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Since the 1970s, governments in many high-income countries have implemented a series of reforms in their health care systems to improve efficiency and effectiveness. Many of these reforms have been of a market-oriented character, involving the deregulation of key services, the creation of competitive markets, and the privatization of health and social care. Some scholars have argued that these "neoliberal" reforms have unseated the historical structural embeddedness of medicine, and in some cases even resulted in the proletarianisation of physicians. Other scholars have challenged this view, maintaining that medical hegemony continues to shape health care provision in most high-income countries. In this paper we examine how policy reforms may have altered medical dominance over maternity care in two comparatively similar countries - Canada and Australia. Our findings indicate that neoliberal reforms in these two countries have not substantially changed the historically hegemonic role medicine has played in maternity care provision. We discuss the implications of this outcome for the increased medicalisation of human reproduction., (Crown Copyright 2010. Published by Elsevier Ltd. All rights reserved.)

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]

For more than a decade, there has been a strong trend in many Western countries to decrease the length of time that women spend in hospital following childbirth. The research evidence regarding the consequences of early discharge for mothers and babies is mixed. Recent evidence has suggested that early discharge may not be randomly distributed across all sociodemographic groups of birthing women, and that the structures of home care have an important influence on maternal and child outcomes. In the context of decreasing lengths of hospital stay, the aim of the present study was to evaluate a new postnatal home support worker introduced into a geographically defined catchment area of a metropolitan hospital in South Australia. The evaluation included a formative process component to monitor recruitment strategies into the programme, as well as summative evaluation of a number of projected programme outcomes. The research methods used included interviews with antenatal women ( n = 20) about their knowledge of and attitudes to the programme, and interviews with postnatal women ( n = 63) about their transition home experience and assessment of the programme. Secondary analysis of client satisfaction surveys ( n = 163) and aggregate breast-feeding data was also conducted. The results concur with previous research findings regarding the importance of rest and practical, home-based support in the postnatal period to maternal well-being, successful bonding and transition to motherhood. The results demonstrate the importance of well-structured home support services to maternal satisfaction and maternal well-being through the provision of physical, social and emotional care and support in the home. [ABSTRACT FROM AUTHOR]

There have been significant changes in the way that maternity services have been organised in recent years. One of the most dramatic has been the significant reduction of time women spend in hospital following childbirth. Yet despite this there has been little debate about whether additional home and community-based support services might be needed for mothers and their newborn infants. At the same time, though, there has been a seemingly parallel occurrence - growing emphasis on the importance of 'early intervention' (including the antenatal as well as the postnatal period) to maximise the health and wellbeing of infants and their mothers. This involves the identification of 'at risk' families and children, and service provision or surveillance that is home or community-based. Two recently implemented strategies in South Australia target maternal and child health in the postnatal period. One is a local program which provides home-based support (the 'Mothercarer' program). The other is a South Australian government sponsored Universal Home Visiting Program called Every Chance for Every Child. While there are variations in the emphases of the programs, it is suggested that an important trend in policy regarding the postnatal period involves an elision between two kinds of objectives: maternal support in the home, and 'early intervention' to minimise the risk of health and social problems. Furthermore, it could be argued that risk assessment through surveillance is being seen as at least as important, if not even more important, than the provision of support. Finally, the trend to early discharge, going hand in hand with the emphasis on surveillance of these programs, suggests a loosening of the medicalised appropriation of the postnatal period in favour of a wider social panopticon. [ABSTRACT FROM AUTHOR]