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OBJECTIVE: To examine the prevalence of COVID-19 vaccination, and factors associated with vaccination intention and hesitancy in pregnant and postnatal women in Australia. DESIGN AND SETTING: A national online survey was conducted over 6 months between 31 August 2021 and 1 March 2022 and responses to vaccination status were categorised as: 'vaccinated', 'vaccine intended' and 'vaccine hesitant'. The data were weighted to reflect the proportion of women of reproductive age. Potential confounding variables were examined using multinomial logistic regression analyses, and all comparisons were made against vaccinated pregnant and postnatal women. PARTICIPANTS: 2140 women responded to the survey (838 pregnant; 1302 recently post partum). RESULTS: Amongst pregnant women, 586 (69.9%) were vaccinated, 166 (19.8%) indicated intention and 86 (10.3%) were hesitant. In postnatal women, this was 1060 (81.4%), 143 (11.0%) and 99 (7.6%), respectively. Only 52 (6.2%) of pregnant women stated never wanting a COVID-19 vaccine. Vaccine hesitancy increased over time, and for pregnant women was associated with: living in a state other than New South Wales (NSW) (Adjusted Relative Risk (ARR) 2.77, 95%CI: 1.68-4.56 for vaccine intention and ARR=3.31, 95%CI: 1.52-7.20 for vaccine hesitancy), younger age <30 years, not having a university education, income <80K AUD, gestation <28 weeks, having no pregnancy risk factors, and being less satisfied with life (ARR=2.20, 95%CI: 1.04-4.65 for vaccine intention and ARR=2.53, 95%CI: 1.02-6.25 for vaccine hesitancy) . For postnatal women: living in a state other than NSW or Victoria, income <80K AUD and having private obstetric care (ARR=2.06, 95%CI: 1.23-3.46) were significantly associated with vaccine hesitancy. CONCLUSIONS: Around 1 in 10 pregnant women and just over 1 in 13 postnatal women reported vaccine hesitancy in this Australian survey, and hesitancy was higher in the latter 3-month period. Tailored messages to younger mothers and those fro

BACKGROUND: Despite robust evidence on the benefits of midwifery group practice (MGP), there remains difficulties with implementing and sustaining the model. However, contemporary data on the MGP workforce and how each model has been operationalised are limited. This constrains an understanding of the factors that help or hinder implementation and sustainability of MGP. AIM: To describe the characteristics of Australian MGPs and the factors that help or hinder sustainability. METHODS: A national cross-sectional survey was undertaken in Australia between March 2021 and July 2022, inclusive. Quantitative data were analysed using descriptive analysis while qualitative data were analysed using content analysis. FINDINGS: Of 669 survey responses, 579 were midwives and 90 were managers. The mean years of experience for clinical midwives was eight years, and 47.8% (almost twice the national average) completed a Bachelor of Midwifery (BMid). Half (50.2%) the models provided care for women of all risk. Midwives resigned from MGP because of the MGP work conditions (30%) and how the service was managed or supported (12.7%). Managers resigned from MGP because of role changes, conflict with their manager, and limited support. Almost half (42.6%) of MGP managers also managed other areas, leading to heavy workloads, competing demands, and burnout. CONCLUSION: The BMid appears to be a common educational pathway for MGP midwives, and many MGP services are providing care to women with complexities. Flexible practice agreements, organisational support and appropriate workloads are vital for recruitment, retention, and sustainability of MGP.

BACKGROUND: The Midwifery Initiated Oral Health-Dental Service was developed to train midwives to promote maternal oral health, and a large trial showed it substantially improved the oral health, knowledge and behaviours of pregnant women. AIM: Evaluate the long-term effectiveness of the program (post-trial) on maternal oral health knowledge, dental behaviours, and early childhood caries in offspring. METHODS: A prospective cohort study involving 204 women and children 3-4 years (followed after trial) was conducted in Sydney, Australia from 2017 to 2019. RESULTS: The program did not have a significant impact on the study measures. Mothers who received the program did have comparatively better knowledge around preventative behaviours to reduce early childhood caries and significantly more mothers were engaging in a key behaviour of using a cup to feed their child. Overall maternal oral health knowledge and level of education did have a protective effect on the dental decay of children. Higher knowledge and levels of education reduced the odds of having a dmft of one or more by over half (OR 0.473), and almost 80% (OR 0.212) respectively. CONCLUSIONS: Although the MIOH-DS program was not effective, there is still value in exploring other complementary interventions to improve maternal oral health, especially for disadvantaged families. Future research should focus on co-designing an antenatal and postnatal oral health intervention and exploring its long-term impact on the oral health of children.

BACKGROUND: Childbirth education, which includes providing information and practical techniques to help manage childbirth, aims to support women and their birth partners. It is unknown how birth partners and care providers influence the utilisation of childbirth education information and techniques during women's labour and birth. AIM: To explore the literature that investigates the influence that birth partners and care-providers have on the application of childbirth education information and techniques used by women during childbirth. METHODS: A meta-ethnography was performed using a systematic synthesis of reciprocal translation and refutational investigation. There were 22 papers included in the final synthesis. Quality appraisal was undertaken using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBIQARI) quality appraisal tool for qualitative studies. FINDINGS: An over-arching theme of 'you are either with me on this or not' emerged from the data, which expressed the positive and negative influences on the use of childbirth education information and techniques during labour and birth. The influence of birth partners was captured in the themes 'stepping up to their full potential' and 'a spare part'. The themes 'in alignment with the woman' and 'managed by another' were conceptualised from the data in relation to care-providers' influence. A theme, 'the right fit', described organisational and contextual influences. CONCLUSION: Birth partners and care-providers who are present during a woman's labour have significant potential to influence her use of childbirth education strategies in labour, which provides important insights for translation of evidence into practice.

The effectiveness of childbirth education (CBE) has long been debated with studies showing contradictory outcomes for mothers and babies. Understanding how what is learned in CBE is translated into practice during labor and birth is an area that requires investigation as this may be a mediating factor in its effectiveness. Bowen family system theory's concept of differentiation of self, the ability to be guided by and to act from one's beliefs and values, is an organizing principle that may affect how relational factors affect the use and application of CBE at the time of birth. The ability to act with emotional maturity when faced with a stressor, such as childbirth, depends on an individual's capability to separate thoughts from the more reactive feeling process. Recognizing how one's level of differentiation interacts with the anxious responses of others may assist pregnant women and birth partners to make decisions more objectively about how they want to manage the birthing process. For the health professional, understanding the interplay of relationship variables, physiological stress, anxiety and individual reactivity may allow for the provision of more thoughtful evidence-based practice, which may increase objectivity, and aid communication and decision-making for women during birth. Bowen theory, as a comprehensive systems-based approach to understanding human functioning under stress, offers a novel approach to exploring the application of CBE during birth.

BACKGROUND: Midwifery group practice (MGP) has consistently demonstrated optimal health and wellbeing outcomes for childbearing women and their babies. In this model, women can form a relationship with a known midwife, improving both maternal and midwife satisfaction. Yet the model is not widely implemented and sustained, resulting in limited opportunities for women to access it. Little attention has been paid to how MGP is managed and led and how this impacts the sustainability of the model. This study clarifies what constitutes optimal management and leadership and how this influences sustainability. METHODS: This qualitative study forms part of a larger mixed methods study investigating the management of MGP in Australia. The interview findings presented in this study are part of phase one, where the findings informed a national survey. Nine interviews and one focus group were conducted with 23 MGP managers, clinical midwife consultants, and operational/strategic managers who led MGPs. Transcripts of the audio-recordings were analysed using inductive, reflexive, thematic analysis. RESULTS: Three themes were constructed, namely: The manager, the person, describing the ideal personal attributes of the MGP manager; midwifing the midwives, illustrating how the MGP manager supports, manages, and leads the group practice midwives; and gaining acceptance, explaining how the MGP manager can gain acceptance beyond group practice midwives. Participants described the need for MGP managers to display midwife-centred management. This requires the manager to have qualities that mirror what is generally accepted as requirements for good midwifery care namely: core beliefs in feminist values and woman-centred care; trust; inclusiveness; being an advocate; an ability to slow down or take time; an ability to form relationships; and exceptional communication skills. Since emotional labour is a large part of the role, it is also necessary for them to encourage and practice self-care

AIMS: The primary aim of the review was to provide an overall assessment of residential parenting services in Australia, by describing the characteristics of infants and parents using residential parenting services, their prior service use and reasons for admission, referral pathways for access and parenting and infant outcomes. The secondary aims were to explore parent and staff perception of the programmes. DESIGN: An integrative literature review. METHODS: A systematic and comprehensive search of health and social sciences databases was conducted for studies related to residential parenting services (published between 1st January 1990-31st December 2019). Six hundred and eleven peer-reviewed papers were identified, after which 301 duplicates were removed and an additional 256 papers excluded after titles/abstracts were read. Of the remaining 54 abstracts/papers, a further 14 were omitted as not relevant. Forty papers were independently reviewed by four authors. ENTREQ and MOOSE checklists were applied. RESULTS: Thirty studies were quantitative, nine were qualitative, and one was mixed methods. All studies originated from in Australia. Women and babies admitted to residential parenting services were found more likely to be: older, Australian born, from higher socio-economic groups, and first-time mothers, and having labour and birth interventions and a history of mental health disorders. The babies were more likely to be twins, male and admitted with sleep disorders and dysregulated behaviour. Studies reporting postintervention outcomes demonstrated improvements to maternal mental health, breastfeeding, parenting confidence and sleep quality, and infant sleeping and behaviour.

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

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Birth centres offer a midwifery-led model of care which supports a non-medicalised approach to childbirth. They are often reported as having low rates of birth intervention, however the precise impact is obscured because less disadvantaged mothers with less complex pregnancies, and who prefer and often select little intervention, are more likely to choose a birth centre. In this paper, we use a methodology that purges the impact of these selection effects and provides a causal interpretation of the impact of birth centres on intervention outcomes. Using administrative birth data on over 364,000 births in Australia's most populous state between 2001 and 2012, we implement an instrumental variables framework to address confounding factors influencing choice of birth setting. We find that giving birth in a birth centre results in significantly lower probabilities of intervention, and that critically, this impact has been increasing over time. Our estimates are larger than those in existing studies, reflecting our newer data, diverging intervention rates across birth settings, and our accounting for important selection effects. The results emphasise the greater role of birth centres in delivering on policy priorities which include greater maternal autonomy, lower intervention rates, and lower health system costs.

ISSUE ADDRESSED: All pregnant women should have a comprehensive oral health evaluation. Unfortunately, many pregnant women seldom seek dental care and some dentists are hesitant to treat during pregnancy. To address these issues, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in Australia. The aim of this study was to undertake a process evaluation and explore the perceptions of dental professionals involved in the program to determine the acceptability, feasibility and effectiveness of the program if it were to be upscaled. METHODS: A qualitative approach using content analysis was conducted on data from two focus groups involving 12 dental professionals. RESULTS: All participants were supportive of the MIOH-DS program. They thought pregnant women were receptive to their care, and reported markedly improved oral health. The provision of free dental care and the involvement of midwives were cited as major factors that improved the uptake of the program. Some of the challenges encountered were the prevailing misconceptions about the safety of dental treatment and pregnancy-related impairments. CONCLUSIONS: Dental professionals found the MIOH-DS to be acceptable, feasible and effective in improving oral health of pregnant women and their uptake of dental services. However, some challenges need to be addressed as the MIOH-DS program is upscaled into a cost-effective model. SO WHAT?: Dental professionals are important stakeholders in the MIOH-DS model. The process evaluation of the successful dental intervention is necessary to understand how and why such interventions work, and is an important step in scaling up to a population-wide intervention.

BACKGROUND:Early childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries. METHODS:A systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting. RESULTS:Nine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children's clinical and mother's behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed resu

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth. Design A linked population data cohort study was undertaken for the years 2000-2012. Setting New South Wales (NSW), Australia. Participants All women giving birth and babies born in NSW were compared with those admitted to RPS. Results During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth. Conclusion Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase.

© 2018 The Author(s). 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 12months 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 12months 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-38weeks); 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 i

© 2018 The Author(s) Background: The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal. Few have attempted to synthesise findings. Objective: To compare maternal and perinatal outcomes from different places of birth via a systematic review of high-quality research, and meta-analysis of appropriate data (Prospero registration CRD42016042291). Design: Reviewers searched CINAHL, Embase, Maternity and Infant Care, Medline and PsycINFO databases to identify studies comparing selected outcomes by place of birth among women with low-risk pregnancies in high-income countries. They critically appraised identified studies using an instrument specific to birth place research and then combined outcome data via meta-analysis, using RevMan software. Findings: Twenty-eight articles met inclusion criteria, yielding comparative data on perinatal mortality, mode of birth, maternal morbidity and/or NICU admissions. Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation. Conclusions and implications for practice

© 2018 John Wiley & Sons Ltd 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 o

© 2016 John Wiley & Sons Ltd 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 th

BACKGROUND: The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labour in one Australian state. METHODS: A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study. RESULTS: Women who planned to give birth in a birth centre or at home were significantly more likely to have a normal labour and birth compared with women in the labour ward group. There were no statistically significant differences in stillbirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences. CONCLUSION: This study provides information to assist the development and evaluation of different places of birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of birth in a low risk population, especially in countries like Australia where homebirth rates are low.

There are many published studies about the epigenetic effects of the prenatal and infant periods on health outcomes. However, there is very little knowledge regarding the effects of the intrapartum period (labor and birth) on health and epigenetic remodeling. Although the intrapartum period is relatively short compared to the complete perinatal period, there is emerging evidence that this time frame may be a critical formative phase for the human genome. Given the debates from the National Institutes of Health and World Health Organization regarding routine childbirth procedures, it is essential to establish the state of the science concerning normal intrapartum epigenetic physiology. EPIIC (Epigenetic Impact of Childbirth) is an international, interdisciplinary research collaboration with expertise in the fields of genetics, physiology, developmental biology, epidemiology, medicine, midwifery, and nursing. We hypothesize that events during the intrapartum period - specifically the use of synthetic oxytocin, antibiotics, and cesarean section - affect the epigenetic remodeling processes and subsequent health of the mother and offspring. The rationale for this hypothesis is based on recent evidence and current best practice. © 2013 Elsevier Ltd.

Objective: vaginal birth after caesarean (VBAC) is a controversial issue with strong opinions for and against. The means in which women work through the different opinions and options using the internet should be of interest to midwives, obstetricians and policy makers. The aim of this study was to examine how women use English language internet blog sites to discuss the option of VBAC and what factors influence these women's decision to have a VBAC or repeat caesarean section. Design: a qualitative study using internet blog sites as the source of data was undertaken. Google alerts were created to search for the term VBAC in internet blogs. These alerts were sent to the first author's email account daily for a one-year period (November 2007 to October 2008) and downloaded. The content was analysed using thematic analysis. Findings: there were 311 blogs mentioning the word VBAC in the one-year period. Most of the blog sites and discussion originated from the USA. There were more blogs written during the Northern Hemisphere winter months than during other seasons. The main theme identified was a dichotomy in philosophical framework women held about birth; that is a 'motherbirth' or 'childbirth' framework. Whether women eventually wrote that they chose a VBAC or repeat caesarean or the extent to which they pursued their birth choice depended on whether they came from a perspective that a 'good parent sacrifices themselves for their baby (prioritises the baby) and takes no risks' (childbirth) or that 'giving birth matters to the woman and a happy, healthy mother is a happy healthy baby (mother and baby have equal priority)' (motherbirth). Several themes were identified including: surviving the damage; inadequate bodies; choice and control; fearing and trusting birth; negotiating the system; and minimising or overestimating risk. Key conclusion: women filtered their decision making regarding VBAC through a belief system that prioritises according to their personal approa

UNLABELLED: Objective. To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Design. Cross-sectional, descriptive study. Setting. An Australian public hospital antenatal clinic. SAMPLE POPULATION: Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women. Main Outcome Measures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a). Results. There was a high prevalence of self reported LPP during the pregnancy (71%). An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition. Most women (71%) had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy.

A review of key historical texts that mentioned perineal care was undertaken from the time of Soranus (98-138. A.D.) to modern times as part of a PhD into perineal care. Historically, perineal protection and comfort were key priorities for midwives, most of whom traditionally practised under a social model of care. With the advent of the Man-Midwife in the seventeenth and eighteenth century, the perineum became pathologised and eventually a site for routine surgical intervention - most notably seen in the widespread use of episiotomy. There were several key factors that led to the development of a surgical rather than a social model in perineal care. These factors included a move from upright to supine birth positions, the preparation of the perineum as a surgical site through perineal shaving and elaborate aseptic procedures; and the distancing of the woman from her support people, and most notably from her own perineum. In the last 30 years, in much of the developed world, there has been a re-emergence of care aimed at preserving and protecting the perineum. A dichotomy now exists with a dominant surgical model competing with the re-emerging social model of perineal care. Historical perspectives on perineal care can help us gain useful insights into past practices that could be beneficial for childbearing women today. These perspectives also inform future practice and research into perineal care, whilst making us cautious about political influences that could lead to harmful trends in clinical practice. © 2010 Australian College of Midwives.

Background: There is a belief amongst midwives that Asian women are less likely to breastfeed compared to non-Asian women. The aim of this research was to compare the infant feeding decisions of Asian and non-Asian women on discharge from two Sydney hospitals, and at 6 and 12 weeks following birth. Participants: 235 Asian and 462 non-Asian first time mothers. Methods: A secondary analysis was undertaken into data from a randomised clinical trial of a perineal management technique (perineal warm packs). Simple descriptive statistics were used for analysis and Chi-square and logistic regression was used to examine differences between women from Asian and non-Asian backgrounds. Results: Compared with non-Asian women, Asian women were no less likely to exclusively breastfeed on discharge from hospital (83% vs. 87%, OR 0.7, 95% CI 0.4-1.2), at 6 weeks (60% vs. 61%, OR 1, 95% CI 0.7-1.4) or 12 weeks postpartum (51% vs. 56%, OR 0.8, 95% CI 0.6-1.2). They were, however, significantly more likely to be partially breastfeeding on discharge from hospital (10% vs. 2%, OR 5.3, 95% CI 2.3-12.4), at 6 weeks (22% vs. 11%, OR 1.9, 95% CI 1.2-3.2) and 12 weeks postpartum (17% vs. 8%, OR 2.2, 95% CI 1.2-3.9). Discussion: Asian women were more likely than non-Asian women to be giving their baby some breast milk at 6 and 12 weeks postpartum when partial breastfeeding was taken into account. This contradicts popular beliefs amongst midwives regarding the infant feeding practices of Asian women. Conclusion: Further research into this important issue is needed in order to improve breastfeeding support for women from different cultural backgrounds. The issue of causes of, and variations in, the levels of partial breastfeeding between different ethnic groups needs more investigation. Crown Copyright © 2009.

Objective: to explore the experiences of a small group of first-time mothers giving birth at home or in hospital. Design: a grounded theory methodology was used. Data were generated from in-depth interviews with women in their own homes. Setting: Sydney, Australia. Participants: 19 women were interviewed. Seven women who gave birth for the first time in a public hospital and seven women who gave birth for the first time at home were interviewed, and their experiences were contrasted with two mothers who gave birth for the first time in a birth centre, one mother who gave birth for the first time in a private hospital and two women who had given birth more than once. Results: these women shared common experiences of giving birth as 'novices'. Regardless of birth setting, they were all 'reacting to the unknown'. As they entered labour, the women chose different levels of responsibility for their birth. They also readjusted their expectations when the reality of labour occurred, reacted to the 'force' of labour, and connected or disconnected from the labour and eventually the baby. Implications for practice: knowing that first-time mothers, irrespective of birth setting, are essentially 'reacting to the unknown' as they negotiate the experience of birth, could alter the way in which care is provided and increase the sensitivity of midwives to women's needs. Most importantly, midwives need to be aware of the need to help women adjust their expectations during labour and birth. Identifying the 'novice' status of first-time mothers also better explains previous research that reports unrealistic expectations and fear that may be associated with first-time birthing. © 2008.

Objective: to determine women's and midwives' experiences of using perineal warm packs in the second stage of labour. Design: as part of a randomised controlled trial (Warm Pack Trial), women and midwives were asked to complete questionnaires about the effects of the warm packs on pain, perineal trauma, comfort, feelings of control, satisfaction and intentions for use during future births. Setting: two hospitals in Sydney, Australia. Participants: a randomised controlled trial was undertaken. In the late second stage of labour, nulliparous women (n=717) giving birth were randomly allocated to having warm packs (n=360) applied to their perineum or standard care (n=357). Standard care was defined as any second stage practice carried out by midwives that did not include the application of warm packs to the perineum. Three hundred and two nulliparous women randomised to receive warm packs (84%) received the treatment. Questionnaires were completed by 266 (88%) women who received warm packs, and 270 (89%) midwives who applied warm packs to these women. Intervention: warm, moist packs were applied to the perineum in the late second stage of labour. Findings: warm packs were highly acceptable to both women and midwives as a means of relieving pain during the late second stage of labour. Almost the same number of women (79.7%) and midwives (80.4%) felt that the warm packs reduced perineal pain during the birth. Both midwives and women were positive about using warm packs in the future. The majority of women (85.7%) said that they would like to use perineal warm packs again for their next birth and would recommend them to friends (86.1%). Likewise, 91% of midwives were positive about using the warm packs, with 92.6% considering using them in the future as part of routine care in the second stage of labour. Key conclusions: responses to questionnaires, eliciting experiences of women and midwives involved in the Warm Pack Trial, demonstrated that the practice of applying perin

Purpose: To determine the views of midwives towards perineal repair and the most effective way to teach and support midwives in developing this skill. Procedure: A questionnaire was distributed to 111 midwives who attended a 1-day seminar. Information was sought on a range of views relating to perineal repair, including experience, confidence, education and accreditation, attitudes and trends. Findings: One hundred and six (96%) questionnaires were returned. All respondents (100%) believed midwives should be taught to undertake perineal repair. The most important reason was to provide continuity of care for women. Experience increased confidence and enjoyment in undertaking perineal repair as well as lessening fears over the impact of suturing on women. Experience did not significantly impact on concerns regarding legal implications associated with perineal repair. Three quarters of respondents reported that midwifery students should have practical experience of perineal repair. There was strong support for doctors and midwives to undertake perineal repair education together (96%), preferably in a 1-day workshop format (56%); for standards to be set by the professional colleges (midwifery and obstetrics) (66%); for midwives and doctors to be accredited as competent before performing perineal repair independently (>90%) and for regular updates in perineal repair (93%). The majority of midwives (73%) felt that they were more likely to suture than 5 years ago, due mainly to a greater appreciation of woman centred care (35%). Over 60% of midwives said they would not suture a first-degree tear more than half of the time and 13% would not suture a second-degree tear more than half of the time. Principle conclusion: A desire to provide continuity of care appears to be a major motivator for midwives to learn to undertake perineal repair. There is need for standards to be set for perineal repair to encourage consistency in education. Perineal repair programs that involve mid

Background: Perineal warm packs are widely used during childbirth in the belief that they reduce perineal trauma and increase comfort during late second stage of labor. The aim of this study was to determine the effects of applying warm packs to the perineum on perineal trauma and maternal comfort during the late second stage of labor. Methods: A randomized controlled trial was undertaken. In the late second stage of labor, nulliparous women (n = 717) giving birth were randomly allocated to have warm packs (n = 360) applied to their perineum or to receive standard care (n = 357). Standard care was defined as any second-stage practice carried out by midwives that did not include the application of warm packs to the perineum. Analysis was on an intention-to-treat basis, and the primary outcome measures were requirement for perineal suturing and maternal comfort. Results: The difference in the number of women who required suturing after birth was not significant. Women in the warm pack group had significantly fewer third- and fourth-degree tears and they had significantly lower perineal pain scores when giving birth and on "day 1" and "day 2" after the birth compared with the standard care group. At 3 months, they were significantly less likely to have urinary incontinence compared with women in the standard care group. Conclusions: The application of perineal warm packs in late second stage does not reduce the likelihood of nulliparous women requiring perineal suturing but significantly reduces third- and fourth-degree lacerations, pain during the birth and on days 1 and 2, and urinary incontinence. This simple, inexpensive practice should be incorporated into second stage labor care. © 2007, Blackwell Publishing, Inc.

Objective: to determine risk factors for the occurrence of severe perineal trauma (third and fourth degree tears) during childbirth. Design: a prospective cohort study was conducted using the hospital's computerised obstetric information system. Additional data were gathered on women who sustained severe perineal trauma. Descriptive statistics and logistic regression were used to assess risk factors for severe perineal trauma. Midwives were asked to comment on possible reasons for severe perineal trauma. Written responses made by midwives were analysed using content analysis. Discussion groups with midwives were held to further explore their experiences. Setting: Royal Prince Alfred Hospital, Sydney, Australia. Participants: all women having vaginal births (n=6595) in a 2-year period between 1 April 1998 and 31 March 2000, in both the birth centre and the labour ward. Measurements and findings: 2% of women (n=134) experienced severe perineal trauma. One hundred and twenty-two women had third-degree tears and 12 had fourth-degree tears. Primiparity, instrumental delivery, Asian ethnicity and heavier babies were associated with an elevated risk of severe perineal trauma. Midwives identified several factors they believed contributed to severe perineal trauma. These were lack of effective communication with the woman during the birth, different birth positions, delivery technique, ethnicity and obstetric influences. Key conclusions: findings support current knowledge that primiparity, instrumental birth, heavier babies and being of Asian ethnicity are associated with increased rates of severe trauma. Specific attention needs to be paid to the strong association found between being of Asian ethnicity and experiencing severe perineal trauma. Implications for practice: further identification and validation of the concerns expressed by midwives to reduce severe perineal trauma is warranted so that preventative strategies can be used and researched. © 2006 Elsevier Ltd. All