novel evidence provided in this study, in conjunction with a strong consensus on research priorities and an interdisciplinary approach, strengthens the findings of this study and amplifies the mandate of action without delay.

Childbearing women's experiences of the maternity care system in Australia during the first wave of the COVID-19 pandemic.

BACKGROUND: Substantial changes occurred in Australian healthcare provision during the COVID-19 pandemic to reduce the risk of infection transmission. Little is known about the impact of these changes on childbearing women. AIM: To explore and describe childbearing women's experiences of receiving maternity care during the COVID-19 pandemic in Australia. METHODS: A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. Twenty-seven interviews were conducted with women from across Australia. Data was analysed thematically. FINDINGS: Three primary themes and nine sub-themes emerged: 'navigating a changing health system' (coping with constant change, altered access to care, dealing with physical distancing restrictions, and missing care), 'desiring choice and control' (experiencing poor communication, making hard decisions, and considering alternate models of care), and 'experiencing infection prevention measures' (minimising the risk of exposure and changing care plans to minimise infection risk). DISCUSSION: The substantial changes in care delivery for pregnant and postpartum women during the pandemic appear to have reduced woman-centred care. In most cases, care was perceived as impersonal and incomplete, resulting in a very different experience than expected; consequences included missing care. The presence of a known care provider improved women's sense of communication, choice, and control. CONCLUSION: This study provides unique insight into the experiences of childbearing women across Australia. The importance of respectful woman-centred care cannot be forgotten during a pandemic. The findings may inform future service planning during pandemics and disaster situations.

Sexual and reproductive health education: Midwives' confidence and practices.

PROBLEM: There is limited evidence regarding midwives' confidence and practices in providing sexual and reproductive health care in Australia. BACKGROUND: Midwives provide important public health education to women regarding sexual and reproductive health care. AIM: The aim of this study was to explore midwives' confidence and practices around providing education to women on three key areas of sexual and reproductive health: contraception and family planning; sexual activity; and sexual health. METHODS: A cross-sectional exploratory study was conducted with responses from n = 164 midwives (43.1% response rate) working in a public tertiary maternity hospital in Western Australia. The survey included items measuring confidence; method and frequency of practice. Open-ended questions captured qualitative data. Data analysis was conducted using descriptive statistics for quantitative data and content analysis for qualitative data. FINDINGS: There was a significant association between age, years of clinical experience (p = 0.001) and work setting (p = 0.032) on the confidence to provide education on sexual activity. Most (92.1%) midwives indicated that they wanted further education. Lack of time, knowledge and language barriers were key factors preventing education. DISCUSSION: Midwives' provision of education to women is essential for improving health literacy and health outcomes. Results reveal the necessity to include sexual and reproductive health education in entry to registration courses and the importance of continuing professional development. CONCLUSION: Evidence of midwives' confidence and current practices in the provision of sexual and reproductive health care offers utility for leaders and educators in midwifery to prepare and equip midwives to fulfil this important public health role.

Midwives' experiences of providing maternity care during the COVID-19 pandemic in Australia.

PROBLEM: The COVID-19 pandemic has required rapid and radical changes to the way maternity care is provided in many nations across the world. BACKGROUND: Midwives provide care to childbearing women across the continuum and are key members of the maternity workforce in Australia. AIM: To explore and describe midwives' experiences of providing maternity care during the COVID-19 pandemic in Australia. METHODS: A two-phased cross-sectional descriptive study was conducted. Data were collected through an online survey and semi-structured interviews between May-June 2020. FINDINGS: Six hundred and twenty midwives responded to the online survey. Many reported a move to telehealth appointments. For labour care, 70% of midwives reported women had limited support; 77% indicated postnatal visiting was impacted. Five main themes were derived from the qualitative data including: coping with rapid and radical changes, challenges to woman-centred care, managing professional resilience, addressing personal and professional challenges, and looking ahead. DISCUSSION: Restrictions applied to women's choices, impacted midwives' ability to provide woman-centred care, which resulted in stress and anxiety for midwives. Professional resilience was supported through collaborative relationships and working in continuity models. Midwives revealed 'silver linings' experienced in providing care during the pandemic. CONCLUSION: Findings provide valuable evidence to understand the impact on midwives who have provided care during the COVID-19 pandemic. Knowledge will be useful for health leaders and policy makers as they consider ways to continue care during the pandemic and support the essential midwifery workforce. Recommendations are presented to improve preparedness for future pandemics.

Receiving maternity care during the COVID-19 pandemic: Experiences of women's partners and support persons.

BACKGROUND: In Australia, the provision of maternity care during the COVID-19 pandemic was significantly altered to limit transmission of the virus. Many hospitals limited face-to-face appointments to only the pregnant woman and restricted the number of support people present during labour, birth, and postnatal visits to one person. How these restrictions were experienced by partners and support persons of childbearing women are unknown. AIM: To explore the experiences of partners and support persons of women receiving maternity care during the COVID-19 pandemic. METHODS: A two-phased qualitative study including an online survey and interviews. Analysis was undertaken using content analysis. FINDINGS: Partners and support persons experienced a sense of 'missing out' from the pregnancy and maternity care experience because of changes in the provision of care during the pandemic. They reported feelings of isolation, psychological distress, and reduced bonding time with babies. Conflicting information and processes within and across maternity services contributed to feelings of uncertainty and a perceived reduction in the quality of care. Partners and support persons were negatively impacted by restrictions on maternity wards, however they also perceived these to be of benefit to women. DISCUSSION: Many partners and support persons were negatively impacted by restrictions in maternity services during the pandemic; strategies to ensure their active involvement in maternity care are needed. CONCLUSION: This study offers insights from the unique perspective of partners and support people of women receiving maternity care during the pandemic. Policies and processes that exclude partners and support persons need to be reconsidered.

Australian women's experiences of receiving maternity care during the COVID-19 pandemic: A cross-sectional national survey.

BACKGROUND: The COVID-19 pandemic has led to multiple changes in maternity services worldwide. Systems rapidly adapted to meet public health requirements aimed at preventing transmission of SARS-CoV-2, including quarantine procedures, travel restrictions, border closures, physical distancing and "stay-at-home" orders. Although these changes have impacted all stakeholders in maternity services, arguably the women at the center of this care have been most affected. This study aimed to explore women's experiences of receiving maternity care during the COVID-19 pandemic in Australia. METHODS: A national cross-sectional online survey, including fixed choice and open-ended questions, was conducted during the first wave of the COVID-19 pandemic in Australia; pregnant and postnatal women were recruited through social media networks. RESULTS: The survey was completed by 3364 women. Women felt distressed and alone due to rapid changes to their maternity care. Limited face-to-face contact with health practitioners and altered models of care often required women to accommodate significant changes and to coordinate their own care. Women felt that they were often "doing it alone," due to public health restrictions on support people and visitors, both within and outside health services. Women described some benefits of visitor restrictions, such as, more time for rest, breastfeeding establishment, and bonding with their baby. CONCLUSIONS: This large nationwide Australian study provides unique data on women's experiences of receiving maternity care during the COVID-19 pandemic. Lessons learned provide an opportunity to rebuild and reshape the maternity sector to best meet the needs of women and their families during current and future public health crises.

Looking back moving forward: The history of midwifery in Western Australia.

PROBLEM: To date there is has been very little research into midwifery in Western Australia (WA), therefore this paper addresses a significant gap in the literature. The aim of this paper was to gain insight into the history of midwifery in WA. BACKGROUND: Since the beginning of recorded history midwives have assisted women in childbirth. Midwifery is recognised as one of the oldest professions; midwives are mentioned in ancient Hindu texts, featured on Egyptian papyrus and in The Bible. Up until the seventeenth century childbirth was the responsibility of midwives, but the gradual emergence of barber-surgeons, then man-midwives and obstetricians heralded a shift from women-led and community-supported birth to a patriarchal and medical model. Throughout the twentieth century childbirth practices in the Western World have continued to change, leading to a move from midwifery-led care at home to doctor-led care in the hospital. DISCUSSION: The first non-Indigenous Australian midwives were not formally trained; they came on ships bringing convicts to Australia and are described as 'accidental' midwives, as assistance in childbirth came from whoever was available at the time. This period was followed by what was called the 'Aunt Rubina' period where older married women helped younger women in childbirth. Throughout the early 1800s untrained or 'lay' midwifery care continued alongside the more formally trained midwives who had arrived with the colonists. From the early 20th century, when birth moved into the hospital, midwives in WA have been incorporated into the hierarchy of the professions with obstetrics as the lead profession and midwifery considered a speciality of nursing. The role of the midwife has been subordinated, initially controlled by medicine and then incorporated into the institutions and nursing. The increase in legislative and training requirements for midwives throughout Australia and the move from home to the hospital, gradually led to the decrease in autonomous midwives working within the community, impacting women's choice of birth attendant and place of birth. CONCLUSION: The historical suppression of midwifery in Australia has impacted the understanding of the role of the midwife in the contemporary setting. Understanding the development and evolution of the midwifery profession in Australia can help future directions of the profession.

E-professionalism and social media use amongst nurses and midwives: A cross-sectional study.

AIM: To describe nurses' and midwives' social media use, knowledge, attitudes and information needs, in the context of e-professionalism. A secondary aim was to identify any relationship between these variables and age, or professional role. BACKGROUND: Midwives and nurses are viewed by the public as trusted professionals. On social media, the boundary between professional and personal identities can be blurred. Previous research has explored how student nurses navigate professional behaviour online, or e-professionalism. However, confusion persists amongst established nurses and midwives, despite the policies which guide and regulate their online conduct. DESIGN: A cross-sectional designwas applied. The STROBE guideline informed reporting of the findings. METHODS: A validated survey tool was modified to the study setting. Responses to 17 survey items were analysed using Chi-square and Fisher's exact tests. Qualitative content analysis was conducted on responses to two open-ended questions. RESULTS: In total, 311 nurses and midwives from one Western Australian tertiary hospital participated between August 2019 and February 2020. Social media use was widespread (97.4%, n = 299). Associations were identified between age group and eight survey items assessing social media use, knowledge and attitudes. No associations were identified between professional role and social media use, knowledge and attitudes. Content analysis revealed five themes: Maintaining professional boundaries; Avoidance; Protecting self; Responsibilities and consequences; and Social media as a tool. CONCLUSIONS: Midwives and nurses in this study approached social media with caution yet many were curious about its potential. If midwives and nurses are to be held accountable to social media policies and use the benefits social media affords, they must be supported to evolve into proficient users by educators and policy makers. TWEETABLE ABSTRACT: Nurses and midwives must be supported through policy and education to embrace social media as a tool of the future.

COVID-19 vaccination perceptions and intentions of maternity care consumers and providers in Australia.

INTRODUCTION: Vaccination against COVID-19 is a key global public health strategy. Health professionals including midwives and doctors support and influence vaccination uptake by childbearing women. There is currently no evidence regarding the COVID-19 vaccination perceptions and intentions of those who receive or provide maternity care in Australia. The aim of this study was to address this gap in knowledge and explore the perceptions and intentions regarding COVID-19 vaccination from consumers and providers of maternity care in Australia. METHODS: A national cross-sectional online study conducted in early 2021 in Australia, a country that has had a very low number of COVID-19 cases and deaths. Recruitment was undertaken through parenting and health professional social media sites and professional college distribution lists. A total of 853 completed responses, from women (n = 326), maternity care providers including doctors (n = 58), midwives (n = 391) and midwifery students (n = 78). FINDINGS: Personal intention to be vaccinated ranged from 48-89% with doctors most likely and women least likely. Doctors and midwifery students were significantly more likely to recommend the vaccine to pregnant women in their care than midwives (p<0.001). Fewer doctors (2%) felt that women should wait until breastfeeding had concluded before being vaccinated compared with 24% of midwives and 21% of midwifery students (p<0.001). More than half of the midwives (53%) had concerns about the COVID-19 vaccine for the women in their care compared with 35% of doctors and 46% of midwifery students. Despite national guidelines recommending vaccination of breastfeeding women, 54% of practitioners were unlikely to recommend vaccination for this group. CONCLUSION: This is the first study to explore the perceptions and intentions regarding COVID-19 vaccination from the perspective of those who receive and provide maternity care in Australia. Findings have utility to support targeted public health messaging for these and other cohorts.

Influencers of women's choice and experience of exclusive formula feeding in hospital.

OBJECTIVES: Explore what influenced women's decision to exclusively formula feed, and their experiences with formula feeding within a maternity hospital environment. DESIGN: This mixed methods study used a cross-sectional exploratory survey design. Short surveys were administered by telephone in the postpartum period. Content analysis revealed common themes for responses to open-ended questions on what influenced women's choice and experience with formula feeding. Descriptive statistics were used for demographic characteristics, and frequencies conducted on some themes. PARTICIPANTS AND SETTING: English-speaking women who chose to exclusively formula feed, and attended a tertiary maternity hospital in Australia were invited to participate; 102 women were interviewed. FINDINGS: Themes that influenced women to choose exclusive formula feeding were: 'Previous breastfeeding challenges', 'social and societal issues' including convenience, comfort, and trust in formula, and 'maternal health' including medical issues and medications, breast physiology and mental health. Themes from the formula feeding experience in hospital were: 'Supportive' elements such as midwifery care, convenience, and resources, and 'hindering' elements such as a perceived breastfeeding agenda and systemic barriers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Previous breastfeeding difficulties were a common influence on exclusive formula feeding in subsequent pregnancies, highlighting the importance of adequate support during the primary lactation/infant feeding experience. Greater comfort and confidence levels with formula feeding and a sense of trust in formula were also influential. Some maternal medications, conditions, or physiological circumstances were perceived by women as impacting breastfeeding or breastmilk, signposting the importance of antenatal screening and assessment to support women's options and decisions regarding infant feeding. A perception of professional and organisational preferences for breastfeeding over formula feeding contributed to some women feeling judged for their choice. This reminds midwives to consider the complex intersection of factors that influence infant feeding decisions and ensure all mothers are respected and fully supported.

When can I hold my baby? An audit of time to first cuddle for preterm babies (<32 weeks) pre introduction and post introduction of a Family-Integrated Care model.

AIM: The audit examined time to first cuddle between preterm babies (born < 32 weeks) and their parent pre- and post-introduction of a family-integrated care model. Secondary outcomes included time to full feeds and length of neonatal intensive care stay. BACKGROUND: Parental separation due to neonatal intensive care unit admission is known to negatively affect parental and baby wellbeing. DESIGN: A "before-after" design compared outcomes for babies admitted pre- (2015) and post (2018)-implementation of the model in a Western Australian neonatal intensive care unit. METHODS: A retrospective medical record audit included babies from two gestational age groups in 2015 and 2018, born ≤27 + 6 weeks and 28-31 + 6 weeks. SQUIRE checklist guided reporting of the audit. RESULTS: One hundred fifty-three babies were included in the audit, 79 from 2015 (≤27 + 6 weeks n = 39 and 28-31 + 6 weeks n = 40) and 74 from 2018 (≤27 + 6 weeks n = 35 and 28-31 + 6 weeks n = 39). Babies in both years were born at similar median gestational ages with comparable birthweights. Babies born ≤27 + 6 weeks in 2018 were cuddled earlier (median = 141 h old) compared with those in 2015 (median = 157 h old). Median time to reach full feeds decreased and was significant in the ≤27 + 6-week group: 288 h (12 days) in 2015 to 207.5 h (8.6 days) in 2018. Length of stay was longer for the ≤27 + 6-week gestation 2018 group (median = 64 days) and 28-31 + 6-week gestation 2018 group (median = 22 days). CONCLUSION: Family-integrated care models may decrease the time to first cuddle and full feeds. Further research on outcomes such as breastfeeding, infant weight gain and length of stay can extend existing knowledge. RELEVANCE TO CLINICAL PRACTICE: Family-integrated care models may offer benefits to families of hospitalised preterm babies and investigating barriers to its implementation and creation of solutions to overcome barriers warrants attention.

Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial.

BACKGROUND: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. OBJECTIVE: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. METHODS: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. RESULTS: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. CONCLUSIONS: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12884-015-0601-5.

Becoming a mother in the 'new' social world in Australia during the first wave of the COVID-19 pandemic.

BACKGROUND: Substantial public health measures occurred in Australian society during the COVID-19 pandemic to reduce the risk of community transmission. Little was known about the impact of these changes on childbearing women. AIM: To describe childbearing women's experiences of becoming a mother during the COVID-19 pandemic in Australia. METHODS: A qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. A total of 27 interviews were conducted with women across Australia. Data were analysed thematically. FINDINGS: The thematic analysis resulted in four primary themes and ten sub-themes. The themes were 'going it alone - having a baby was an isolating experience' ('receiving maternity care alone', 'dealing with government restrictions', and 'desiring social support'), 'advocating for self or others' ('seeking reliable information', 'valuing peersupport', and 'having to be resourceful'), 'finding a way through' ('a changed experience for all', 'managing stress and anxiety', 'requiring constant adjustments', and 'managing fear mongering'), and 'keeping safe'. CONCLUSION: Becoming a mother during the COVID-19 pandemic in Australia was a profound experience for the women. Following the public health initiatives which resulted in physical distancing restrictions, isolation, and the need to provide and receive social and peer support were common experiences. Whilst public health initiatives are implemented to keep people safe, the social and emotional toll on childbearing women should be considered by healthcare professionals. Childbearing women need to be safe but also require support and reassurance.

Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison.

INTRODUCTION: The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. METHODS: A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. FINDINGS: While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family's health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women's partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. CONCLUSION: This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders' experiences of the rapid changes to health services.

Reproductive planning, vitamin knowledge and use, and lifestyle risks of women attending pregnancy care with a severe mental illness.

OBJECTIVE: Women with severe mental illnesses are a vulnerable population and little is known about their reproductive planning needs. The aim of our study was to describe rates of unintended pregnancies, postpartum contraception, identify use and knowledge of prenatal/pregnancy vitamins and identify modifiable lifestyle risks. DESIGN: Mixed methods study incorporating a cross-sectional survey and prospective pregnancy data collection. SETTING: A multidisciplinary antenatal clinic in Australia. METHOD: Thirty-eight pregnant women with severe mental illnesses: schizophrenia, schizoaffective, bipolar and severe post-traumatic stress disorder. MAIN OUTCOME MEASURES: Unintended pregnancy rates, immediate postpartum contraception, use of prenatal and pregnancy vitamins and knowledge sources, obesity, and use and cessation rates for smoking, and substances, and comorbid medical conditions. RESULTS: Overall 42% of women had unintended pregnancy, with those with schizophrenia at most risk (56%). A long acting reversible contraception was inserted in 5 women (13%), with 45% having no immediate contraception prescribed prior to postnatal discharge. Women's main source of vitamin supplementation for pregnancy was from general practitioners. Prenatal folic acid use occurred in 37%, with rates differing for those with a diagnosis of bipolar disorder (52%) and schizophrenia (25%). Vitamin deficiencies occurred in pregnancy, with iron deficiency (ferritin <30 ng/mL) (n = 27, 73%) the most frequent. Overall 21% of women smoked cigarettes and 35% were obese. DISCUSSION: Addressing gaps in use of effective contraception, proactive reproductive planning and lifestyle management may improve outcomes for women with mental illnesses and their babies.Key pointsWomen with severe mental illnesses have complex health needs that require targeted reproductive counselling. This study adds to what is known by highlighting that:•Women with schizophrenia appear more likely to have unintended pregnancy.•Prenatal counselling for women with severe mental disorders should include recognition and optimisation of management for the high rates of pre-existing medical comorbidities, obesity and elevated nicotine and substance use.•Many women with severe mental illness need increased doses (5 mg) of prenatal folic acid due to psychotropic medication risk and obesity, as well as treatment for high rates of iron and vitamin D deficiency in pregnancy.

A cross sectional study of midwifery students' experiences of COVID-19: Uncertainty and expendability.

The impact of COVID-19 on midwifery students is anticipated to be multi-faceted. Our aim was to explore Australian midwifery students' experiences of providing maternity care during the COVID-19 pandemic. In a cross-sectional study 147 students were recruited through social media. Data were collected through an online survey and semi-structured interviews. Surveys were analysed using descriptive statistics; interviews and open text responses were interpreted through qualitative analysis. Findings revealed students found communication from hospitals and universities to be confusing, inconsistent and they relied on mass media and each other to remain updated. Moving to online learning and being isolated from peers made learning difficult. During clinical placements, students felt expendable in terms of their value and contribution, reflected in essential equipment such as personal protective equipment not always being available to them. Witnessing perceived compromised midwifery care increased students' emotional burden, while personal household responsibilities and financial concerns were problematic. One silver lining witnessed was women's appreciation of an improved 'babymoon', with fewer visitors, allowing uninterrupted time to establish breastfeeding and connection with their baby. Findings may guide management of midwifery education during future pandemics or health crises for universities and hospitals.