Immediate, uninterrupted skin-to-skin contact and breastfeeding after birth: A cross-sectional electronic survey.

OBJECTIVE: To determine the incidence of immediate, uninterrupted skin-to-skin contact and breastfeeding after birth; and which factors are associated with it. DESIGN: Cross-sectional e-survey was developed and piloted prior to distribution. Sampling was purposive and included snowball sampling. Associations between maternity care practices and the primary outcome measure were examined using logistic regression. SETTING: Australia. PARTICIPANTS: Women who birthed a term baby within the previous three years, in any Australian setting (hospital, birth centre or at home), were eligible to participate. MEASUREMENTS AND FINDINGS: 1200 postpartum women met the eligibility criteria and completed the e-survey. The primary outcome, 'pronurturance', included: (1) immediate mother/baby holding; (2) skin-to-skin contact; (3) uninterrupted holding for at least 60 min; 4) breastfeeding in the birth setting. Of 1200 participants, 22% (n = 258) experienced pronurturance. Pronurturance was less likely following caesarean section (adjusted Odds Ratio (aOR) 0.07, 95% Confidence Interval (CI) 0.03-0.17). Pronurturance was more likely with a known midwife during labour and birth (aOR 1.89, 95% CI 1.35-2.65). Contributing to the low rate of pronurturance were lack of antenatal skin-to-skin information; babies being wrapped; women wearing clothing; and non-urgent caregiver interruptions including weighing the baby or facilitating the mother to shower. KEY CONCLUSION: Health services must strategically address the institutional processes which delay and/or interrupt skin-to-skin contact and breastfeeding in birth suite and operating theatre settings. IMPLICATIONS FOR PRACTICE: Midwives and midwifery students providing continuity of carer are best placed to provide pronurturance to mothers and babies. Caregivers should educate women about pronurturance antenatally, and actively support immediate, uninterrupted mother/baby skin-to-skin contact and breastfeeding after birth.

The Milky Way educational and support programme: Structure, content and strategies.

BACKGROUND: Health professionals have put much effort into supporting women to continue breastfeeding up to six months and beyond. The majority of those efforts have not been successful for primiparous women. Primiparous women who engaged in the Milky Way Programme had an improvement in breastfeeding rates of almost 50% at six months when compared to women in a control group. PURPOSE: To provide details of the Milky Way Programme including the educational structure, content and strategies as well as the process of postnatal telephone support. OVERVIEW: The details of the Milky Way Programme are presented including a summary of literature review that was used to design the programme. The structure and content of the programme is then presented. Finally, the strategies with some practical examples are outlined in more detail. CONCLUSION: The programme is evidence-based, theoretically informed and woman-centred. This paper provides the necessary information to health professionals who are trained to educate and support breastfeeding women to implement similar programmes in their workplaces.

Midwifery students experience of teamwork projects involving mark-related peer feedback.

BACKGROUND: Lack of teamwork skills among health care professionals endangers patients and enables workplace bullying. Individual teamwork skills are increasingly being assessed in the undergraduate health courses but rarely defined, made explicit or taught. To remedy these deficiencies we introduced a longitudinal educational strategy across all three years of the Bachelor of Midwifery program. AIM: To report on students' experiences of engaging in team based assignments which involved mark-related peer feedback. METHODS: Stories of midwifery students' experiences were collected from 17 participants across the three years of the degree. These were transcribed and analysed thematically and interpreted using feminist collaborative conversations. RESULTS: Most participants reported being in well-functioning teams and enjoyed the experience; they spoke of 'we' and said 'Everyone was on Board'. Students in poorly functioning teams spoke of 'I' and 'they'. These students complained about the poor performance of others but they didn't speak up because they 'didn't want to make waves' and they didn't have the skills to be able to confidently manage conflict. All participants agreed 'Peer-related marks cause mayhem'. CONCLUSION: Teamwork skills should be specifically taught and assessed. These skills take time to develop. Students, therefore, should be engaged in a teamwork assignment in each semester of the entire program. Peer feedback should be moderated by the teacher and not directly related to marks.

Expert validation of a teamwork assessment rubric: A modified Delphi study.

BACKGROUND: Teamwork is a 'soft skill' employability competence desired by employers. Poor teamwork skills in healthcare have an impact on adverse outcomes. Teamwork skills are rarely the focus of teaching and assessment in undergraduate courses. The TeamUP Rubric is a tool used to teach and evaluate undergraduate students' teamwork skills. Students also use the rubric to give anonymised peer feedback during team-based academic assignments. The rubric's five domains focus on planning, environment, facilitation, conflict management and individual contribution; each domain is grounded in relevant theory. Students earn marks for their teamwork skills; validity of the assessment rubric is critical. QUESTION: To what extent do experts agree that the TeamUP Rubric is a valid assessment of 'teamwork skills'? DESIGN: Modified Delphi technique incorporating Feminist Collaborative Conversations. PARTICIPANTS: A heterogeneous panel of 35 professionals with recognised expertise in communications and/or teamwork. METHODS: Three Delphi rounds using a survey that included the rubric were conducted either face-to-face, by telephone or online. Quantitative analysis yielded item content validity indices (I-CVI); minimum consensus was pre-set at 70%. An average of the I-CVI also yielded sub-scale (domain) (D-CVI/Ave) and scale content validity indices (S-CVI/Ave). After each Delphi round, qualitative data were analysed and interpreted; Feminist Collaborative Conversations by the research team aimed to clarify and confirm consensus about the wording of items on the rubric. RESULTS: Consensus (at 70%) was obtained for all but one behavioural descriptor of the rubric. We modified that descriptor to address expert concerns. The TeamUP Rubric (Version 4) can be considered to be well validated at that level of consensus. The final rubric reflects underpinning theory, with no areas of conceptual overlap between rubric domains. CONCLUSION: The final TeamUP Rubric arising from this study validly measures individual student teamwork skills and can be used with confidence in the university setting.

Midwifery students' evaluation of team-based academic assignments involving peer-marking.

BACKGROUND: Midwives should be skilled team workers in maternity units and in group practices. Poor teamwork skills are a significant cause of adverse maternity care outcomes. Despite Australian and International regulatory requirements that all midwifery graduates are competent in teamwork, the systematic teaching and assessment of teamwork skills is lacking in higher education. QUESTION: How do midwifery students evaluate participation in team-based academic assignments, which include giving and receiving peer feedback? PARTICIPANTS: First and third year Bachelor of Midwifery students who volunteered (24 of 56 students). METHODS: Participatory Action Research with data collection via anonymous online surveys. KEY FINDINGS: There was general agreement that team based assignments; (i) should have peer-marking, (ii) help clarify what is meant by teamwork, (iii) develop communication skills, (iv) promote student-to-student learning. Third year students strongly agreed that teams: (i) are valuable preparation for teamwork in practice, (ii) help meet Australian midwifery competency 8, and (iii) were enjoyable. The majority of third year students agreed with statements that their teams were effectively coordinated and team members shared responsibility for work equally; first year students strongly disagreed with these statements. Students' qualitative comments substantiated and expanded on these findings. The majority of students valued teacher feedback on well-developed drafts of the team's assignment prior to marking. CONCLUSION: Based on these findings we changed practice and created more clearly structured team-based assignments with specific marking criteria. We are developing supporting lessons to teach specific teamwork skills: together these resources are called "TeamUP". TeamUP should be implemented in all pre-registration Midwifery courses to foster students' teamwork skills and readiness for practice.

A feminist critique of foundational nursing research and theory on transition to motherhood.

QUESTION: is using 'transition to motherhood theory' the best way to guide midwives in providing woman-centred care? BACKGROUND: contemporary research about changes to women's embodied sense of self during childbearing is influenced by foundational research and theory about the transition to motherhood. Rubin and Mercer are two key nursing authors whose work on transition to motherhood theory still shapes the ways in which a woman's experience of change during childbearing is understood in midwifery. METHODS: using a feminist post-structural framework, Rubin and Mercer's theory and research is described, critiqued and discussed. FINDINGS: Rubin and Mercer used pre-existing theories and concepts that had the effect of finding similarities and discarding differences between women. Rubin and Mercer's theory and research is an expression of humanistic philosophy. This philosophy creates frameworks that have an assumed, disempowered role for childbearing women. Their research used a logico-empirical, quantitative approach. Qualitative interpretive or constructivist approaches offer more appropriate ways to study the highly individualised, embodied, lived experience of a woman's changing self during childbearing. CONCLUSION: Rubin and Mercer's theory is baby-centred. Transition to motherhood theory privileges the position of experts in directing how a woman should become a mother. This has the effect of making midwives agents for the social control of women. IMPLICATIONS FOR PRACTICE: Rubin and Mercer's transition to motherhood theory is a well-intentioned product of its time. The theory is inconsistent with contemporary midwifery philosophy which promotes a woman-centred partnership between the midwife and the woman. The usefulness of this outdated nursing theory in midwifery teaching, research or practice is debatable.

Including the nonrational is sensible midwifery.

Since the subordination of midwifery by medicine and nursing in the 19th and 20th centuries the standard approach to childbirth has been dominated by rationality. This approach proceeds by creating dichotomies and then prioritising one half of the dichotomy whilst rejecting the opposite term. Rationality itself is prioritised, for example, by contrasting it with the rejected opposite: irrationality. Expert clinical practice is, however, increasingly identified as being inclusive of more than merely rational ways of knowing and behaving. This paper is based on a post-structural study concerning changes to women's embodied sense of self during childbearing. We expose the limitations of pure rationality in the context of childbirth and use the concept of safety to exemplify the limitations that pure rationality imposes. The paper draws on philosophical and spiritual theory to present an analysis of ideas about mind, body, soul and spirit. The standard rational/irrational dichotomy is critiqued and contrasted with the embodied reality of nonrational experiences that are individual, contextual and 'in-the-moment'. Nonrational experiences are identified to be inclusive of power and knowledge that are both rational and nonrational. This revised conceptualisation provides a theoretical basis that allows for and promotes more possibilities and thus more holistic ways of knowing in midwifery. Our thesis is that midwives and women need to take conscious account of nonrational knowledge and power during the childbearing year. We argue that pure rational thinking limits possibilities by excluding the midwife's embodied ways of knowing along with the ways of knowing embodied by the woman. The inclusion of women's and midwives'nonrational ways of knowing in childbearing situations opens us up to knowledge and power that provides for a more complete, and therefore a more optimal, decision-making process.