From Liminality to Vitality: Infant Feeding Beliefs Among Refugee Mothers From Vietnam and Myanmar.

Infant feeding in traditional (non-White societies) is imbued within beliefs surrounding the human body and food. This article, framed within the liminality theory, demonstrates perspectives of 38 Vietnamese and Myanmarese refugee mothers. Situated within the postmodern methodological framework, innovative methods of in-depth interviewing and drawing were used to gather participant's subjectivities. As birthing renders the new mother and infant weak, the findings mirror a "liminality to vitality" nurturing continuum, acknowledging the (a) essentialism of bodily breast milk, (b) rituals that strengthen mothers for lactation, (c) lactation-inducing food, and (d) culturally symbolic non-milk food that promote an independence for nourishment other than from the maternal body. Health care professionals are called to value the importance of bodily vitality in birthing and clinical maternal-child health/nutrition spheres so that culturally specific services and consultations are rendered. Our findings also offer a platform to developing models of care for families from Vietnamese and four ethnic Myanmarese communities.

Postpartum breastfeeding experiences in the traditional-biomedical crossroads: A qualitative study using drawing with Vietnamese and Myanmarese refugee women in Australia.

AIMS: To explore how postpartum support networks, hospital stay and healthcare services had an impact on breastfeeding experiences of refugee women from Vietnam and Myanmar in Brisbane, Australia. DESIGN: A qualitative study guided by feminist methodological inquiry. METHODS: Semi-structured interviews and drawing exercises were conducted with recent (<10 years) and established (≥10 years) refugee women between July 2015 - June 2016. Verbal data were analysed thematically, whereas drawings were analysed with the critical visual analytical framework. RESULTS: The findings reflect how 36 mothers negotiated their breastfeeding experiences in the "traditional-biomedical" intersection (major theme) in face of changing support networks, social structures, hospital policies and postpartum services postresettlement (sub-themes). Tensions of cultural unfamiliarity in the western setting generally contributed to early breastfeeding cessation among recent arrivals, whereas social (extended families, tertiary education) and cultural (English literacy) capitals and a longer stay in Australia enabled established arrivals to integrate the traditional and western biomedical beliefs. CONCLUSION: The ability of established arrivals to integrate both traditional and western worldviews may assist in addressing breastfeeding uncertainties that affect recent arrivals. Perspectives of midwives from the western postnatal spheres merit future exploration. IMPACT: Positive early breastfeeding experiences lead to its long-term success. By identifying the impact that conflicting beliefs have on breastfeeding experiences of refugees in the western biomedical environment, this study suggests how interventions that focus on reinforcing maternal cultural and social capital could benefit community empowerment, healthcare and policy sectors nationally and globally.

Navigating motherhood and maternal transitional infant feeding: Learnings for health professionals.

Given the lifelong associations between infant diet and weight, understanding maternal transitional infant feeding decisions can assist efforts to establish healthy eating habits early in life. Feeding experiences were explored using semi-structured interviews with 15 first-time mothers who were selected based on their concerns about their infants' weight in an infant feeding survey. Thematic synthesis of the interview transcripts identified three main themes: (1) Expectations of a "responsible mother", (2) Trusting oneself and trust in others, and (3) From stress to successful feeding. Dominant social ideals of motherhood and infant behaviour influenced feeding practices, some of which are associated with obesity. Judgments of mothers' infant feeding practices and infant size alongside feeding and weight gain 'checklists' undermines maternal transitional feeding knowledge. Family-centred, non-judgmental guidance from peers, family members and health professionals would better support mothers to navigate the day-to-day reality of feeding and caring for an infant throughout the first year of life that is based on achievable personal goals rather than societal ideals.

Impact of Maternal Infant Weight Perception on Infant Feeding and Dietary Intake.

Introduction Obesity is a global problem that is challenging to prevent and expensive to treat. Early childhood interventions show promise in establishing lifelong healthy eating patterns, however a better understanding of how parental feeding practices develop is needed. The study aimed to investigate maternal perception of infant weight and its relationship to feeding practices and infant dietary intake. Methods A questionnaire was completed by 263 Queensland mothers of infants aged between 5 and 13 months. Logistic regression was used to describe the association between maternal feeding practices (restriction, pressure-to-eat, monitoring), parenting style (warmth, hostility), infant weight concern and infant dietary intake. Correlation and linear regression were used to identify relationships between maternal feeding practices, parenting style, infant weight concern and infant weight. Results Mothers were found to be more concerned about underweight than overweight, misjudge infants as being underweight and failed to recognise overweight infants. Underweight concern was associated with infant weight (r = -0.27, p < 0.01), early introduction of solids (OR 0.24, CI 0.11-0.51) and pressure-to-eat (r = 0.19, p < 0.01). Pressure-to-eat was associated to maternal perception of infant weight (r = - 0.21, p < 0.01), infant weight (r = - 0.17, p < 0.05) and lower fruit and vegetable intake (OR 0.50, CI 0.27-0.92). Restrictive feeding practices were correlated to overweight concern (r = 0.08, p < 0.05). Discussion Maternal infant weight perception and concerns are related to control feeding practices which can be detrimental to infant dietary intake. Inability to recognise healthy weight may ignite these concerns or fail to address infant feeding risk factors. Discussing healthy growth should be a fundamental component of strategies to support healthy infant feeding and eating.

Barriers and enablers to postpartum contraception among Aboriginal Australian women: factors influencing contraceptive decisions.

This qualitative research obtained insights into factors influencing postpartum contraception use among Aboriginal women in southern Queensland. Seventeen women participated in focus groups or interviews from July to October 2015 at an Aboriginal and Torres Strait Islander Community-Controlled Health Organisation. Data were analysed with open coding and thematic analysis. The results affirmed Aboriginal women want control over family planning. Participants indicated more could be done to improve health literacy and contraception uptake. A variety of family planning preferences were revealed, with an almost universal desire for increased access to postpartum contraception. Participants wanted information given antenatally and postnatally. Obtaining and using contraception were difficult for many. Social factors that hinder access such as shame, ideas surrounding women's health, cultural disengagement, social isolation and using childbearing to control relationships were identified. The reproductive outcomes of Aboriginal women often do not reflect their preferences. A mandate exists to provide information about and access to postpartum contraception, empowering women with greater control over their reproductive practices. Health professionals can play a key role in dismantling barriers to autonomous family planning by offering information and resources both antenatally and postnatally.

Loss of group memberships predicts depression in postpartum mothers.

PURPOSE: The postpartum period presents the highest risk for women's mental health throughout the lifespan. We aimed to examine the Social Identity Model of Identity Change in this context. More specifically, we investigated changes in social identity during this life transition and their consequences for women's postpartum mental health. METHODS: Women who had given birth within the last 12 months (N = 387) reported on measures of depression, social group memberships, and motherhood identification. RESULTS: Analyses indicated that a decrease in group memberships after having a baby, controlling for group memberships prior to birth, was associated with an increase in depressive symptomology. However, maintaining pre-existing group memberships was predictive of better mental health. New group memberships were not associated with depressive symptomology. Identification as a mother was a strong positive predictor of mental health in the postpartum period. CONCLUSIONS: The social identity model of identity change provides a useful framework for understanding postpartum depression. Interventions to prevent and treat postpartum depression might aim to support women in maintaining important social group networks throughout pregnancy and the postpartum period.

Women's questions about medicines in pregnancy - An analysis of calls to an Australian national medicines call centre.

BACKGROUND: For many medicines, safe use during pregnancy is not established and adherence is often poor due to safety concerns. Therefore, it is important to identify consumers' medicines information needs during pregnancy. MATERIALS AND METHODS: A retrospective, mixed methods analysis was conducted on eight years of pregnancy-related calls to an Australian national medicines call centre. The call profile of pregnancy and non-pregnancy-related questions were compared. Medicines involved in pregnancy calls were categorised by class (Anatomical Therapeutic Chemical (ATC)3 level), and Therapeutic Goods Administration pregnancy category. Questions in these calls were also themed by pregnancy stage. RESULTS: We identified 4573 pregnancy-related and 118 547 non-pregnancy-related calls. The caller profile for pregnancy-related calls was female (93.7%), asking for herself (83.0%), and while 70.1% of questions involved one medicine, 9.6% involved three or more medicines. Pregnancy enquiries were prompted more often by conflicting information, inadequate information or desire for a second opinion. For 1166 calls, where the stage of pregnancy was available, most questions concerned safety. Medication classified as 'safe' during pregnancy accounted for 34% of these questions. After antidepressants, most calls were made about over-the-counter (OTC) medicines (paracetamol, dexchlorpheniramine, codeine). Safe treatment for everyday conditions was of increasing concern as the pregnancy progressed. CONCLUSION: Pregnant women are concerned about the safety of medication use in pregnancy and a significant proportion overestimate risk. Psychotropic medication and fertility are strong drivers to seek information during preconception. Everyday illnesses and self-medication with OTC medication are a common concern throughout pregnancy, even though many medicines are safe to use.

A qualitative systematic review of maternal infant feeding practices in transitioning from milk feeds to family foods.

Evidence supports the establishment of healthy feeding practices early in life to promote lifelong healthy eating patterns protective against chronic disease such as obesity. Current early childhood obesity prevention interventions are built on extant understandings of how feeding practices relate to infant's cues of hunger and satiety. Further insights regarding factors that influence feeding behaviors in early life may improve program designs and outcomes. Four electronic databases were searched for peer-reviewed qualitative studies published between 2000 to 2014 with transitional infant feeding practice rationale from developed countries. Reporting transparency and potential bias was assessed using the Consolidated Criteria for Reporting Qualitative Research quality checklist. Thematic synthesis of 23 manuscripts identified three themes (and six sub-themes): Theme 1. Infant (physical cues and behavioural cues) focuses on the perceived signs of readiness to start solids and the feeding to influence growth and "health happiness." Theme 2. Mother (coping strategies and knowledge and skills) focuses on the early survival of the infant and the family and the feeding to satisfy hunger and influence infant contentment, and sleep. Theme 3. Community (pressure and inconsistent advice) highlights the importance of generational feeding and how conflicting feeding advice led many mothers to adopt valued familial or culturally established practices. Overall, mothers were pivotal to feeding decisions. Satisfying infant's needs to reach "good mothering" status as measured by societal expectations was highly valued but lacked consideration of nutrition, obesity, and long term health. Maternal interpretation of healthy infant feeding and successful parenting need attention when developing strategies to support new families.

Practice related factors that may impact on postpartum care for mothers and infants in Australian general practice: a cross-sectional survey.

BACKGROUND: While there is a significant focus on the health and well-being of women during pregnancy, labour and birth, much less emphasis is placed on the care of postpartum women and their infants in primary care following the birth. Some studies have investigated the role of GPs in postpartum care, and others examined facilitators and barriers to mothers accessing care. However there is little information available to investigate the effect of practice related factors on access to care of mothers and infants at this time. METHODS: A 20-item questionnaire for completion by the practice managers was mailed to 497 general practices in Southern Queensland, Australia between February and July 2013. Questionnaire items included practice demographics, practice procedures and personnel including appointment scheduling, billing, practice nurse function and qualifications and a free-text option for comments. Descriptive statistics are presented as numbers and percentages. Chi Squared test compared practice location with methods of identification of postpartum women, practice size with other Queensland data and ANOVA compared practice size with the number of postpartum appointments. Logistic regression was used to predict variables that were related to booked appointment times. Free text responses were grouped in common themes. RESULTS: The response rate was 27.4 %. At 67.2 % of the practices, mothers had to self-identify as needing a postpartum consultation and most consultations were allocated 15 minutes or less. Only 20 % of practices accepted the government insurance payment (bulk-billing) for all maternal and infant services, with more practices bulk-billing children only. Out-of-pocket expenses ranged from $10-$60. Nearly 80 % of practice nurses saw postpartum mothers or infants 'nearly always' or 'sometimes'. Approximately 30 % had midwifery or child health training. There were higher odds of longer booked appointment times for solo practitioner practices (unadj OR 3.30 95%CI 1.03-10.57), but no other variables predicted booked appointment times CONCLUSIONS: This study identified a number of practice related factors that, if addressed, could positively impact on postpartum care. These include ensuring ongoing practice relationships to assist with booking appropriate consultation times and guaranteeing that there are no financial impediments to women accessing care. Some factors can easily be adapted within practices. Others would require changes of policy at a local or national level.

How do rural placements affect urban-based Australian junior doctors' perceptions of working in a rural area?

Objectives The aim of the present study was to provide qualitative insights from urban-based junior doctors (graduation to completion of speciality training) of the effect of rural placements and rotations on career aspirations for work in non-metropolitan practices. Methods A qualitative study was performed of junior doctors based in Adelaide, Brisbane and Melbourne. Individual face-to-face or telephone semistructured interviews were held between August and October 2014. Thematic analysis focusing on participants' experience of placements and subsequent attitudes to rural practice was undertaken. Results Most participants undertook rural placements in the first 2 years after graduation. Although experiences varied, positive perceptions of placements were consistently linked with the degree of supervision and professional support provided. These experiences were linked to attitudes about working outside metropolitan areas. Participants expressed concerns about being 'forced' to work in non-metropolitan hospitals in their first postgraduate year; many received little warning of the location or clinical expectations of the placement, causing anxiety and concern. Conclusions Adequate professional support and supervision in rural placements is essential to encourage junior doctors' interests in rural medicine. Having a degree of choice about placements and a positive and supported learning experience increases the likelihood of a positive experience. Doctors open to working outside a metropolitan area should be preferentially allocated an intern position in a non-metropolitan hospital and rotated to more rural locations. What is known about the topic? The maldistribution of the Australian medical workforce has led to the introduction of several initiatives to provide regional and rural experiences for medical students and junior doctors. Although there have been studies outlining the effects of rural background and rural exposure on rural career aspirations, little research has focused on what hinders urban-trained junior doctors from pursuing a rural career. What does this paper add? Exposure to medical practice in regional or rural areas modified and changed the longer-term career aspirations of some junior doctors. Positive experiences increased the openness to and the likelihood of regional or rural practice. However, junior doctors were unlikely to aspire to non-metropolitan practice if they felt they had little control over and were unprepared for a rural placement, had a negative experience or were poorly supported by other clinicians or health services. What are the implications for practitioners? Changes to the process of allocating junior doctors to rural placements so that the doctors felt they had some choice, and ensuring these placements are well supervised and supported, would have a positive impact on junior doctors' attitudes to non-metropolitan practice.

Continuity of care in the post partum period: general practitioner experiences with communication.

Objectives Informational and management continuity of care assists in providing a seamless transition for women and infants from tertiary or secondary to primary care during the post partum period. Few studies have evaluated the interaction between different aspects of the health system following a woman's discharge from hospital after the birth of her infant. The present study describes how general practitioners (GPs) experience communications with hospitals and other post partum care providers relevant to continuity of care. Methods In the present cross-sectional study, a 52-item questionnaire adapted from a previously used survey was mailed to 932 GPs in southern Queensland, Australia, between February and July 2013. Questionnaire items included participant demographics, the timeliness and usability of discharge summaries, communication with other post partum care providers and consultation practices. Results The response rate was 17.4%. Nearly one-quarter of participants never or rarely received a hospital discharge summary in a timely manner and most considered the summaries somewhat useful. Few GPs (14.3%) had contact with or received information from domiciliary midwives who conducted post partum home visits. A higher proportion (38%) had some communication with a Child and Family Health nurse in the month before the survey. Conclusions Information flow from hospital to general practice and between other post partum care providers is less than ideal and may affect ongoing care for mothers and infants, especially those at risk. Knowledge exchange between healthcare services and initiatives to improve information sharing needs to be developed and implemented. What is already known on this topic? Transitions from tertiary or secondary care to primary care and between primary care providers are often times of vulnerability for patients, including women and infants in the post partum period. There is little information documenting communications between different maternity services and GPs that facilitate ongoing care. What does this paper add? There are significant gaps in the exchange of information about post partum women and infants from hospitals to GPs and a lack of communication between GPs and other post partum care providers, such as domiciliary midwives and Child and Family Health nurses. What are the implications for practitioners? Improvements in the timeliness, presentation and content of hospital discharge summaries, as well as enhancing channels of communication, collaboration, cooperation and information sharing between providers of community post partum care, are necessary if mothers are to receive the best care possible.

Postpartum consultations in Australian general practice.

Many GPs undertake postpartum care for women and their infants. GP follow-up enables early identification and management of problems, education and support for parenting, and reconnection with general practice following the birth. However, there is little information about GPs' understanding of their role in postpartum care and how it is undertaken. This cross-sectional survey of GPs in Southern Queensland, conducted between February and July 2013, describes the involvement of GPs in postpartum care. GPs were posted a 52-item questionnaire adapted from a previous Victorian GP study and were telephoned 2 weeks later. GPs completed the survey on paper or online. The response rate was 17.4% (163 GPs). Approximately 39% were uncertain whether women were happy with the GP-provided postpartum care. GPs' recommendations for the timing of postpartum reviews were inconsistent within and across birthing sectors and consultations took longer than anticipated. Developing guidelines around the timing and appropriate length of postpartum consultations could assist GPs in providing appropriate care for mothers and infants.

Beyond the hospital door: a retrospective, cohort study of associations between birthing in the public or private sector and women's postpartum care.

BACKGROUND: In Australia, maternity care is available through universal coverage and a parallel, competitive private health insurance system. Differences between sectors in antenatal and intrapartum care and associated outcomes are well documented but few studies have investigated differences in postpartum care following hospital discharge and their impact on maternal satisfaction and confidence. METHODS: Women who birthed in Queensland, Australia from February to May 2010 were mailed a self-report survey 4 months postpartum. Regression analysis was used to determine associations between sector of birth and postpartum care, and whether postpartum care experiences explained sector differences in postpartum well-being (satisfaction, parenting confidence and feeling depressed). RESULTS: Women who birthed in the public sector had higher odds of health professional contact in the first 10 days post-discharge and satisfaction with the amount of postpartum care. After adjusting for demographic and postpartum contact variables, sector of birth no longer had an impact on satisfaction (AOR 0.95, 99% CI 0.78-1.31), but any form of health professional contact did. Women who had a care provider's 24 hour contact details had higher odds of being satisfied (AOR 3.64, 95% CI 3.00-4.42) and confident (AOR 1.34, 95% CI 1.08- 1.65). CONCLUSION: Women who birthed in the public sector appeared more satisfied because they had higher odds of receiving contact from a health professional within 10 days post-discharge. All women should have an opportunity to speak to and/or see a doctor, midwife or nurse in the first 10 days at home, and the details of a person they can contact 24 hours a day.

Which mothers receive a post partum home visit in Queensland, Australia? A cross-sectional retrospective study.

OBJECTIVE: Although home visiting in the early post partum period appears to have increased, there are limited data defining which women receive a visit and none that include Queensland. We aimed to investigate patterns of post partum home visiting in the public and private sectors in Queensland. METHODS: Data were collected via a retrospective cross-sectional survey of women birthing in Queensland between 1 February and 31 May 2010 at 4 months post partum (n = 6948). Logistic regression was used to assess associations between receiving a home visit and sociodemographic, clinical and hospital variables. Analyses were stratified by public and private birthing sector because of significant differences between sectors. RESULTS: Public sector women were more likely to receive a visit from a nurse or midwife (from the hospital or child health sector) within 10 days of hospital discharge (67.2%) than private sector women (7.2%). Length of hospital stay was associated with home visiting in both sectors. Some vulnerable subpopulations in both sectors were more likely to be visited, whereas others were not. CONCLUSIONS: Home visiting in Queensland varies markedly between the public and private sector and is less common in some vulnerable populations. Further consideration to improving the equity of community post partum care in Queensland is needed.

Antenatal information sources for maternal and infant diet.

This report describes information sources accessed by pregnant women around antenatal and early infant diet. Australian women in their first pregnancy (n = 277) responded to questionnaires online and on paper between June 2010 and March 2011 as part of the Feeding Queensland Babies Study. Antenatal information sources are reported for maternal diet, breastfeeding and formula-feeding. Pregnant women sought and encountered information for their own and their infants' diet from many sources. Health care professionals provided antenatal dietary information for 80% of respondents and infant feeding advice for 69%. Relatives or friends were the respondents' largest reported information source for infant feeding, reported by 78%. Information on artificial baby milk was accessed on television by 77% and on the internet by 52% of respondents. Health care professionals should proactively support clients' informational needs and address encountered nutrition misinformation. Further research is necessary to establish the nature and accuracy of dietary information in the mass media.

Primary care of women after gestational diabetes mellitus: mapping the evidence-practice gap.

OBJECTIVE: To determine the extent to which preventive activities, including the ordering of an oral glucose tolerance test (OGTT) between 6 and 12 weeks of birth, are integrated into women's primary care postpartum visits after a gestational diabetes mellitus (GDM)-affected pregnancy. DESIGN AND SETTING: Prospective survey and retrospective chart audit of general practices that provide maternity shared care in south-east Queensland, July 2011 to June 2012. PARTICIPANTS: General practitioners (n = 38) and medical records of women to whom they provided care (n = 43 women). MAIN OUTCOME MEASURES: GPs' awareness and knowledge of GDM guidelines and delivery of postpartum preventive care. RESULTS: The response rate for the survey/chart audit was 47%. All respondents recommended an OGTT between 6 and 12 weeks; a variety of guidelines informed practice; and weight, blood pressure and infant feeding practices were regularly checked. Mental health status and diet and exercise were discussed less consistently. CONCLUSIONS: GPs surveyed knew guidelines around the timing and type of test for women who have experienced GDM, and the audit demonstrated that this knowledge is translated into practice. Adherence to preventive screening and advice was less consistent. This problem may exist due to the absence of a systems approach to care, resulting in a lost opportunity to systematically reduce the incidence of type 2 diabetes and promote the wellbeing of women and their infants.

Clinical guidelines for postpartum women and infants in primary care-a systematic review.

BACKGROUND: While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. METHODS: PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. RESULTS: Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. CONCLUSIONS: Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.

The impact of community health professional contact postpartum on breastfeeding at 3 months: a cross-sectional retrospective study.

This study investigated the effect of any health professional contact and the types of contact new mothers received in the first 10 days post-discharge on breastfeeding rates at 3 months. This cross-sectional retrospective self-report survey was distributed to women who birthed in Queensland, Australia between 1st February and 31st May 2010 at 4-5 months postpartum. Data were collected on pregnancy, birth, postpartum care and infant feeding. Logistic regression was used to assess the relationship between health professional contact and breastfeeding at 3 months. Data were analysed by birthing facility sector because of significant differences between sectors in health professional contact. The study cohort consisted of 6,852 women. Women in the public sector were more likely to be visited at home than women birthing in the private sector. Any health professional contact (AOR 1.65 99 % CI 0.98-2.76 public sector, AOR 0.78 99 % CI 0.59-1.03 private sector) and home visits (AOR 1.50 99 % CI 0.89-2.54 public sector, AOR 0.80 99 % CI 0.46-1.39 private sector) were not associated with breastfeeding at 3 months in either sector. A telephone call (AOR 2.07 99 % CI 1.06-4.03) or visit to a general practitioner (GP) (AOR 1.83 99 % CI 1.04-3.21) increased the odds of breastfeeding in public sector women. Health professional contact or home visiting in the first 10 days post-discharge did not have a significant impact on breastfeeding rates at 3 months. Post-discharge telephone contact for all women and opportunities for self-initiated clinic visits for women assessed to be at higher risk of ceasing breastfeeding may be the most effective care.

A qualitative study of pharmacy nurse providers of community based post-birth care in Queensland, Australia.

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

The views of mothers and GPs about postpartum care in Australian general practice.

BACKGROUND: The postpartum period is a time of increased morbidity for mothers and infants under 12 months, yet is an under-researched area of primary care. Despite a relatively clear framework for involving general practitioners (GPs) in antenatal care, the structure of maternity service provision in some Australian jurisdictions has resulted in highly variable roles of general practice in routine postpartum care. This study aimed to investigate the views and experiences of mothers and GPs about postpartum care in general practice. METHODS: This was a qualitative study of mothers and GPs in rural, regional and metropolitan areas of Queensland, Australia. Semi-structured interviews were conducted with 88 mothers and six general practitioners between September 2010 and February 2012. Interviews were recorded and transcribed verbatim. Data were analysed thematically and compared across groups. RESULTS: Three main themes emerged: The relationship between the mother and GP; practice management; and GP visits. This paper focuses on the theme GP visits and its subthemes: recommendations for GP visits; scope of practice; and content of a routine visit. Recommendations about GP visits given to mothers varied by birthing sector, obstetric provider and model of maternity care resulting in confusion amongst mothers about the timing and role of GPs in routine postpartum care. Similarly, GPs voiced concerns about a lack of consistent guidelines for their involvement in routine postpartum care. Although ideally placed to provide primary care to mothers and their infants in the postpartum period, the lack of consistent guidelines for the role of GPs is of concern to both the GPs and early parenting women. CONCLUSION: General practice is an important source of postpartum care for mothers and provides a basis for ongoing support for the family. More consistent guidelines and better coordination with other care providers would benefit both mothers and GPs.