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In Australia, one of the most frequent reasons for not breastfeeding is a previously unsuccessful experience. This qualitative study used an appreciative inquiry approach to co‐design a model of peer and professional breastfeeding support, in a metropolitan area of New South Wales (NSW) Australia, in collaboration with women who have had previous negative experiences of breastfeeding. In total, 30 mothers, health professionals and peer supporters participated in a two‐part study, involving interviews and a collaborative workshop. The data were analysed using content analysis. The appreciative inquiry approach led to a solution focused attitude among participants and a commitment to improving breastfeeding support. We noted a level of apathy when the participant groups were interviewed individually prior to the collective workshop. During the collaborative workshop, all three participant groups came together to look at what was currently working well and designed improvements for the future. Midwifery care was identified as important for the start of the breastfeeding journey, during pregnancy and for the first 1–2 weeks after birth, but thereafter it was community and trained peer counsellors who were prioritised for breastfeeding support. Participants identified the need for a variety of support options including face‐to‐face meetings, Skype meetings, phone calls and/or texting. Workshop participants emphasised the need for women, especially those with previous negative experiences, to be linked in with their local peer support community group. An appreciative inquiry approach brought together all key stakeholders to develop practice‐based change which included the end user and care providers. The collaborative workshop enabled participants to come together, as individuals, rather than as designated health professionals or trained peer counsellors, or breastfeeding women with negative experiences. This led to a unified approach and a harnessing of collective energy to initiate positive change. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the characteristics and service needs of women and babies admitted to residential parenting services (RPS) in the first year following birth in New South Wales, Australia. Background: In Australia, there is a tiered system to support maternal, child and family health, which includes RPS. Design: Sequential explanatory mixed‐methods design. Methods: Individual patient data were obtained from a random review of 10% of all medical records (n = 300 of 3,011 admissions) of women with an infant of <12 months of age who were admitted to RPS in 2013. Following review of the medical records, qualitative data were collected via interviews with eight women who accessed RPS. Chi‐square analysis and Student's t test were used to analyse quantitative data. Qualitative data were analysed using a descriptive interpretive approach. An integrative approach was taken in reporting the findings. Results: Women admitted to the RPS were on average 32 years of age, were Australian born (72%) and had a university qualification (40%), and most were employed. The majority of women were primiparous (60%) and had a vaginal birth (61%). Women with male infants were much more likely to be admitted to the RPS (58%) compared to the NSW male‐to‐female ratio (51.3% vs. 48.7%). Over 50% of women reported mental health issues with 27% having an Edinburgh Postnatal Depression Scale score ≥13 on admission. The primary reason women sought parenting support was for sleep and settling (83%). During their stay, services used by women included social workers (44%), psychologists (52%) and psychiatrists (4.5%). Conclusion: Women who access RPS report psychosocial and mental health issues. Services provided by RPS support women during this challenging early parenting period by providing multidisciplinary, holistic and peer support. Relevance to clinical practice: A high prevalence of mental health issues identified in this study indicated a need for ongoing training and support for RPS staff. Ensuring clinicians have the appropriate skill sets to best support their clientele will maximise the outcomes for women and families who access RPS during the early parenting period. [ABSTRACT FROM AUTHOR]

Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the challenges of, and steps taken to successfully collect video ethnographic data during and after caesarean sections. Background Video ethnographic research uses real-time video footage to study a cultural group or phenomenon in the natural environment. It allows researchers to discover previously undocumented practices, which in-turn provides insight into strengths and weaknesses in practice. This knowledge can be used to translate evidence-based interventions into practice. Design Video ethnographic design. Methods A video ethnographic approach was used to observe the contact between mothers and babies immediately after elective caesarean sections in a tertiary hospital in Sydney, Australia. Women, their support people and staff participated in the study. Data were collected via video footage and field notes in the operating theatre, recovery and the postnatal ward. Conclusions Challenges faced whilst conducting video ethnographic research included attaining ethics approval, recruiting vast numbers of staff members and 'vulnerable' pregnant women, and endeavouring to be a 'fly on the wall' and a 'complete observer'. There were disadvantages being an 'insider' whilst conducting the research because occasionally staff members requested help with clinical tasks whilst collecting data; however, it was an advantage as it enabled ease of access to the environment and staff members that were to be recruited. Despite the challenges, video ethnographic research enabled the provision of unique data that could not be attained by any other means. Relevance to clinical practice Video ethnographic data are beneficial as it provides exceptionally rich data for in-depth analysis of interactions between the environment, equipment and people in the hospital environment. The analysis of this type of data can then be used to inform improvements for future care. [ABSTRACT FROM AUTHOR]

Aim and objectives To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. Background For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. Design A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. Results Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. Conclusions There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. Relevance to clinical practice Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding for the first 6 months of life offers the recommended best start in the life for a newborn baby. Yet, in Australia only a small number of babies receive breast milk exclusively for the first 6 months. Reasons for the introduction of formula milk are multi‐factorial including access to appropriate support and the woman's experience of breastfeeding. The language and practices of health professionals can impact upon how a woman feels about breastfeeding and her breastfeeding body. One aspect of breastfeeding support that has had scarce attention in the literature is the language used by health professionals to describe the behaviour of the breastfeeding infant during the early establishment phase of breastfeeding. This paper reveals some of the ways in which midwives, lactation consultants and breastfeeding women describe the newborn baby during the first week after birth. The study was conducted at two maternity units in New South Wales. Interactions between midwives and breastfeeding women were observed and audio recorded on the post‐natal ward and in women's homes, in the first week after birth. The transcribed data were analysed using discourse analysis searching for recurring words, themes and metaphors used in descriptions of the breastfeeding baby. Repeated negative references to infant personality and unfavourable interpretations of infant behaviour influenced how women perceived their infant. The findings revealed that positive language and interpretations of infant breastfeeding behaviour emerged from more relationship‐based communication. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe the use of family conversations as a data collection strategy in a study that aimed to explore how 'social context' impacts on the infant feeding and early parenting choices of first-time mothers. Specifically, the authors aim to describe the challenges and benefits of facilitating 'family conversations' and the importance of considering the needs of the researcher and the research participants in the data collection process. Background Breastfeeding is endorsed by the World Health Organisation as a key health promotion strategy, and yet many women in Australia cease breastfeeding (either fully or partially) before the recommended time frame of six months. Engaging with and interviewing families is a well-established research strategy, but interviewing the family as a whole has rarely been used as a part of breastfeeding research. Design A component of a study, conducted in Sydney, Australia, was to use 'family conversations' to ascertain the views and beliefs that are held by those in the first-time mother's social network and how these impact on her experience of mothering and associated decision-making. Conclusions Being able to balance the needs of the researcher and the research participants is an important challenge that is a core component of conducting ethical research. Relevance to clinical practice This paper highlights the viability of 'family conversations' as a data collection method for midwifery and nursing research and the need for midwives and child and family health nurses to more actively engage with a woman's support network with education and other strategies to assist in creating an environment for new mothers that is conducive to the continuation of breastfeeding and thriving as a mother. [ABSTRACT FROM AUTHOR]

Women who have few social supports, poor health and a history of stressful life events are at risk of poor mental health during the perinatal period. Infants of parents whose parenting capacity is compromised are also at risk of adverse outcomes. Specifically, poor perinatal mental health can impact maternal-infant attachment. To identify women at risk of poor perinatal mental health, psychosocial assessment and depression screening in the antenatal and early postnatal periods are recommended. This qualitative study is part of a larger mixed methods study, which explored two specialist perinatal and infant mental health ( PIMH) services in New South Wales ( Australia). Eleven women who had accessed and been discharged from a PIMH service participated in either face-to-face or telephone interviews. Data were transcribed verbatim and analysed thematically. One overarching theme, 'my special time' and three sub-themes, 'there is someone out there for me', 'it wasn't just a job' and 'swimming or stranded: feelings about leaving the service', were identified. The themes describe the women's experiences of being a client of a PIMH service. Overall, women reported a positive experience of the service, their relationship with the clinician being a key component. Findings from this study highlight the importance of the relational aspect of care and support; however, women need self-determination in all therapeutic processes, including discharge, if recovery and self-efficacy as a mother are to be gained. Importantly, further research is needed about how clinicians model a secure base and how mothers emulate this for their infants. [ABSTRACT FROM AUTHOR]

Aims and objectives To examine child and family health nurses' perceptions of and practices related to working with families of preschool-aged children about their child's behaviour. Background Emotional and behavioural problems in young children are of increasing concern. Child and family health nurses are well placed to support parents and provide education about behavioural concerns. Design A qualitative interpretive study informed by ethnography was used. Methods Forty-eight nurses participated in focus groups. Of these nurses, 11 participated in observations of clinical interactions with 23 mothers. Eight managers were interviewed. Results Three themes and two subthemes emerged from the data: Parents as deficit and nurse as expert; Parents have strengths and nurse as partner; Shaping practice - Time pressures and Wanting respect and to be valued. Conclusions Child and family health nurses enjoy working with preschool-aged children; however, complex issues and tensions are evident. Nurses need support at all levels within the health service if they are to negotiate an environment of ongoing change and to be enabled to work in partnership with parents and families and thereby promote the emotional and behavioural development of preschool-aged children. Relevance to clinical practice The universal role of child and family health nurses provides unique opportunities to support parents about child behaviour concerns. Without appropriate support, nurses continue to work within an expert model that may alienate parents and families from using this service. [ABSTRACT FROM AUTHOR]

Aim To report a programme theory for pre-natal home visiting by nurses in the context of a sustained nurse home visiting programme by exploring pre- and postnatal outcomes and characteristics of the intervention that may have contributed to the outcomes. Background Studies have shown sustained nurse home visiting commencing pre-natally to be effective. Few studies have explored the processes by which pre-natal activities by nurses contribute to achieving effective outcomes. Design Process evaluation. Methods Process and outcome data from a randomized controlled trial of sustained nurse home visiting in an area of socioeconomic disadvantage in Western Sydney between 2005-2008 were collated. The pre-natal intervention focused on improving transition to parenting by supporting mothers through pregnancy. Health and service use outcome data were analysed for 208 women (111 intervention; 97 comparison receiving usual care). Five nurses delivering the intervention completed checklists detailing activities undertaken. Results Nurses provided information, psychosocial support, and health promoting activities for families. Intervention mothers had a higher rate of unassisted vaginal births than the general population. Compared with comparison mothers, intervention mothers at 4-6 weeks postnatally reported better general health and felt significantly more enabled to cope with and understand their baby and to care for themselves and their baby. Conclusion Comprehensive support, in a context of enabling client-nurse relationships and continuity of carer are the ways by which antenatal nurse home visiting achieves benefits for women and infants, having an impact on both clinical outcomes such as rates of normal vaginal delivery and maternal service engagement. [ABSTRACT FROM AUTHOR]

Studies of women's experiences of being overweight and pregnant are limited in the literature. Given the increasing rates of obesity in pregnant women, and the impact of being overweight on the health of the mother and the child, this qualitative descriptive study aimed to explore the perceptions and experiences of overweight pregnant women attending two maternity units in Sydney, Australia. Fourteen women aged between 25 and 42 years with a body mass index greater than 30 kg/m2 participated in a face-to-face interview in their third trimester of pregnancy or in the early post-natal period. All interviews were recorded and transcribed. Field notes were also recorded following each interview. Data were analysed using thematic analysis. Four themes were identified in the data: 'being overweight and pregnant', 'being on a continuum of change', 'get alongside us' and finally 'wanting the same treatment as everyone else'. Most women recognised their weight as an issue both for their own health and well-being and for its impact on the baby. Women believed health professionals should address the issue of obesity with them but do so in a supportive and positive way that recognised their individual needs and expectations. Health professionals need to consider new approaches or models of care for overweight women that give them support and enable individual needs and expectations to be met. Culturally specific programs may also need to be developed. [ABSTRACT FROM AUTHOR]

Aim: To report on the development of an observation tool that can help a single researcher to collect field data about clinician and client interactions. Background: Qualitative studies from a range of disciplines investigate the dynamics of interactions between clinicians and clients. These studies share and report findings but rarely provide details on the practical challenges and methods involved in managing such interactions when collecting rich ethnographic data. Review methods: Development of the observational tool was informed by the study's requirements and context, previous research, and the authors' cross-disciplinary knowledge and experience. Discussion: In relation to how clinicians interact with clients and how clients respond, four domains have been identified and integrated into the observational tool. These domains act as prompts during observations of interactions between clients and nurses. Use of the tool has indicated its effectiveness in assisting with observations and the recording of field notes. Conclusion: The article shows how to develop a tool for qualitative field-data collection. The method can be adapted to studies that require observations of interactions and its components can be modified to suit their fields of study. Implications for practice or research: The 4D&4R tool discussed in this article provides indicators of clinician-client interactions and is transferable to other research and practice contexts [ABSTRACT FROM AUTHOR]

Background: Severe perineal trauma occurs in 0.5-10% of vaginal births and can result in significant morbidity including pain, dyspareunia and faecal incontinence. The aim of this study is to determine the risk of recurrence, subsequent mode of birth and morbidity for women who experienced severe perineal trauma during their first birth in New South Wales (NSW) between 2000 - 2008. Method: All singleton births recorded in the NSW Midwives Data Collection between 2000-2008 (n=510,006) linked to Admitted Patient Data were analysed. Determination of morbidity was based upon readmission to hospital within a 12 month time period following birth for a surgical procedure falling within four categories: 1. Vaginal repair, 2. Fistula repair, 3. Faecal and urinary incontinence repair, and 4. Rectal/anal repair. Women who experienced severe perineal trauma during their first birth were compared to women who did not. Results: 2,784 (1.6%) primiparous women experienced severe perineal trauma during this period. Primiparous women experiencing severe perineal trauma were less likely to have a subsequent birth (56% vs 53%) compared to those not who did not (OR 0.9; CI 0.81-0.99), however there was no difference in the subsequent rate of elective caesarean section (OR 1.2; 0.95-1.54), vaginal birth (including instrumental birth) (OR 1.0; CI 0.81-1.17) or normal vaginal birth (excluding instrumental birth) (OR 1.0; CI 0.85-1.17). Women were no more likely to have a severe perineal tear in the second birth if they experienced this in the first (OR 0.9; CI 0.67-1.34). Women who had a severe perineal tear in their first birth were significantly more likely to have an 'associated surgical procedure' within the ⩽12 months following birth (vaginal repair following primary repair, rectal/anal repair following primary repair, fistula repair and urinary/faecal incontinence repair) (OR 7.6; CI 6.21-9.22). Women who gave birth in a private hospital compared to a public hospital were more likely to have an 'associated surgical procedure' in the 12 months following the birth (OR 1.8; CI 1.54-1.97), regardless of parity, birth type and perineal status. Conclusion: Primiparous women who experience severe perineal trauma are less likely to have a subsequent baby, more likely to have a related surgical procedure in the 12 months following the birth and no more likely to have an operative birth or another severe perineal tear in a subsequent birth. Women giving birth in a private hospital are more likely to have an associated surgical procedure in the 12 months following birth. [ABSTRACT FROM AUTHOR]

Background: In a General Practitioner (GP) setting, preventative medicine is reported as the predominant source of health care for the well-child. However, the role of the GP in well-child health care is not well understood in Australia. The aim of this study was to describe the role of the GP in providing services for well-children and families in Australia. Methods: This was a qualitative descriptive study. Face-to-face interviews were held with 23 GPs to identify their role in the provision of well-child health care. Participants worked in a variety of general practice settings and 21 of the 23 GPs worked in the Greater Western Sydney area. Results: Five main themes were identified in the analysis: 'prevention is better than cure', 'health promotion: the key messages', 'working with families', 'working with other health professionals', and 'barriers to the delivery of well-child health services'. Conclusions: Participating GPs had a predominantly preventative focus, but in the main well-child care was opportunistic rather than proactive. The capacity to take a primary preventative approach to the health of children and families by GPs is limited by the increasing demands to manage chronic disease. Serious consideration should be given to developing collaborative models of care where GPs are joined up with services funded by State and Territory governments in Australia, such as the universal maternal child and family health nursing services that have well children and families as their prime focus. [ABSTRACT FROM AUTHOR]

Aim: Lack of engagement in parenting support programs by young parents has been identified previously in the literature. This paper reports an innovative strategy utilizing appreciative inquiry (AI) to involve service providers and young parents in identifying strategies to engage young parents in services and programs. Methods: A one-day workshop was held involving service/program staff and young mothers in three phases of AI: discovery, dreaming, and delivery. A variety of activities were used to gather data from participants: Small group discussion, creative 'art work' development, and notes. Results: Results identified strategies that would promote and sustain young parents' engagement in services/programs, such as supportive non-judgmental attitude of staff, having a 'one stop shop' for services, and meeting childcare and educational needs of parents. Conclusion: Through AI, factors were identified that promote and sustain engagement of young parents into parenting support programs, and the need to engage fathers was also recognized. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this study is to explore neonatal nurses' perspectives of their role in facilitating family centred care in the neonatal intensive care unit. Background. The philosophy of family centred care focuses on the health and wellbeing of the newborn and their family, through the development of a respectful partnership between the health care professional and the infant's parents. Many studies report family centred care in the context of paediatric care; however, few studies explore neonatal nurses' perspective of family centred care in the context of neonatal care. Design. Qualitative interpretative approach. Methods. Four focus groups and five individual face-to-face interviews were conducted with neonatal intensive care nurses (total n = 33) currently practicing in a tertiary Neonatal Intensive Care Unit in Australia. Each focus group and face to face interview was audio-taped and transcribed. Data was analysed using thematic analysis. Results. Four dominant themes emerged from the data: (1) Getting to know parents and their wishes (2) Involving family in the day to day care (3) Finding a 'happy' medium (4) Transitioning support across the continuum. Conclusion. These findings revealed a general understanding of family centred care principles. Nurses reported the potential benefits and challenges of adopting a family centred care approach to deliver optimal care for neonates and their families. The study highlighted that nurses need ongoing organisation support, guidance and further education to assist them in delivering family centred care effectively. Relevance to clinical practice. Family centred care is a central tenet underpinning neonatal care. Understanding neonatal nurses' perspectives will be useful when developing strategies to strengthen family centred care in the neonatal intensive care unit, and potentially improve neonatal care and family outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives. To report the findings of a service review - specifically the strategy to provide early childhood services 'on site' at opioid treatment clinics to address access difficulties. Background. Child and family health nurses are skilled in the assessment and support of families during early childhood. However, women with a history of substance abuse are often cautious when engaging with universal and other health services, with the result that the infant may miss recommended developmental screening and early referral to improve health outcomes. Design. In 2006, an internal review was undertaken of the integration of early childhood and parenting services at opioid treatment clinics in a large Area Health Service of New South Wales, Australia. Methods. A qualitative study design, using semi-structured interview questions was used. Data were collected via six focus groups (4-15 participants in each group) and individual interview of child and family health nurses, nurse unit managers and clinical staff ( n = 58). Results. Three key components of a model for providing early childhood support in collaboration with opioid treatment services were identified. First, the importance of building a trusting relationship between the woman and the child and family health nurses, second, maintaining continuity of care and a multidisciplinary/multiagency approach, and finally the importance of staff education, support and professional development. Conclusion. The provision of early childhood and parenting services on site, as part of a multidisciplinary 'one stop shop' approach to service delivery was a clear recommendation of the review. Relevance to clinical practice. Reduction of access difficulties to specialised early childhood support is of benefit to clients, community health services attempting to provide a service to this difficult to reach population and to drug and alcohol services seeking to provide a high level of holistic care for clients. [ABSTRACT FROM AUTHOR]

Aim. The aim of this study was to generate insight into younger women’s experiences of recovery from breast cancer-related breast surgery and to contribute to the knowledge base for clinicians practising in this field. Background. Despite the abundance of literature concerning the impact of breast cancer and breast loss on older women over 50 years of age, fewer studies have been conducted specifically with women younger than 50 years focusing on the recovery from breast cancer and related breast surgery. The effects of breast cancer on younger women differ to those of older women; younger women may have difficulty coming to terms with loss of fertility, perceived loss of femininity, sexuality and may experience body image disfigurement. Younger women may face these issues as a result of the treatment and surgery they have received to confine the breast cancer and attempt to improve their chances of survival. Design. A phenomenological qualitative methodology was used to capture the true essence and lived experience of four Australian women under the age of 50, who had undergone surgery as a result of being diagnosed with breast cancer. Methods. Tape-recorded semi-structured face-to-face interviews. Results. Thematic analysis revealed four major themes. These were ‘It absolutely encompassed me,’‘Being overwhelmed,’‘Living with fear and uncertainty’ and ‘Finding strength within.’ Conclusions. Findings of this study shed light on the experiences of recovery from breast cancer-related surgery in women under 50. Relevance to clinical practice. This research study will assist clinicians in understanding the needs of younger women undergoing breast cancer-related breast surgery, who may require counselling in relation to fertility and relationship issues and assistance in coping with the demands of work and home life. [ABSTRACT FROM AUTHOR]

The "Early Bird Program" is a support group facilitated by child and family health nurses and offered to families of infants aged 0-8 weeks in South East Sydney, Australia. This paper describes the experiences of 20 women who participated in the Early Bird groups and 20 women who chose to use individual consultations with the child and family health nurse. The qualitative evaluation used focus groups and interviews with the 40 women, and data were analysed using content analysis. Key findings show the Early Bird Program mothers received support and knowledge from both the nurses and each other, while the women who utilised the individual consultations with the nurses sought out and received specific services and information that focused on the baby. The group approach appears to promote group relationships and to empower mothers as a group by de-emphasising the power and expertise of the professional. [ABSTRACT FROM AUTHOR]

Background: Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). It appears to be increasingly diagnosed and causes great distress in the first year of infancy. In New South Wales (NSW), residential parenting services support families with early parenting difficulties. These services report a large number of babies admitted with a label of GOR/GORD. The aim of this study was to explore the maternal and infant characteristics, obstetric interventions, and reasons for clinical reporting of GOR/GORD in NSW in the first 12 months following birth (2000-2011).Methods: A three phase, mixed method sequential design was used. Phase 1 included a linked data population based study (n = 869,188 admitted babies). Phase 2 included a random audit of 326 medical records from admissions to residential parenting centres in NSW (2013). Phase 3 included eight focus groups undertaken with 45 nurses and doctors working in residential parenting centres in NSW.Results: There were a total of 1,156,020 admissions recorded of babies in the first year following birth, with 11,513 containing a diagnostic code for GOR/GORD (1% of infants admitted to hospitals in the first 12 months following birth). Babies with GOR/GORD were also more likely to be admitted with other disorders such as feeding difficulties, sleep problems, and excessive crying. The mothers of babies admitted with a diagnostic code of GOR/GORD were more likely to be primiparous, Australian born, give birth in a private hospital and have: a psychiatric condition; a preterm or early term infant (37-or-38 weeks); a caesarean section; an admission of the baby to SCN/NICU; and a male infant. Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. Focus group data revealed two themes: "It is over diagnosed" and "A medical label is a quick fix, but what else could be going on?"Conclusions: Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular). [ABSTRACT FROM AUTHOR]

Aims: To identify young parents' perceptions and experiences of a parenting support programme, run by a non-government organisation, which provided both community group-based, and one-on-one home visiting, support. Study Design: A qualitative descriptive study was conducted in one of the most socio-economically disadvantaged areas of Sydney, NSW; this is also an area with one of the highest percentage of births among young parents. Young parents were eligible to participate whether they attended one of the parenting groups and/or received professional home visiting through the young parents programme. Eighteen young women were interviewed, and a further ten participated in a focus group. Thematic analysis of the focus groups and interviews was undertaken. Findings: Four themes were identified in the analysis: 'someone I know and trust', 'we just talk about anything and everything', 'doing the personal' and 'getting out and relaxing'. These themes were linked through the common thread of relationships; the relationships between themselves and other young mothers, and with the workers on the programme. The characteristics of the person with whom they had a relationship, the type of relationship, the content of their interactions and the benefits of these relationships were all important. Conclusions: This study is limited by the small sample size and the 'low risk' status of the young parents who engaged in the programme. This study demonstrated not only the importance for young parents of all forms of interaction, whether it is one-on-one, in a group or social networking; but most importantly, the benefits of having someone to talk to. [ABSTRACT FROM AUTHOR]

Background: There is growing recognition internationally of the need to identify women with risk factors for poor perinatal mental health in pregnancy and following birth. In the state of New South Wales, Australia the Supporting Families Early policy provides a framework of assessment and support for women and families and includes routine psychosocial assessment and depression screening. This study investigated the approach taken by Child and Family Health Nurses (CFHNs) following birth to assessment and screening as recommended by state policy. This was a qualitative ethnographic study that included 83 CFHN and 20 women. Observations occurred with thirteen nurses; with 20 women, in the home or the clinic environment. An additional 70 nurses participated in discussion groups. An observational tool (4D&4R) and field notes were used to record observations and analysed descriptively using frequencies. Field notes, interview data and discussion group transcripts were analysed thematically.Methods: This was a qualitative ethnographic study that included 83 CFHN and 20 women. Observations occurred with thirteen nurses; with 20 women, in the home or the clinic environment. An additional 70 nurses participated in discussion groups. An observational tool (4D&4R) and field notes were used to record observations and analysed descriptively using frequencies. Field notes, interview data and discussion group transcripts were analysed thematically.Results: CFHNs demonstrated a range of approaches to assessment and screening. Psychosocial assessment was conducted in 50% (10 out of the 20) of the interactions observed; however, all the women were screened using the Edinburgh Depression Scale. Four major themes that represent the approach taken to the assessment process were identified: 'Engagement: getting that first bit right', 'Doing some paperwork', 'Creating comfort' and 'Psychosocial assessment: doing it another way'. Nurses utilised other skills such as observing the women interacting with their baby, taking note of non verbal communication and using intuition to develop a clinical decision.Conclusion: Overall, nurses' took a sensitive and caring approach to assessment and screening, however, there were differences in interpretations of the policy recommendations across the two sites. Nurses adopt a flexible, relationship-based approach to the assessment process; however, they experience tension when required to incorporate structured psychosocial assessment processes. To undertake assessment and screening effectively, CFHNs require ongoing support, training and supervision to maintain this sensitive and emotionally challenging work. [ABSTRACT FROM AUTHOR]

Background: There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women., Methods: A linked population data study of all women giving birth in NSW 2000-2012. Statistical differences were calculated using chi-square and student t-tests., Results: Over the 12-year timeframe, 32,071 women and 33,035 babies were admitted to RPS, with 5191 of these women also having one or more hospital admissions (7607 admissions). The comparator group comprised of 99,242 women not admitted to RPS but having hospital admissions over the same timeframe (136,771 admissions). Statistically significant differences between cohorts were observed for the following parameters (p ≤ .001). Based upon calculated percentages, women who were admitted to RPS were more often older, Australian born, socially advantaged, private patients, and having their first baby. RPS admitted women also had more multiple births and labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy). Their infants were also more often male and admitted to Special Care Nursery/Neonatal Intensive Care. Additionally, RPS admitted women had more admissions for mental health and behavioural disorders, which appeared to increase over time. There was no statistical difference between cohorts regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses., Conclusion: Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties., (© 2022. The Author(s).)

Objective: To explore women's experience of skin-to-skin contact and what women want in the first two hours after a caesarean., Design: Audio recorded interviews were conducted with women as a part of a larger video ethnographic research study where video recordings, observations, field notes, focus groups and further in-depth interviews were conducted., Setting: A metropolitan hospital in Sydney, Australia., Participants: Twenty-one women who had a caesarean section were involved in interviews around six weeks postpartum., Analysis: The transcribed interviews were thematically analysed., Findings: Women wanted their baby to stay with them and have skin-to-skin contact, even if they felt apprehensive about providing this care. An overarching theme was, 'I want our baby'. Several subthemes also emerged: 'I felt disconnected when I was separated from my baby', 'I want to explore my naked baby', 'I want my partner involved', and 'It felt right'., Key Conclusions: Despite the challenges of providing skin-to-skin contact in the operating theatre and recovery, health professionals and institutions should recognise the importance of advocating for what women want including keeping women, their partners and babies together and encouraging continuous maternal and infant contact and skin-to-skin contact., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Current research into severe perineal trauma (3rd and 4th degree) focuses upon identification of risk factors, preventative practices and methods of repair, with little focus on women's experiences of, and interactions with, health professionals following severe perineal trauma (SPT). The aim of this study is to describe current health services provided to women in New South Wales (NSW) who have experienced SPT from the perspective of Clinical Midwifery Consultants (CMC) and women., Methods: This study used a descriptive qualitative design and reports on the findings of a component of a larger mixed methods study. Data were collected through a semi-structured discussion group using a variety of non-directive, open-ended questions leading CMCs of NSW. A survey was distributed prior to the discussion group to collect further information and enable a more comprehensive understanding of services provided. Data from individual interviews with twelve women who had experienced SPT during vaginal birth is used to provide greater insight into their interactions with, and ease of access to, health service providers in NSW. An integrative approach was undertaken in reporting the findings which involved comparing and analysing findings from the three sets of data., Results: One overarching theme was identified: A Patchwork of Policy and Process which identified that current health services operate in a 'patchwork' manner when caring for women who sustain SPT. They are characterised by lack of consistency in practice and standardisation of care. Within the overarching theme, four subthemes were identified: Falling through the gaps; Qualifications, skills and attitudes of health professionals; Caring for women who have sustained SPT; and Gold standard care: how would it look?, Conclusion: The findings from this study suggest that current health services in NSW represent a 'patchwork' of service provision for women who have sustained SPT. It appeared that women seek compassionate and supportive care based upon a clear exchange of information, and this should be considered when reflecting upon health service design. This study highlights the benefits of establishing multi-disciplinary collaborative specialist clinics to support women who experience SPT and associated morbidities, with the aim of providing comprehensive physiological and psychological support.

Amid tremendous changes in contemporary health care stimulated by shifts in social, economic and political environments, health care managers are challenged to provide new structures and processes to continually improve health service delivery. The general public and the media are becoming less tolerant of poor levels of health care, and health care professionals need to be involved and supported to bring about positive change in health care. Appreciative inquiry (AI) is a philosophy and method for promoting transformational change, shifting from a traditional problem-based orientation to a more strength-based approach to change, that focuses on affirmation, appreciation and positive dialog. This paper discusses how an innovative participatory approach such as AI may be used to promote workforce engagement and organizational learning, and facilitate positive organizational change in a health care context.

Objective: this qualitative ethnographic study describes the content and process of psychosocial assessment and depression screening undertaken by midwives in the antenatal booking visit in two maternity units in New South Wales (NSW), Australia., Study Design: participants included 34 pregnant women and 18 midwives who agreed to be observed during the antenatal booking visit. A structured observation tool and field notes were used to record observations of the assessment and screening process including the midwives' approaches (actions and interactions) communication styles, and the interactive dynamics between the midwives and the women. Midwives also participated in a brief interview after the observation., Findings: midwives varied in their approach to psychosocial assessment. Some followed the structured format tending to deliver the questions in a directive manner, whereas others appeared more flexible in their approach and delivery of sensitive questions. In some instances midwives modified the questions. Modification appeared to occur to assist in the interpretation and comprehension of the questions., Conclusion: midwives were observed using a range of skills when undertaking psychosocial assessment including empathetic responding, however, modification of questions may reflect a level of discomfort on the part of the midwife in asking sensitive questions and may impact on the integrity of the assessment. Further training and support is required to 'fine tune' the process of assessment and better respond to disclosure of sensitive information., Implications for Practice: midwives require organisational support for ongoing training and clinical supervision to effectively undertake routine psychosocial assessment., (Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.)

Little sociological research has focused specifically on the moment of birth. In this article we draw upon interview data with women who had very recently given birth for the first time to explore the ways in which they described both their own embodiment and that of their infants at this time. We use the term 'the body-being-born' to describe the liminality and fragmentation of the foetal/infant body as women experience it when giving birth. The study found that mode of birth was integral to the process of coming to terms with this body during and following birth. The women who gave birth vaginally without anaesthesia experienced an intense physicality as they felt their bodies painfully opening as the 'body-being-born' forced its way out. In contrast the women who had had a Caesarean section tended to experience both their own bodies and those of their infants as absent and alienated. Most of the women took some time to come to terms with the infant once it was born, conceptualising it as strange and unknown, but those who delivered by Caesarean section had to work even harder in coming to terms with the experience., (© 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.)

Background: There is increasing recognition of the need to identify risk factors for poor mental health in pregnancy and following birth. In New South Wales, Australia, health policy mandates psychosocial assessment and depression screening for all women at the antenatal booking visit and at six to eight weeks after birth. Few studies have explored in-depth women's experience of assessment and how disclosures of sensitive information are managed by midwives and nurses. This paper describes women's experience of psychosocial assessment and depression screening examining the meaning they attribute to assessment and how this influences their response., Methods: This qualitative ethnographic study included 34 women who were observed antenatally in the clinic with 18 midwives and 20 of the same women who were observed during their interaction with 13 child and family health nurses after birth in the home or the clinic environment. An observational tool, 4D&4R, together with field notes was used to record observations and were analysed descriptively using frequencies. Women also participated in face to face interviews. Field note and interview data was analysed thematically and similarities and differences across different time points were identified., Results: Most participants reported that it was acceptable to them to be asked the psychosocial questions however they felt unprepared for the sensitive nature of the questions asked. Women with a history of trauma or loss were distressed by retelling their experiences. Five key themes emerged. Three themes; 'Unexpected: a bit out of the blue', 'Intrusive: very personal questions' and 'Uncomfortable: digging over that old ground', describe the impact that assessment had on women. Women also emphasised that the approach taken by the midwife or nurse during assessment influenced their experience and in some cases what they reported. This is reflected in the themes titled:, Approach: 'sensitivity and care' and 'being watched'., Conclusions: The findings emphasise the need for health services to better prepare women for this assessment prior to and after birth. It is crucial that health professionals are educationally prepared for this work and receive ongoing training and support in order to always deliver care that is empathetic and sensitive to women who are disclosing personal information.

Providing support and parenting education through home visiting is a key early intervention strategy with young parents. Less is known about what home visitors do that makes a difference. The purpose of this paper is to describe the role and experiences of professional staff working with young parents participating in a multicomponent parent support programme (home visiting and supported parenting groups) provided by a non-government organisation in a socially disadvantaged area of Sydney, Australia. This was a qualitative descriptive study. Data were collected through three focus groups conducted with the same six staff over an 18-month period. Participant descriptions of their role and experiences working with young mothers were analysed thematically. Additional data from 20 anonymised client records were analysed through content analysis. Analysis of the focus group data revealed two themes, 'Connecting' and 'Facilitating Learning'. The theme 'Connecting' reflected the development of a relationship with the young mother commencing with 'how do we engage them?', 'building trust' through to formation of a relationship described as 'they know we're not friends, they know we're workers'. The second theme, 'Facilitating Learning' was informed by the analysis of both group and client record data and comprised a number of themes around what and how mothers learnt, through to 'ending the relationship' as the mothers left the programme. The quality of a mothers' learning was dependent on the quality of the connection between herself and the staff, similarly their capacity and, or confidence to leave the programme was dependent on the relationship, 'connecting' and the learning undertaken. Role modelling through interactions with children as well as with each other was seen as the most effective way to facilitate social and parenting skill development, while formal education sessions were evaluated by the workers to be less successful than informal ones., (© 2012 Blackwell Publishing Ltd.)

Aim: To describe the experiences of women who have had an emergency hysterectomy following a severe postpartum haemorrhage and the impact on their early mothering experiences., Background: Postpartum haemorrhage and subsequent hysterectomy is a traumatic birth event. Traumatic birth experiences have the potential to impact on a woman's experience of motherhood and her initial relationship with her baby. The relative rarity of this event makes it easy to dismiss the experiences of women having a hysterectomy following childbirth. Little is known about a woman's early mothering experience in the context of having an emergency hysterectomy., Design: Qualitative naturalistic inquiry approach., Method: Data were collected through semi-structured qualitative interviews from 21 Australian women who had an emergency hysterectomy following a severe postpartum haemorrhage., Results: Findings revealed three themes in relation to early mothering experiences in the context of having a hysterectomy following a severe postpartum haemorrhage. They were 'initial separation: lost bonding time', 'feelings of failure' and 'relinquishing care of the infant'., Conclusions: This paper highlights the ways undergoing emergency hysterectomy following childbirth can impact on the experience of early mothering in the postnatal period., Relevance to Clinical Practice: Greater recognition and attention to the specific needs of women who have an emergency hysterectomy following childbirth is required. Providing women with an opportunity to talk, debrief and ask questions related to their birthing experiences, will help women to reconcile their feelings. Giving women the opportunity to have their infants with them in intensive care unit, together with ongoing emotional support and anticipatory guidance, may also be useful approaches in assisting women during this difficult and traumatic time., (© 2011 Blackwell Publishing Ltd.)

Objective: To explore the challenges of conducting an observational study of postnatal interactions, between midwives and women, when the researcher was a midwife observing in familiar midwifery settings., Background: Participant observation conducted by researchers who are themselves midwives raises questions regarding the influence of 'identity' and 'insider' knowledge on the conduct of such projects. The insider/outsider status of researchers has been explored in other disciplines, yet this is an area which is underdeveloped in the midwifery literature where few attempts have been made to subject this issue to sustained analysis., Design: A qualitative study (investigating the provision of breast-feeding support in the first week after birth) provided the opportunity for reflexive exploration of the tensions faced by midwife researchers., Setting: Two maternity units in New South Wales, Australia., Participants: Participants included 40 midwives and 78 breast-feeding women., Findings: Possessing 'insider' midwifery knowledge was advantageous in the 'getting in' and 'fitting in' phases of this research study however unanticipated role ambiguity, and moral and ethical challenges, arose as a result of this 'insider' knowledge and status. Prolonged periods of observation challenged the midwife researcher's preconceived ideas and early decisions about the advantages and disadvantages of being an 'insider' or an 'outsider' in the research setting., Key Conclusions: Reflexive analysis of insider/outsider experiences revealed the middle ground which participant observers tend to navigate. Whilst professional insider knowledge and status offered many advantages, especially at the first study setting, some of the inherent embodied, and socially constructed features of the 'midwife' observer role, were unanticipated. Cultural competence, in these observational study settings, translated into role ambiguity, and at times, culturally entrenched role expectations., Implications for Practice: Midwifery observation of clinical practice, for research, or practice development purposes, requires a degree of juggling of insider knowledge to facilitate observation and analysis. Prior to conducting observations midwives should consider how best to occupy the middle ground between insider and outsider. Within the middle ground the midwife can draw on those aspects of 'self' required to negotiate respectful relationships with colleagues, whilst also ensuring the maintenance of an analytical degree of distancing., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: to explore the experiences and concerns of health professionals who care for childbearing women who are obese., Background: obesity is increasing nationally and internationally and has been described as an epidemic. A number of studies have highlighted the risks associated with obesity during childbirth, yet few studies have investigated the experiences and concerns of midwives and other health professionals in providing care to these women., Design: a descriptive qualitative study using focus groups and face-to-face interviews to collect data. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis., Setting: three maternity units in New South Wales, Australia., Participants: participants included 34 midwives and three other health professionals., Findings: three major themes emerged from the data analysis: 'a creeping normality', 'feeling in the dark' and 'the runaway train'. The findings highlight a number of tensions or contradictions experienced by health professionals when caring for childbearing women who are obese. These include, on the one hand, an increasing acceptance of obesity ('a creeping normality'), and on the other, the continuing stigma associated with obesity; the challenges of how to communicate effectively with pregnant women about their weight and the lack of resources, equipment and facilities ('feeling in the dark') to adequately care for obese childbearing women. Participants expressed concerns about how quickly the obesity epidemic appears to have impacted on maternity services ('the runaway train') and how services to meet the needs of these women are limited or generally not available., Conclusion and Implications for Practice: it was clear in this study that participants felt that they were 'not waving but drowning'. There was concern over the fact that the issue of obesity had moved faster than the health response to it. There were also concerns about how to communicate with obese women without altering the relationship. Continuity of care, training and skills development for health professionals, and expansion of limited services and facilities for these women are urgently needed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Australia has high breastfeeding initiation rates however, at 3 and 6 months exclusive breastfeeding rates fall below global recommendations. Research suggests significant others in a woman's life can influence infant feeding decisions and practices but how and why they do so needs investigation., Research Question: This study explored grandmothers' perceptions of their role in supporting new families and examined the potential for grandmothers to influence infant feeding decisions and parenting practices of new mothers in an area of Sydney, Australia, with low breastfeeding maintenance rates., Participants and Method: A qualitative, descriptive study was conducted in South Western Sydney, Australia. Eleven grandmothers participated in one to one interviews and three of these also participated in a group discussion., Results: Analysis revealed three themes: 'Presence'; 'Position'; and 'Power versus Preservation' which provide insight into the complexity of the grandmother-new mother relationship and describe the potential influence that grandmothers may have on infant feeding and parenting., Discussion and Conclusion: The findings highlight challenges and dilemmas faced by grandmothers in their supportive role for the new mother in her breastfeeding and early parenting experience and the difficulties grandmothers face in balancing potential risks and rewards in their interactions with the new family., (2009 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

The first Australian trial of sustained nurse home visiting provided an opportunity to explore nurses' understanding of the situations that support mothers of infants to disclose personal and sensitive psychosocial information. Using a qualitative descriptive design, semi-structured interviews were conducted and transcripts were analysed drawing upon aspects of Smith's interpretative phenomenological analysis. Five themes pertaining to the experience of relationship building to foster disclosure of sensitive information emerged: (1) building trust is an ongoing process of giving and giving in return, (2) being 'actively passive' to develop trust, (3) the client is in control of the trust-relationship, (4) the association between disclosure of sensitive issues and a trust-relationship, and (5) empowerment over disclosure. This study provides a deeper understanding of how child and family health nurses develop relationships that lead women to entrust the nurse with personal, sensitive information, and may inform the practice of psychosocial needs assessment in other contexts.

Aim and Objective: This study aimed to design, implement and evaluate strategies to improve the quality and content of hospital-based postnatal care., Background: Following birth, women report physical health problems, difficulties with breastfeeding, a lack of parenting self-efficacy and there is high occurrence of postnatal distress and depression. Despite these significant needs, women are frequently dissatisfied with the advice and support they receive from hospital-based postnatal care., Design: A pre/post test design compared the effect of multifaceted strategies on perceptions of quality and content of postnatal care, knowledge and experience of postnatal problems, parenting self-efficacy and breastfeeding outcomes. The key strategy, 'one-to-one time', focused on providing women an uninterrupted period of time each day when a midwife would be available to discuss women's concerns about their health and that of their baby., Method: A convenience sample of 146 women at baseline and 148 women postintervention completed a postal self-report questionnaire between 2-4 weeks postpartum., Results: There were no significant differences between baseline and postintervention groups in perceived quality of care, breastfeeding outcomes and maternal self-efficacy. Women experiencing health issues, including insufficient milk supply, backache, abnormal bleeding and urinary incontinence, were more likely to report that they received good or excellent care and advice in the postintervention group. Strategies to increase rest appeared effective with women less likely to report excessive tiredness postintervention. The key strategy, 'one-to-one time' was not consistently implemented, 57% of women reported they received 10 minutes or less of uninterrupted time with a midwife and only 11% reported that they were provided with 20 minutes or more., Conclusion: There is the potential for individualised care to impact on outcomes for women but established routines and institutional priorities are difficult to change., Relevance to Clinical Practice: Midwives require both skill development and time to be able to sensitively listen to women's needs in the hospital postnatal setting.

Background: The way in which women and their babies transition from maternity services to the care of child and family health nurses differs across Australia. The aim of the study was to understand the transition of care from one service to another and how to promote collaboration in the first few weeks after the birth., Method: A descriptive study was undertaken. All midwifery, child and family health and Families NSW managers in NSW were invited to participate by completing a questionnaire., Results: There was a wide range of transition of care models. These varied by setting, geography, context and history. Three main models emerged from the analysis. These were as follows:, Discussion: There were a range of different models of transition of care identified in NSW depending on local context, expertise, interests and policies. Some are very structured and others have developed and evolved over time. Many models seem to be dependant on the goodwill and enthusiasm of individual clinicians., Conclusion: A more coordinated and systematised approach needs to be developed. Collaboration and communication between midwives and child and family health nurses is essential if the needs of families are to be addressed during this transition period.

Background: Home visiting programs comprising intensive and sustained visits by professionals (usually nurses) over the first two years of life show promise in promoting child health and family functioning, and ameliorating disadvantage. Australian evidence of the effectiveness of sustained nurse home visiting in early childhood is limited. This paper describes the method and cohort characteristics of the first Australian study of sustained home visiting commencing antenatally and continuing to child-age two years for at-risk mothers in a disadvantaged community (the Miller Early Childhood Sustained Home-visiting trial)., Methods and Design: Mothers reporting risks for poorer parenting outcomes residing in an area of socioeconomic disadvantage were recruited between February 2003 and March 2005. Mothers randomised to the intervention group received a standardised program of nurse home visiting. Interviews and observations covering child, maternal, family and environmental issues were undertaken with mothers antenatally and at 1, 12 and 24 months postpartum. Standardised tests of child development and maternal-child interaction were undertaken at 18 and 30 months postpartum. Information from hospital and community heath records was also obtained., Discussion: A total of 338 women were identified and invited to participate, and 208 were recruited to the study. Rates of active follow-up were 86% at 12 months, 74% at 24 months and 63% at 30 months postpartum. Participation in particular data points ranged from 66% at 1 month to 51% at 24 months postpartum. Rates of active follow-up and data point participation were not significantly different for the intervention or comparison group at any data point. Mothers who presented for antenatal care prior to 20 weeks pregnant, those with household income from full-time employment and those who reported being abused themselves as a child were more likely to be retained in the study. The Miller Early Childhood Sustained Home-visiting trial will provide Australian evidence of the effectiveness of sustained nurse home visiting for children at risk of poorer health and developmental outcomes., Trial Registration: ACTRN12608000473369.

Background: In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care., Aim: To design and implement strategies to improve hospital-based postnatal care at a Sydney metropolitan hospital., Method: This was an Action Research study. In Phase One, midwives considered the literature and participated in group discussions and interviews to determine their perceptions of postnatal care and the factors that facilitate or hinder the provision of quality care. In Phase Two, midwives participated in 12 working group meetings to design strategies to improve care., Results: Several important principles of postnatal care were described, including building a relationship with women, meeting their individual needs, being flexible in approach and providing continuity of care. 'Listening to women', 'being there,' and 'normalising experiences and expectations' were believed to be critical to achieving these principles. A key strategy 'One to One Time' was designed to provide women with an uninterrupted period of time each day with a midwife who was available to listen to their needs and concerns and discuss issues related to their health and that of their baby., Conclusion: Midwives designed and implemented strategies that they believed would improve in-hospital postnatal care.

Objectives: To explore the relationships between maternal distress, breast feeding cessation, breast feeding problems and breast feeding maternal role attainment., Design: Longitudinal cohort study., Setting: Three urban hospitals within Sydney, Australia., Participants: 449 women were invited to participate in the study, with an 81% response rate., Measurement: Self-report questionnaires were used to collect the data in pregnancy (28-36 weeks) and 2 weeks and 3 months after birth. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure postnatal distress, and the Maternal Role Attainment subscale (MRA) of the Maternal Breast Feeding Evaluation Scale (MBFES) was used to measure breast feeding maternal role attainment., Findings: Women with high MRA were less likely to stop breast feeding (even when they had breast feeding problems) than women with low MRA. Antenatal EPDS and anxiety scores were not related to breast feeding cessation or breast feeding problems when analysed alone. As hypothesised, the relationship between breast feeding cessation and postnatal distress (EPDS scores) varied according to MRA level. Women who were categorised as high MRA and no longer breast feeding had higher EPDS scores and were more likely to be categorised as distressed (36%) than women who had low MRA (<12%) or women who had high MRA and continued to breast feed (7%)., Implications: There is a complex relationship between maternal identity, stopping breast feeding earlier than desired, and psychological distress. Women with strong beliefs about the importance of breast feeding to their maternal role may benefit from psychological assessment and support should they decide to stop breast feeding earlier.

Objective: To describe the baby-feeding decisions of a group of Australian women prior to birth., Design, Setting and Participants: A qualitative study using face-to-face in depth interviews was undertaken with 29 women. All interviews were audio-tape recorded and transcribed verbatim. Data were analysed using thematic analysis., Findings: The women observed and sought information from a variety of sources as well as exploring their own understandings of themselves and their breasts. Based on this knowledge the women made their antenatal baby-feeding decisions. These baby-feeding decisions grouped into four thematic groups, 'assuming I'll breast feed'; 'definitely going to breast feed'; 'playing it by ear' and 'definitely going to bottle feed'. Each of these standpoints was associated with, and precipitated a number of behaviours and strategies., Implications: The findings of this research highlight the need for antenatal educators and midwives who provide care in pregnancy to acknowledge a range of experiences and expectations of women and to provide diverse educational opportunities to meet a range of needs. There is a need for further research to identify how midwives can encourage and assist women to explore and challenge their assumptions about breast feeding as they relate to other aspects of their lives.