Search

Oral language is the primary means through which a child controls, describes, organises, and evaluates their life experiences and their ability to use oral language which effectively impacts their future literacy development. Currently, the world is awash with dynamic change and constant disruption. These include natural disasters such as the ongoing Australian floods and bush fires, droughts, the global COVID-19 pandemic, the pervasive use of digital technologies, continuing global unrest, and impacts on economic and social adversity. Many of these disruptions are having a negative impact on the development of children's oral language and ongoing communication capacities. This is interesting given the prioritisation in many western nations, including Australia, of learning to read and write over learning to talk and communicate. This paper serves as an example of what makes good classroom literacy research. It outlines the elements of robust research including a research proposal structure. In this instance, our research investigates educator perceptions of children's developing oral language and communication skills and practices in birth to 8-year-old education contexts within the current backdrop of extreme disruption. The paper includes a literature review, our proposed research methodology which includes interviews from participants in birth to 8-year-old education settings, in both national and global contexts sourced via snowball sampling. The data analysis uses Fairclough's Critical Discourse Analysis (CDA) of the contextualised interview responses from educators within a socio-cultural global malaise of disruption and power. We outline future plans and funding sources, including publications and potential school resources in the spirit of collegial cooperation to support excellence in literacy classroom research. [ABSTRACT FROM AUTHOR]

The views expressed here are based on my professional experience as a consultant obstetrician, and previous role as clinical head of service for a small (<1800 births/year) obstetric unit in Perth metro. The obstetric unit in which I work has no 24/7 on‐site staffed theatre capacity, no high dependency unit, and at night is staffed by a resident medical officer and junior obstetric registrar, with a consultant on‐call within 30 min travel time. Based on my review of the literature on obstetric services nationally and various state guidelines (see Sources section), other Australian metro‐located obstetric services appear to have similar challenges, but in this paper I focus on the health service models and patient safety systems that I am most familiar with (Perth metro) and ask why obstetric services in this, and by inference, other areas of the country which have similar high population density, would continue to have these staffing/service profiles. [ABSTRACT FROM AUTHOR]

The tight link between childbearing and being married has substantially unraveled in recent decades. This paper documents the extent to which this unraveling has occurred in Australia. It examines current levels of ex-nuptial births and the steep increase in such births. The link between ex-nuptial births on the one hand and maternal age and ethnicity on the other are explored. Accompanying the rise in ex-nuptial births has been a rise in lone- parent families. The paper examines the extent to which this rise is due to parental separation and the extent to which it is due to unpartnered mothers having children. The paper also explores whether children born to cohabiting but unmarried parents experience a greater rate of parental separation than do those born to married parents. Data are also provided that suggest that the sharp rise in ex-nuptial births has taken place within a social context in which such births are increasingly accepted. [ABSTRACT FROM AUTHOR]

Childcare within Australia has undergone significant reform as a result of the implementation of the nationally mandated Belonging, Being and Becoming: The Early Years Learning Framework [EYLF] (Department for Education, Employment and Workplace Relations [DEEWR]. 2009. Belonging, Being and Becoming. The Early Years Learning Framework for Australia. Canberra: Australian Government Department of Education, Employment and Workplace Relations). The EYLF articulates contemporary perspectives of the child through its principles, practices and learning outcomes. Educators are required to promote these principles, practices and learning outcomes with children aged from birth to 5 years. This paper reports the findings from a research project that sought to investigate how educators applied their understanding of learning outcome two of the EYLF (children are connected with and contribute to their world). The focus of this research was educators working with children aged two to three years within childcare centres operating on school sites, in metropolitan Western Australian. The research design was qualitative and situated within the interpretivist paradigm. Observations were used as the method for gathering data and these were analysed through a process of coding. This paper presents the observational findings of educators' practices within learning outcome two. Composite vignettes from the voice of the child are included to present the observational findings. In centralising the voice of the child, contemporary perspectives are made explicit. [ABSTRACT FROM AUTHOR]

Background. Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. Aim. To integrate the findings of the current literature on the phenomenon of freebirthing, asking the question: ‘Why do some women choose to freebirth?' Design. A metasynthesis was carried out based upon Noblit and Hare’s (1988) meta-ethnography. Searches were carried out in March 2013 and updated in March 2014 using 15 key databases. Inclusion criteria were applied: primary qualitative work, in English, focusing upon women who had freebirthed intentionally. A quality appraisal was carried out. This paper reports the findings from international studies, as there were no studies based on a UK population. Findings and key conclusions. Four studies were found that incorporated data collected from 272 women. The studies identified were based in the US (n=3) and in Australia (n=l). Four key themes were generated: rejection of the medical and midwifery models of birth; faith in the birth process; autonomy; and agency. There was a prevailing sense of opting to freebirth in order to retain choice, control and autonomy over their bodies during the birth process. Implications for practice. For some, within their particular context of maternity provision, the biomedical model of childbirth is clearly not acceptable, therefore, it is important practitioners identify and address women's bio-psychosocial needs. Even the midwifery model of childbirth is apparently not satisfactory, suggesting the gulf between the midwifery philosophy of care and that which is currently practised needs attention. For some women, a previous negative experience with maternity care provision motivated their decision to freebirth. It is, therefore, important that maternity service providers improve the quality of care provision so women feel dignified, supported, and are participatory in the care that they receive. A UK-based study is being undertaken in order to establish the motivations of women who choose to freebirth in the UK. [ABSTRACT FROM AUTHOR]

Objective: Although there is some research on women's choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia. Methods: This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman's choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson's Chi-squared test was used to compare public and private births for multiple variables. Binary logistic regression was used to determine the odds ratio for each potential factor based on whether participants with private health insurance (PHI) elected to birth in the public or private regional hospitals. Open coding was used to group responses to open ended questions into themes. Results: Data from 510 questionnaires were analysed. The three most frequently reported factors influencing a woman's decision about birthplace were financial reasons, the ability to choose their doctor and not having PHI. Women with PHI who opted for birth in the public system were almost four-fold more likely to select access to intensive care services and 2.6-fold more likely to select a preference for a low-intervention birth as one of their top five most influential factors. The results highlight that women want access to midwifery continuity of care. Conclusion: This study provides insights into the factors influencing a woman's complex decision about where and with whom to birth and how health insurance affects that decision, an area where there is a paucity of peer-reviewed literature. This research highlights the importance of being able to choose one's doctor and the desire for access to midwife-led models of care, and provides evidence to advocate for improved access to additional models of care in the private sector. What is already known?: The viability of regional private maternity hospitals is in question because, once the birth rate goes below a certain threshold, providing private obstetric service becomes unviable. Closure of regional private hospitals means less choice in regional areas. Minimal information is available about the factors influencing a woman with PHI to give birth in the public system, and much of the evidence is anecdotal. What does this paper add?: This study provides insight into how PHI status and other factors influence a woman's decision to birth in the public versus private sector, an area where there is a paucity of peer-reviewed literature. It also highlights a desire from women for access to midwifery continuity of care in the private system. What are the implications for practitioners?: This research provides evidence to advocate for improved access to additional models of care, especially for midwifery-led care in the private sector. [ABSTRACT FROM AUTHOR]

Background: In Australia, between the years 2010 and 2014, over 4500 adolescents and young adults (15–25 years old) were diagnosed with cancer. Treatment regimens are often gonadotoxic and are well known to induce ovarian and testicular failure. Oncofertility is an emerging discipline in obstetrics and gynaecology which seeks to preserve and restore the reproductive future of cancer patients. Aim: To perform a systematic literature review to assess the current fertility preservation techniques available to patients and examine access and uptake of fertility preservation in Australia. Materials and Methods: Electronic databases, including Medline, Cochrane Review, SCOPUS and CINHAL, were searched for peer‐reviewed publications and national guidelines examining oncofertility practices from 2008 to July 2018. Three hundred and seventy‐five articles were initially screened, with 158 articles for full text review and an additional five clinical guidelines were identified. Results: There is a paucity of Australian data on oncofertility with <50% of data included for analysis reflecting the Australian experience. The majority of primary research included retrospective papers with small cohort numbers. Key areas addressed included live birth outcomes, uptake of services and patient and physician perspectives on fertility preservation. Few articles sought to examine the positive and negative side effects of fertility preservation in oncology, social challenges of oncofertility and access to services worldwide. Conclusion: Oncofertility is an emerging discipline which seeks to provide safe, efficient and effective fertility preservation options for young adults and adolescents diagnosed with cancer. A multi‐disciplinary approach with collaborative communication with oncologists is key to providing this service within Australia. [ABSTRACT FROM AUTHOR]

Although he was not the first scholar to investigate it, there is little question that the Ph.D. research of Alan Gray, completed in 1983, represented a landmark in the study of Indigenous fertility in Australia. Convinced that 'Aboriginal' fertility had fallen rapidly through the 1970s, Gray set out to document and explain the decline. Weaving through a maze of sub-optimal census data he produced a series of age-specific and total fertility rates, refined by three broad geographic location categories, for 5-year periods from 1956–1961 to 1976–1981. These he subsequently updated to also include 1981–1986 and the 10-year period 1986–1996 as new census children-ever-borne data became available. He would doubtless have extended his series further had he lived to do so. For years his fertility estimates were graphed in the annual ABS publication Births Australia as the Bureau began publishing registration-based Indigenous fertility estimates from the late 1990s, but Indigenous birth registration data and fertility estimates based thereon remain to this day problematic in several respects. This paper summarises Alan Gray's work, extends his Indigenous fertility estimates to the 2011–2016 intercensal period, and examines the results against registration-based estimates that have been subjected to (a) regular retrospective revision (in light of data processing flaws and substantial errors of closure in intercensal Indigenous population increments), and (b) the vagaries of significant late registration, and periodic registry efforts to clear backlogs of unregistered Indigenous births. [ABSTRACT FROM AUTHOR]

This paper introduces the concept of the ‘age-profile’, which represents the proportions of cohort populations surviving from birth to a given year. Life tables for Australia and three-dimensional diagrams based on these data are used to illustrate the difference between the ‘age-profile’ values for a given year and the transverse survival values for the same year. The last part of the paper describes areas in which the ‘age-profile’ might be used with reference to its value in representing the experience of cohorts. [ABSTRACT FROM PUBLISHER]

INTRODUCTION Recent research highlights that women experience great benefits from immersing in warm water during labor and birth. While there has been an increase in research examining women's experiences of using water, there has been little investigation of the views and perceptions of women who have not. The objective of this study was to examine the views and perceptions of water immersion from women who had birthed in Australia but had not used the option. METHODS An e-survey was distributed to women using purposive and snowball sampling methods between November 2016 and October 2017. Email, text, social media, and parenting forums maximized recruitment. A total of 395 women who had not used water immersion for labor or birth participated. RESULTS Three quarters of all women surveyed suggested that they would have considered using the option of water immersion if it was offered to them. Nearly 20% of all women did not know it was an option and, therefore, were only made aware of it as a result of completing this survey. Women indicated that they most often learned about water immersion from a midwife. When asked to rate the benefits and concerns, the majority held very little concern and generally agreed that water immersion would probably provide the associated benefits that are commonly cited in the literature. CONCLUSIONS Water immersion offers women many benefits although may not always be discussed antenatally. In light of these results, water immersion could be included in the discussions about labor and birth options antenatally and better supported during labor and birth. [ABSTRACT FROM AUTHOR]

Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Little is known about how the physical design of a birthing unit can influence the experiences of labour and birth for women, their supporters and midwives. We proposed that an interdisciplinary approach (disciplines of midwifery, architecture, design, communication and public health) was likely to be the most effective way to better understand the complexities and interactions of design, behaviour, communication and experiences. In this methodological paper we aim to provide a roadmap that other researchers may find helpful when considering the use of video as a data collection technique, especially in the study of the powerful and intimate setting of childbirth. The paper also outlines our process for engaging both researchers and participants in reviewing video footage with the aim to contribute multiple perspectives to the analysis process. [ABSTRACT FROM AUTHOR]

Objectives: This study examines involvement with a range of complementary and alternative medicine (CAM) during pregnancy on the use of pharmacologic (PPMT) and nonpharmacologic (NPMT) pain management techniques for labor and birth. Design: Longitudinal analysis of survey data. Participants: A substudy ( n=2445) of the 'young' cohort of the nationally representative Australian Longitudinal Study on Women's Health was conducted. Outcome measures : Use of PPMT and NPMT during labor and birth. Results: The survey was completed by 1835 women (response rate, 79.2%). Most respondents used either intrapartum PPMT (81.9%) or NPMT (74.4%). Many (60.7%) used some form of CAM during pregnancy and also used PPMT during birth. More than two thirds of women (66.7%) who used NPMT used CAM during pregnancy. There was a general trend of increased likelihood of NPMT use by women who applied CAM during pregnancy. There was an inverse effect on use of epidural analgesia for women who consumed herbal teas during pregnancy (odds ratio, 0.60). Conclusions: Because of the study design, this paper does not confirm a causative relationship between the use of CAM during pregnancy and intrapartum pain management choices. It does, however, indicate that the use of CAM during pregnancy may not significantly affect the uptake of intrapartum PPMT, despite possible attempts to reduce PPMT by using NPMT. It also highlights the possibility of potential interactions between CAM and PPMT, given the high prevalence of concomitant use. [ABSTRACT FROM AUTHOR]

Abstract: Evidence supporting the practice of skin‐to‐skin contact and breastfeeding soon after birth points to physiologic, social, and psychological benefits for both mother and baby. The 2009 revision of Step 4 of the WHO/UNICEF “Ten Steps to Successful Breastfeeding” elaborated on the practice of skin‐to‐skin contact between the mother and her newly born baby indicating that the practice should be “immediate” and “without separation” unless documented medically justifiable reasons for delayed contact or interruption exist. While in immediate, continuous, uninterrupted skin‐to‐skin contact with mother in the first hour after birth, babies progress through 9 instinctive, complex, distinct, and observable stages including self‐attachment and suckling. However, the most recent Cochrane review of early skin‐to‐skin contact cites inconsistencies in the practice; the authors found “inadequate evidence with respect to details … such as timing of initiation and dose.” This paper introduces a novel algorithm to analyse the practice of skin to skin in the first hour using two data sets and suggests opportunities for practice improvement. The algorithm considers the mother's Robson criteria, skin‐to‐skin experience, and Widström's 9 Stages. Using data from vaginal births in Japan and caesarean births in Australia, the algorithm utilizes data in a new way to highlight challenges to best practice. The use of a tool to analyse the implementation of skin‐to‐skin care in the first hour after birth illuminates the successes, barriers, and opportunities for improvement to achieving the standard of care for babies. Future application should involve more diverse facilities and Robson's classifications. [ABSTRACT FROM AUTHOR]

In contemporary Western society, the concept of risk is mostly linked related to negative or undesirable outcomes and used to explain unusual or abnormal events that have harmful consequences. Working in a poststructuralist framework, in this article we examine how risk shapes interactions between midwives and pregnant women in the context of public hospitals in Australia. We draw on data from an observational study of clinical encounters in three Australian hospitals between October 2014 and July 2015. The research teams recorded 83 health encounters and in this paper we draw on data from the recordings of 10 clinical consultations between 8 midwives and 10 pregnant women at various stages of gestation. We used these data to explore how a discourse of risk was mobilised through rhetorical strategies and practices of ‘hunting’ for the abnormal and attempts to control the body. Our findings demonstrate how a discourse of pregnancy and birth as risky operates within public hospital midwifery consultations. We found that in the midwifery consultations we recorded, pregnancy was constructed as a period of vulnerability and unpredictability. It was normalised through discursive practices of hunting for the abnormal and rhetorical strategies of attempting to control the body. Within this discourse, midwives occupied conflicting positions. They asserted that women, with the right support, were capable of spontaneous and intervention-free (pregnancy and) birth. Yet, they acted to enable medical professionals to assess a woman’s ability to give birth (un)assisted, or the potential for an adverse event. The women, while positioned as passive within the public health system, were positioned as active in surveilling themselves and responsible for taking steps to mitigate against adverse events. [ABSTRACT FROM PUBLISHER]

Background: Reduced length of hospital stay following childbirth has placed increasing demands on community-based post-birth care services in Australia. Queensland is one of several states in Australia in which nurses are employed privately by pharmacies to provide maternal and child health care, yet little is known about their prevalence, attributes or role. The aims of this paper are to (1) explore the experiences and perspectives of a sample of pharmacy nurses and GPs who provide maternal and child health services in Queensland, Australia (2) describe the professional qualifications of the sample of pharmacy nurses, and (3) describe and analyze the location of pharmacy nurse clinics in relation to publicly provided services. Methods: As part of a state-wide evaluation of post-birth care in Queensland, Australia, case studies were conducted in six regional and metropolitan areas which included interviews with 47 key informants involved in postnatal care provision. We report on the prevalence of pharmacy nurses in the case study sites, and on the key informant interviews with 19 pharmacy nurses and six General Practitioners (GPs). The interviews were transcribed and analysed thematically. Results: The prevalence of pharmacy nurses appears to be highest where public services are least well integrated, coordinated and/or accessible. Pharmacy nurses report high levels of demand for their services, which they argue fill a number of gaps in the public provision of maternal and child health care including accessibility, continuity of carer, flexibility and convenient location. The concerns of pharmacy nurses include lack of privacy for consultations, limited capacity for client record keeping and follow up, and little opportunity for professional development, while GPs expressed concerns about inadequate public care and about the lack of regulation of pharmacy based care. Conclusions: Pharmacy based clinics are a market-driven response to gaps in the public provision of care. Currently there are no minimum standards or qualifications required of pharmacy nurses, no oversight or regulation of their practice, and no formal mechanisms for communicating with other providers of postnatal care. We discuss the implications and possible mechanisms to enhance best-practice care. [ABSTRACT FROM AUTHOR]

This paper explores the timing of mothers' return to work using data from the 2005 Parental Leave in Australia Survey (PLAS), which was nested in Wave 1.5 of the Longitudinal Study of Australian Children (LSAC). The analyses explore differences in timing of return to work, within 18 months after a birth, according to mothers' use of leave and employment before the birth of their child. Results showed that having worked before the birth was a strong predictor of timing of return after the birth. For those who were employed, those who used no leave had a relatively slow return to work, while among those who used leave, whether leave was paid, unpaid or a combination of paid and unpaid did not result in large differences in the likelihood of a mother returning to work by 18 months after the birth. Women who used only paid leave had a slightly higher rate of return to work than those who used unpaid leave, either on its own or in combination with paid leave. There were larger differences in timing of return within this 18-month period. [ABSTRACT FROM AUTHOR]

This paper examines Australian fathers' use of leave at the time of the birth of a child, drawing on data from The Parental Leave in Australia Survey, conducted in 2005, and a subsequent organizational case study. Our analysis shows that although most Australian fathers take some leave for parental purposes, use of formally designated paternity or parental leave is limited. This is unsurprising given the Australian policy framework, which lacks legislative provision for paid paternity or parental leave, and does not require any of the shared unpaid parental-leave entitlement to be reserved for fathers. Use of leave is shown to be influenced primarily by fathers' employment characteristics, with those working in small organizations or non-permanent positions least likely to utilize paternity or other forms of leave. Overall, the analysis suggests that improvements in the policy framework would increase Australian fathers' propensity to take parental leave, but highlights barriers to usage associated with labour market divisions and career pressures that will not be solved solely by the adoption of more progressive leave policies. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of primary midwife-led care ('caseload midwifery') on women's experiences of childbirth.Design: Randomised controlled trial.Setting: Tertiary care women's hospital in Melbourne, Australia.Population: A total of 2314 low-risk pregnant women.Methods: Women randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a 'back-up' midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care.Main Outcome Measures: The primary outcome of the study was caesarean section. This paper presents a secondary outcome, women's experience of childbirth. Women's views and experiences were sought using seven-point rating scales via postal questionnaires 2 months after the birth.Results: A total of 2314 women were randomised between September 2007 and June 2010; 1156 to caseload and 1158 to standard care. Response rates to the follow-up questionnaire were 88 and 74%, respectively. Women in the caseload group were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22-1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain.Conclusions: Compared with standard maternity care, caseload midwifery may improve women's experiences of childbirth.Tweetable Abstract: Primary midwife-led care ('caseload midwifery') improves women's experiences of childbirth. [ABSTRACT FROM AUTHOR]

Since the 1971 Census, the Australian Aboriginal and Torres Strait Islander (Indigenous) population has grown faster than predicted by births, deaths and migration. An important and likely source of this unexplained growth is identification change, where a person changes how they identify or are identified by the household between one census and the next. In this paper, we use the Australian Census Longitudinal Dataset to detect identification change between 2006 and 2011 and include this information in a multistate population projection model. The projection model is applied to Australia, New South Wales and the Northern Territory over the period 2011-2061. The results indicate that identification change, particularly in the youngest age groups (0-9 years), had a positive impact on Indigenous population growth between 2006 and 2011. The projected Indigenous population initially grows faster than otherwise due to a net increase in people identifying as Indigenous, but slows as it interacts with the slow-growing non-Indigenous population. The results also suggest that the way in which identification change is modelled substantially affects projected trajectories, particularly in areas where identification change is substantial. While demographic modelling would benefit from further multidisciplinary research on the drivers and populations at risk of Indigenous status change, this study underscores the importance of incorporating identification change to improve projections of the Indigenous population in Australia. [ABSTRACT FROM AUTHOR]

INTRODUCTION Perineal trauma is a commonly observed complication of childbirth, affecting more than 75% of women who have a vaginal birth. Perineal trauma is associated with significant short- and long-term comorbidities that negatively impact women’s quality of life. Severe perineal trauma (SPT) rates in Australia have almost doubled in the last decade. Reasons for increased rates are not completely understood; some researchers suggest improvements in diagnosis and reporting, while others have a view that it may be due to a lack of structured and standardized education in perineal wound assessment and repair for clinicians. METHODS The Joanna Briggs Institute (JBI) scoping review methodology was adopted as a systemic process to identify studies that have investigated the effectiveness of perineal wound assessment and repair education and training for midwives and midwifery students. RESULTS Five studies met the inclusion criteria for this review, to have evaluated a type of education or training, on childbirth-related perineal wound assessment and repair that included midwives and midwifery students. A total of 1279 midwives and midwifery students volunteered to participate in all five studies. The length of the education or training implemented varied between each study from a 1-day workshop to 100 hours of education. All five studies measured the effectiveness of each program through changes in participants’ confidence, knowledge and skills in perineal assessment and repair before and after an intervention using various self-assessment questionnaires. CONCLUSIONS The implementation of a structured educational workshop on perineal wound assessment and repair improves the confidence, skills and knowledge of midwives and students. [ABSTRACT FROM AUTHOR]

Aim: To develop and psychometrically test the Australian Midwifery Workplace Culture instrument. Background: Workplace culture is critical within midwifery settings. Culture determines not only the well‐being and continued retention of maternity staff and managers but it also affects the quality and ultimate safety of the care they provide to women, infants and families. Several studies have identified cultural problems within maternity services. Relatively few instruments take account of the unique aspects of these workplaces and the relationship between midwives and women. Design Three‐stage instrument development involved item generation (based on the Culture of Care Barometer), expert content validation and a pilot test. Methods: During 2016, 38 midwifery experts reviewed the initial items, and 322 midwives then pilot‐tested the draft instrument. We used exploratory factor analysis to identify key domains and to refine the instrument. Results: The refined instrument contained 22 items in three distinct domains: relationship with managers, empowerment and collegiality. Conclusion: The instrument can contribute to understanding important dimensions of the culture in maternity workplaces and thus to examining problematic attitudes and practices. The instrument requires further development and testing with larger and more diverse samples of midwives and validation in specific midwifery settings and models of care. SUMMARY STATEMENT: What is already known about this topic? Previous research reports problems in the organizational culture in maternity services, increasing the stress on midwives and potentially affecting the care they provide to women and infants.Negative workplace culture may contribute to attrition in maternity workforce.There are few measures that specifically address midwifery workplace culture. What this paper adds? This paper presents a new instrument designed to measure dimensions of midwifery workplace culture, detailing item generation and pilot testing.Analysis identified three domains that demonstrated good psychometric properties: relationship with management; empowerment and autonomy; collegiality and relationship with peers. Implications of this paper: The exploratory factor analysis suggests the utility of this instrument for assessing workplace culture in midwifery settings.The study recommends further testing of this instrument and validation in diverse midwifery workplaces, including large and small hospitals, community services and rural and remote areas. [ABSTRACT FROM AUTHOR]

With an unprecedented number of children in early childhood education and care in Australia, demand for early childhood teachers is increasing. This demand is in the context of recognition of the importance of the early years and increasing requirements for more highly qualified early childhood teachers under the National Quality Framework. Increasingly, evidence shows the value-added difference of university-qualified teachers to child outcomes. Within Australia there are multiple ways to become an early childhood teacher. Three common approaches are a 4-year teaching degree to teach children aged birth to 5 years, children aged birth to 8 years, or children aged birth to 12 years. There is, however, no evidence of how effective these degree programmes are. This paper presents the perspectives of 19 employers of early childhood teachers in New South Wales regarding how well prepared early childhood teacher graduates are to work in the early childhood sector in Australia. Although participants noted the strengths of new graduate early childhood teachers, they also identified several areas in which they were less well prepared to teach in the early years. [ABSTRACT FROM AUTHOR]

Objective: To examine the associations of pregnant women's dietary and sedentary behaviours with their children's birth weight. Design: Secondary data analysis was conducted using data from a randomised controlled trial, Communicating Healthy Beginnings Advice by Telephone, conducted in Australia. Information on mothers' socio-demographics, dietary and sedentary behaviours during pregnancy was collected by telephone survey at the third trimester. Birth weight data were extracted from the child's health record book. Multinomial logistic regression models were built to examine the associations of pregnant women's dietary and sedentary behaviours with children's birth weight. Setting: Participating families. Participants: Pregnant women and their children. Results: A total of 1132 mother–child dyads were included in the analysis. The majority of infants (87 %, n 989) were of normal birth weight (2500 g to <4000 g), 4 % (n 50) had low birth weight (<2500 g) and 8 % (n 93) had macrosomia (≥4000 g). Mothers who ate processed meat during pregnancy were more likely to have macrosomia (adjusted risk ratio (ARR) 1·80, 95 % CI (1·12, 2·89)). The risk of macrosomia decreased as the number of dietary recommendations met by mothers increased (ARR 0·84, 95 % CI (0·71, 0·99)). Children's birth weight was not associated with mothers' sedentary time. Children's low birth weight was not associated with mothers' dietary and sedentary behaviours during pregnancy. Conclusion: Maternal consumption of processed meat during pregnancy was associated with an increased risk of macrosomia. Increasing number of dietary recommendations met by mothers was associated with a lower risk of macrosomia. The findings suggested encouraging pregnancy women to meet dietary recommendation will benefit children's birth weight. [ABSTRACT FROM AUTHOR]

The goldrush colony of Victoria, Australia, was a favoured destination for aspirational emigrants from nineteenth-century Britain. Yet the persistence of high rates of infant mortality blighted the happiness of many first and second generation immigrant families alone in a new land. Drawing on birth, death and inquest records this paper interrogates the experience of infant death amongst the poorest families in the capital city popularly known as 'Marvellous Melbourne' during the second half of the nineteenth century. Although few infants died alone, the familial and community networks in which they were enmeshed were not always committed to their survival. While the paper argues that there was a hierarchy of value which determined the degree to which the death of a child would be welcomed or mourned, it also contests popular notions that evil baby farmers and unfeeling mothers were a major cause of infant death. ☆ This paper derives in part from research undertaken for a project funded by the Australian Research Council. The author would like to acknowledge the contribution of co-researchers Professors Janet McCalman and Ruth Morley, and research assistants Cecile Trioli and Jo Townsend. [ABSTRACT FROM AUTHOR]

Current Australian maternity policy, while fragmented and uneven, is moving in new directions. Alliances between consumers, sympathetic health professionals and bureaucrats have placed the objectives of improving women's choices, increasing their control over decision-making and providing continuity of care firmly on the agenda. The state arena is a central space for articulating such demands and policy support has been critical to implementing changes in service delivery. Along with steps forward, though, steps sideways and backwards indicate the contingent character of the late modern state as it responds to social changes at the same time as advancing particular political goals. This paper argues that impediments towards making services more 'women-friendly' lie not only in the historical location of childbirth management in the medically-driven acute sector but in contemporary neoliberal political and economic pressures that both promote and yet constrain change. Research in selected Victorian hospitals suggests that desirable goals are compromised by working realities in contemporary public hospitals. Political mobilisation in the community and around the state remain necessary to encourage further change in childbirth management, but continuing critical assessment of the structural context and human challenges of maternity reform is also essential. [ABSTRACT FROM AUTHOR]

Objective: To understand factors associated with successfully conducting longitudinal studies across early childhood by (i) describing the designs of Australian and New Zealand birth cohort studies; (ii) describing the breadth of variables studied; and (iii) identifying factors influencing study quality, productivity and contributions.Methods: A systematic review was undertaken of 13 birth cohort studies. Data were collected from published papers and questionnaires administered to study investigators.Results: These single cohort studies recruited children prior to their first birthday. Using an ecological model as an organizing framework, the studies were found to have contributed to knowledge about health and development in multiple domains and well beyond early childhood. Areas for increased focus included policy-relevant environmental factors such as child-care and rural/urban differences, and the influence of fathers, family factors, peers, social competence, and genetic factors. Investigators' responses indicated desires for an increased depth of data collection and stronger sampling designs. Data quality was enhanced by maintaining skilled staff and reduced by inadequate data for tracking study participants. Productivity ranged from 1 to 760 publications per study (median = 14.0). The most productive studies were those that had started before 1990, had representative samples, ongoing funding, and larger research teams. Policy impacts have included changed infant sleeping practices, reduced environmental lead emissions and regulated swimming pool safety standards.Conclusions: A suite of coordinated and nested studies could meet sampling needs and facilitate depth of inquiry. Stable, long-term funding is required to staff and maintain well-designed longitudinal studies that can address priority research areas and contribute to the development of health and social policy. [ABSTRACT FROM AUTHOR]

Introduction: Current Australian guidelines differ in their recommendations on optimal iron deficiency anaemia screening and management during pregnancy. A more active approach to screening and treatment of iron deficiency in pregnancy has been beneficial within a tertiary population. However, this approach has not been evaluated within a regional healthcare setting. Objective: To evaluate the clinical impact of standardised screening and management for iron deficiency in pregnancy within a regional Australian centre. Design: Single centre, retrospective cohort observational study that audited medical records pre and post implementation of standardised screening and management for antenatal iron deficiency. We compared rates of anaemia at birth, rates of peripartum blood transfusions and rates of peripartum iron infusions. Findings: There were 2773 participants with 1372 participants in the pre‐implementation group and 1401 in the post‐implementation group. Participant demographics were similar. Anaemia at admission for birth decreased from 35% to 30% (RR 0.87, 95% CI (0.75, 1.00), p 0.043) Fewer blood transfusions were required (16 (1.2%) pre‐implementation, 6 (0.4%) post‐implementation, RR 0.40, 95% CI(0.16, 0.99), p 0.048). Antenatal iron infusions increased from 12% to 18% of participants post implementation (RR 1.47, 95% CI(1.22, 1.76), p 〈0.001).We audited compliance with the guidelines and found improvements post implementation. Discussion: This is the first study to show clinically useful and statistically significant reduction in rates of anaemia and blood transfusions, post implementation of routine ferritin screening and management within a regional Australian population. Conclusion: The results of this study suggest there is benefit to implementation of standardised ferritin screening and management packages in Australian antenatal care. It also encourages RANZCOG to review current recommendations on screening for iron deficiency anaemia during pregnancy. [ABSTRACT FROM AUTHOR]

Abstract This paper discusses the perceptions and experiences of Hmong women, who are now living in Australia, in regard to childbirth, h is based on an ethnographic study of reproductive health among Hmong women in Australia. In general, Hmong women were satisfied with care received during pregnancy, birth and postpartum period. However, the women also had many difficulties during these periods, due largely to the different systems of cultural beliefs and practices related to childbearing. Issues related to communication also presented problems, as women could not speak English proficiently. The results indicate that health professionals in birthing services need to acknowledge cultural diversity as well as variability among women, for individual circumstances present important differences in terms of the care needed. [ABSTRACT FROM AUTHOR]

We use the 1 July 2004 introduction of the Australian Baby Bonus to identify the effect of family income on child test scores at grade three. Using a difference‐in‐differences design, we find no evidence that the Baby Bonus improved child outcomes in aggregate, but some evidence of a modest effect for children from disadvantaged backgrounds. We examine whether birth shifting associated with the Baby Bonus and two other Australian maternity payments had negative long‐term effects on children. Despite widespread concerns about this unintended treatment, regression discontinuity estimates provide no clear evidence of lasting health or educational consequences. [ABSTRACT FROM AUTHOR]

This paper examines the current fertility (1971–72) of migrant women in Australia, in order to compare the fertility levels and patterns prevalent among migrants from nine selected countries with those of the Australian born women. Birth registration data have been mainly used in the analysis.Three main points emerge. Among the married women there were few differences in fertility regardless of the country of birth. A major exception was the somewhat higher fertility levels among the southern European migrants. Extramarital fertility seemed to vary substantially between different migrant groups: New Zealanders had the highest and the Italians and Greeks had the lowest levels. There were major differences in the proportion of women married among the various migrant groups; again the southern Europeans had highest proportions married. Comparison of the reproductive behaviour of migrants with their counterparts in the countries of origin showed that the southern European migrants in Australia had higher fertility rates than those prevalent in their countries of origin. [ABSTRACT FROM PUBLISHER]

Background: Cohort studies may increase or decrease their selection bias as they progress through time. The Western Australian Pregnancy Cohort (Raine) Study has followed 2868 children for over two decades; from fetal into adult life. This paper analyses the cohort over time, assessing potential bias that may come and go with recruitment, retention and loss of participants.Methods: Linked data from all births in Western Australian over the 3 years the Raine Cohort was recruited were obtained to compare perinatal characteristics and subsequent health outcomes between the Western Australian (WA) contemporaneous birth population and the Raine Cohort at five time points. Perinatal exposure-outcome comparisons were employed to assess bias due to non-participation in Raine Study subsets.Results: There were demographic differences between the Raine Study cohort and its source population at recruitment with further changes across the period of follow up. Despite these differences, the pregnancy and infant data of those with continuing participation were not significantly different to the WA contemporaneous birth population. None of the exposure-outcome associations were significantly different to those in the WA general population at recruitment or at any cohort reviews suggesting no substantial recruitment or attrition bias.Conclusions: The Raine Study is valuable for association studies, even after 20 years of cohort reviews with increasing non-participation of cohort members. Non-participation has resulted in greater attrition of socially disadvantaged participants, however, exposure-outcome association analyses suggest that there is no apparent resulting selection bias. [ABSTRACT FROM AUTHOR]

Little is known of subjective experiences of birthing during the first-phase SARS- CoV-2 (COVID-19) lockdown. Semi-structured interviews explored birthing experiences, returning home, and perceived mother-infant bonds overlaid by COVID-19 restrictions. Interpretative phenomenological analysis revealed two superordinate themes from the data: 1) COVID lockdown and childbirth, and 2) Growth and connection. Rich data sets highlighted a deep sense of fear, loss, isolation, and hypervigilance associated with life threats, disrupted medical care, and banned familial support for participants. Conversely, the lockdown provided recovery and bonding opportunities within the immediate family unit, uninterrupted by visitors. Additionally, vulnerable birthing populations, including first nation peoples, need prioritizing during crises. [ABSTRACT FROM AUTHOR]

Background: Antenatal education aims to prepare expectant parents for pregnancy, birth, and parenthood. Studies have reported antenatal education teaching breathing and relaxation methods for pain relief, termed psychoprophylaxis, is associated with reduction in caesarean section rates compared with general birth and parenting classes. Given the rising rates of caesarean section, we aimed to determine whether there was a difference in mode of birth in women based on the type of antenatal education attended. Materials and methods: A cross‐sectional antenatal survey of nulliparous women ≥28 weeks gestation with a singleton pregnancy was conducted in two maternity hospitals in Sydney, Australia in 2018. Women were asked what type of antenatal education they attended and sent a follow‐up survey post‐birth. Hospital birth data were also obtained. Education was classified into four groups: psychoprophylaxis, birth and parenting, other, or none. Results: Five hundred and five women with birth data were included. A higher proportion of women who attended psychoprophylaxis education had a vaginal birth (instrumental/spontaneous) (79%) compared with women who attended birth and parenting, other or no education (69%, 67%, 60%, respectively P = 0.045). After adjusting for maternal characteristics, birth and hospital factors, the association was attenuated (odds ratio 2.03; 95% CI 0.93–4.43). Conclusions: Women who attended psychoprophylaxis couple‐based education had a trend toward higher rates of vaginal birth. Randomised trials comparing different types of antenatal education are required to determine whether psychoprophylaxis education can reduce caesarean section rates and improve other birth outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the prospective associations of neighborhood environmental exposure trajectories with asthma symptom trajectories during childhood developmental stages. Methods: We considered asthma symptom, neighborhood environmental factors, and socio-demographic data from the "Longitudinal Study of Australian Children (LSAC)". Group-based trajectory modeling was applied to identify the trajectories of asthma symptom, neighborhood traffic conditions, and neighborhood livability scales (considered for safety and facilities). We used multivariable logistic regression models to assess associations between various neighborhood environmental factors and asthma symptom trajectories. Results: We included 4,174 children from the LSAC cohort in our study. Three distinct trajectories for asthma symptom were the outcome variables of this study. Among the neighborhood environmental factors, we identified two distinct trajectories for the prevalence of heavy traffic on street, and two trajectories of neighborhood liveability scale. Compared to the 'Low/no' asthma symptoms trajectory group, children exposed to a 'persistently high' prevalence of heavy traffic on street was also significantly associated with both 'transient high' [relative risk ratio (RRR):1.40, 95% CI:1.25,1.58) and 'persistent high' (RRR: 1.33, 95% CI:1.17,1.50)] asthma symptom trajectory groups. Trajectory of moderate and static neighborhood liveability score was at increased risk of being classified as 'transient high' (RRR:1.16, 95% CI:1.07,1.25) and 'persistent high' (RRR:1.38, 95% CI:1.27,1.50) trajectories of asthma symptom. Conclusion: Exposure to heavy traffic and poor neighborhood liveability increased the risk of having an unfavourable asthma symptom trajectory in childhood. Reducing neighborhood traffic load and improving neighborhood safety and amenities may facilitate a favorable asthma symptom trajectory among these children. [ABSTRACT FROM AUTHOR]

Background: The safety of waterbirth is contested because of the lack of evidence from randomized trials and conflicting results. This research assessed the feasibility of a prospective study of waterbirth (trial or cohort). Methods: We conducted a prospective cohort study at an Australian maternity hospital. Eligible women with uncomplicated pregnancies at 36 weeks of gestation were recruited and surveyed about their willingness for randomization. The primary midwife assessed waterbirth eligibility and intention on admission in labor, and onset of second stage. Primary outcomes measured feasibility. Intention‐to‐treat analysis, and per‐protocol analysis, compared clinical outcomes of women and their babies who intended waterbirth and nonwaterbirth at onset of second stage. Results: 1260 participants were recruited; 15% (n = 188) agreed to randomization in a future trial. 550 women were analyzed by intention‐to‐treat analysis: 351 (waterbirth) and 199 (nonwaterbirth). In per‐protocol analysis, 14% (n = 48) were excluded. Women in the waterbirth group were less likely to have amniotomy and more likely to have water immersion and physiological third stage. There were no differences in other measures of maternal morbidity. There were no significant differences between groups for serious neonatal morbidity; four cord avulsions occurred in the waterbirth group with none in the landbirth group. An RCT would need approximately 6000 women to be approached at onset of second stage. Conclusions: A randomized trial of waterbirth compared with nonwaterbirth, powered to detect a difference in serious neonatal morbidity, is unlikely to be feasible. A powered prospective study with intention‐to‐treat analysis at onset of second stage is feasible. [ABSTRACT FROM AUTHOR]

A succession of interconnected environmental factors is believed to contribute substantially to the development of autism spectrum disorder (ASD). This exploratory study therefore aims to identify potential risk factors for ASD that are associated with pregnancy, birth and infant feeding. Demographic and health-related data on children aged 3–13 years (N = 4306) was collected through an online survey completed by biological mothers. A fitted logistic regression model identified advanced maternal age, prenatal bleeding, pre-eclampsia, perinatal pethidine usage, foetal distress before birth and male sex of child as associated with an increased risk of ASD, whereas longer gestational duration demonstrated a protective effect. These findings highlight potential risk factors and predictor interrelationships which may contribute to overall ASD risk. [ABSTRACT FROM AUTHOR]

This paper reviews the Australian historical record in health and gender inequalities since the mid nineteenth century through to the end of the twentieth century, using survival data from an historical cohort of impoverished people born in the Melbourne Lying-In Hospital between 1857 and 1900. This data reveals the long shadow cast by disadvantage in early life and the critical importance of secure households in supporting infancy and childhood. Above all, the income security and support of mothers, was critical to survival of infants and children, and those households trapped in the casual economy, remained the most vulnerable to premature death. Only the improvements in labour force regulation, government employment and trade education after World War II, broke the cycle of poverty that had persisted in Australia since the earliest days of European settlement. [ABSTRACT FROM AUTHOR]

Although Edwards and Steptoe achieved the first IVF pregnancy and birth in 1978, the majority of pioneering developments in IVF during the eighties came from Australia. They included the world's first donor egg pregnancy, the first frozen embryo pregnancy and the first IVF multiple pregnancies. Australia also produced the first national guidelines for IVF practices, the first statute legislation protecting donor gamete pregnancies, and Victoria proclaimed the first statute legislation regarding control of IVF procedures. The reporting of the outcome of all IVF pregnancies began in 1980 as another world initiative. [ABSTRACT FROM AUTHOR]

Background: Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter; however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision‐making during insertion and perceptions of women. Methods: This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non‐participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. Results: Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18‐gauge catheter was considered more painful than a 16‐gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18‐gauge catheters mostly in hand or wrist (66%). Decision‐making about site, catheter gauge, dressing and attempts varied. Thirty‐four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non‐dominant arm as key reasons for the location of PIVC. Conclusions: Regular use of a large‐gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience. [ABSTRACT FROM AUTHOR]

This article focuses on the Australian population policy. Population policy is a policy for a very long term. As an example, one prepares for a large increase in the aged proportion of the population that will occur mainly between 2020 and 2040. Ageing is the product of relatively high birth rates from 1950 to 1970 followed by low birth rates since 1970. Hence, a policy issue in 2030 derives from births 70 years and more beforehand. If the first priority of a population policy has been achieved, the debate shifts back to a debate about population size.

Background: Family-centred maternity care models include the expectation that fathers prepare for and attend the birth. In Australia over 20% of the population is from a culturally and linguistically diverse background. Public policies espouse culturally competent healthcare. Little is known about the experiences of perinatal health care of men from culturally and linguistically diverse (CALD) communities living in high income countries. The aim was to understand the experiences, attitudes and beliefs about father's inclusion in perinatal healthcare, from the growing, and recently settled community of Ethiopian families living in Australia.Methods: A qualitative study using semi-structured individual interviews with Ethiopian-Australian men and women who had experienced Australian maternity care and were sampled for diversity of time since migration, and parity. Interviews were in English, audio-recorded, transcribed and then analysed thematically.Results: Participants were seven women and six men all born in Ethiopia, including two couples. Key themes included: the loss of extended family through migration, new roles for both parents and the need to establish 'family-like' relationships with friendship groups in Australia. There was a willingness to involve male partners in the Ethiopian community in Australia, although it was recognised as a cultural change. Experiences of male partner involvement were mixed among healthcare types, with men attending Maternal and Child Health (MCH) appointments less frequently than antenatal (ANC) appointments.Conclusions: Results suggests men may be missing out on the education provided during antenatal appointments and may benefit from an alternative. There were not universally high levels of cultural competency among healthcare professionals, with further training still required. Commitment to paid employment remains a barrier to men's involvement, suggesting that flexible working conditions and increased paternity leave would support their involvement. Alternatively services could utilise flexible delivery methods such as phone and zoom to include fathers. [ABSTRACT FROM AUTHOR]

This article explores the complexity of women's experiences of coercive control during childbearing, birthing and postpartum and investigates the importance of health practitioners' responses to women's experiences. Research questions were: "What cues, from women's lived experiences, indicate that coercive control is being exerted by their partners?" and "how can health practitioners recognise coercive control during pregnancy, birthing and post-partum?". The qualitative study drew on relational empowerment to access rich data. Sixteen women in Australia participated in the research. Following the temporal sequence of pregnancy, birthing and postpartum, health workers responses are examined. Themes identified included: reproductive coercion followed by coercive control of ante-natal care, control during birthing, intersections with cultural expectations, partner's self-obsession, grandstanding after a birth, and women's feelings of isolation. Women's experience of coercive control, their sense of isolation or, alternatively, support ultimately affected their ability to remove themselves and their children from the abusive situation. Health practitioners' responses either helped women to identify their partner's behaviors as abusive or exacerbated women's feelings of isolation. The research suggests that health practitioners' acknowledgement of coercive control, and the involvement of social workers conversant with feminist informed dynamics of domestic violence, can impact positively on women's agency. [ABSTRACT FROM AUTHOR]

BACKGROUND Studies investigating the correspondence of birth intentions and birth outcomes focus mainly on women's and men's intentions separately and disregard the fact that reproductive decision-making is dyadic. OBJECTIVE We examine the intention-outcome link for fertility taking a genuine couple-level approach. We aim to understand whether a heterosexual couple's conflict is solved in favour or against childbirth and whether the male or the female partner prevails in the decision-making. METHODS Drawing on data from the survey Household, Income and Labour Dynamics in Australia (HILDA), we perform logistic regressions in which couples are the unit of analysis and the variables are computed by combining both partners' characteristics. RESULTS Results show that disagreement about having a first child is located between 'agreement on yes' and 'agreement on not,' with half of disagreeing couples having a child. By contrast, disagreement about having another child is shifted more towards 'agreement on not' and most often prevents the birth of a child. Women prevail in the decision of having a first child, irrespective of gender equity within the couple, while a symmetric doubleveto model is at work if the decision concerns a second or additional child. CONCLUSION Couple disagreement is not always sufficient to prevent the birth of a child in a low fertility country such as Australia, and the increasing level of gender equity within the couple does not necessarily imply increasing female decision-making power on childbearing issues. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influence of acculturation, demonstrated by age on arrival, length of residence, interpreter use and having an Australian-born partner, on disparities observed in the risk of stillbirth between migrant and Australian-born populations in Western Australia (WA). Methods: A retrospective cohort study using linked administrative health data for all non-Indigenous births in WA from 2005–2013 was performed. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Adjusted odds ratios (aOR) for stillbirth in migrants from six ethnicities of white, Asian, Indian, African, Māori, and 'other', with different levels of acculturation, were compared with Australian-born women using multivariable logistic regression analysis and marital status, maternal age group, socioeconomic status, parity, plurality, previous stillbirth, any medical conditions, any pregnancy complications, sex of baby, and smoking during pregnancy as the covariates. Results: From all births studied, 172,571 (66%) were to Australian-born women and 88,395 (34%) to migrant women. Women from African, Indian and Asian backgrounds who gave birth in the first two years after arrival in Australia experienced the highest risk of stillbirth (aOR 3.32; 95% CI 1.70–6.47, aOR 2.71; 95% CI 1.58–4.65, aOR 1.93; 95% CI 1.21–3.05 respectively) compared with Australian-born women. This association attenuated with an increase in the length of residence in Asian and Indian women, but the risk of stillbirth remained elevated in African women after five years of residence (aOR 1.96 [1.10–3.49]). Interpreter use and an Australian-born partner were associated with 56% and 20% lower odds of stillbirth in migrants (p<0.05), respectively. Conclusions: Acculturation is a multidimensional process and may lower the risk of stillbirth through better communication and service utilisation and elevate such risk through increase in prevalence of smoking in pregnancy; the final outcome depends on how these factors are in play in a population. It is noteworthy that in women of African background risk of stillbirth remained elevated for longer periods after immigrating to Australia extending beyond five years. For migrants from Asian and Indian backgrounds, access to services, in the first two years of residence, may be more relevant. Enhanced understanding of barriers to accessing health services and factors influencing and influenced by acculturation may help developing interventions to reduce the burden of stillbirth in identified at-risk groups. [ABSTRACT FROM AUTHOR]

Background: Third‐ and fourth‐degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third‐ and fourth‐degree tears relative to countries of similar economic development. Aims: We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third‐ and fourth‐degree perineal tears in Australian maternity centres. Materials and Methods: We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic. Results: Twenty‐six systematic reviews were identified. The most common risk factors reported in the literature for third‐ and fourth‐degree tears included primiparity, mother's ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births. Conclusions: Third‐ and fourth‐degree perineal tears are associated with immediate and long‐term implications for women and health systems. Evidence‐based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do. [ABSTRACT FROM AUTHOR]

Aim: To assess educational outcomes of twins and quantify the degree this is mediated by gestational age and other perinatal factors.Methods: We conducted a population-based record-linkage cohort study of all live births ≥24 weeks gestation in New South Wales, Australia with a corresponding standardised school test result for grade 3 in 2008-2014. The primary outcome was whether a child met the National Minimum Standard (NMS) cut-off in literacy and numeracy domains. Robust multivariable Poisson models were used to obtain adjusted relative risks (aRRs), and mediation analysis conducted to assess contributing factors on the causal pathway.Results: Of 351 791 liveborn infants, 10 365 (2.9%) were twins. After adjusting for maternal covariates and compared with singletons, twins had an increased risk of not meeting the NMS for all five literacy and numeracy domains (aRR 1.27-1.45, P < .001). Gestational age alone mediated up to 73% of aRRs and small for gestational age further attenuated these effects with only minimal risk remaining after adjusting for all mediators (aRR 0.94-1.07).Conclusion: Almost all of the educational disadvantage experienced by twins, compared with singletons, is attributable to the risk associated with shorter gestational age, and partly by poor foetal growth. These findings support efforts to prolong gestation of twin pregnancies. [ABSTRACT FROM AUTHOR]