Australian, Irish, and Swedish women's comfort levels when breastfeeding in public.

BACKGROUND: Despite a flux of global initiatives to increase and sustain breastfeeding rates, challenges persist. The decision to commence and sustain breastfeeding is influenced by multiple, complex factors. Feelings of social embarrassment, shame, fear of judgement, and lack of confidence when breastfeeding in public, compound women's decisions to breastfeed and may result in formula feeding or early cessation of breastfeeding. A greater understanding of where and how women feel most comfortable when breastfeeding in public can assist in designing interventions to support the initiation and continuation of breastfeeding. METHODS: A cross-sectional survey was conducted with women living in Australia (n = 10,910), Sweden (n = 1,520), and Ireland (n = 1,835), who were currently breastfeeding or who had breastfed within the previous two years. Our aim was to explore where, and how often women breastfeed in public and to compare their levels of comfort when breastfeeding in public. Data were collected in 2018 using an anonymous online survey over a four-week period in Ireland, Australia, and Sweden, and were analyzed using SPSS Version 25. RESULTS: Most respondents were highly educated, with over 70% in each country reporting having a university or college degree. Observing women breastfeeding in public was more commonly reported to be a weekly or daily occurrence in Sweden (24.5%) and Australia (28%), than in Ireland (13.3%). Women in the participating countries reported breastfeeding in public most commonly whenever their babies needed feeding. Very few women never or rarely breastfed publicly. Coffee shops/cafes, restaurants, and parks were the most popular locations. In all three countries, partners were reported to be very supportive of breastfeeding in public, which enhanced breastfeeding women's comfort levels. When asked to score out of a maximum comfort level of 10, women reported higher mean levels of comfort when breastfeeding in front of strangers (Ireland M = 7.33, Australia M = 6.58, Sweden M = 6.75) than with those known to them, particularly in front of their father-in-law (Ireland M = 5.44, Australia M = 5.76, Sweden M = 6.66 out of 10), who scored lowest in terms of women's comfort levels. CONCLUSION: This study offers important insights into the experiences and comfort levels of women breastfeeding in public. Limitations include the anonymous nature of the surveys, thus preventing follow-up, and variances in terminology used to describe locations across the three settings. Recommendations are made for research to determine the relationships between the frequency of breastfeeding in public and breastfeeding women's perceived comfort levels, the influence of family members' perceptions of breastfeeding in public and women's experiences, and the experience of women who feel uncomfortable while breastfeeding in public, with a view to developing support measures.

Women's perceptions of factors needed to encourage a culture of public breastfeeding: a cross-sectional study in Sweden, Ireland and Australia.

BACKGROUND: Breastfeeding in the public sphere is known to be experienced as a problem for many women. It has been shown to arouse negative feelings among the public, depending on the attitude of those in the immediate surroundings. This contributes to the fact that many women hesitate to breastfeed in public and prepare themselves for potential adverse comments. METHODS: An online survey was used for an international cross-sectional study including women living in Sweden (n = 1252), Australia (n = 7602) and Ireland (n = 1597). Women who had breastfed within the previous two years were invited to participate through Facebook. One key open-ended question was presented, inviting women to respond to: "What do you think is important or needed to encourage a breastfeeding culture where breastfeeding in public is seen as normal?" During 2018, data were collected during a four-week period. A thematic analysis of women's responses was conducted separately in each country and then comparison and negotiation occurred once similarities between themes and subthemes were confirmed. Frequencies of subthemes were then determined and compared between the three countries. RESULTS: Seven subthemes developed from the data; 'Make breastfeeding visible in society'; 'Healthcare professionals support and knowledge regarding breastfeeding'; 'Education of the public'; 'Inviting environment'; 'Zero tolerance to other's unwanted opinions'; 'Focusing on the needs and rights of the breastfeeding dyad'; and 'Desexualize breastfeeding and women's' bodies in society'. Subthemes were integrated under two themes; 'Active supportive interventions needed for breastfeeding' and 'The obvious right of breastfeeding women and children to take a seat in the public sphere'. CONCLUSION: The common experience that exists today regarding public breastfeeding requires change towards normalization. Further collaborative research is recommended to meet the expressed requirements from women who wish to breastfeed in public.

E-professionalism and social media use amongst nurses and midwives: A cross-sectional study.

AIM: To describe nurses' and midwives' social media use, knowledge, attitudes and information needs, in the context of e-professionalism. A secondary aim was to identify any relationship between these variables and age, or professional role. BACKGROUND: Midwives and nurses are viewed by the public as trusted professionals. On social media, the boundary between professional and personal identities can be blurred. Previous research has explored how student nurses navigate professional behaviour online, or e-professionalism. However, confusion persists amongst established nurses and midwives, despite the policies which guide and regulate their online conduct. DESIGN: A cross-sectional designwas applied. The STROBE guideline informed reporting of the findings. METHODS: A validated survey tool was modified to the study setting. Responses to 17 survey items were analysed using Chi-square and Fisher's exact tests. Qualitative content analysis was conducted on responses to two open-ended questions. RESULTS: In total, 311 nurses and midwives from one Western Australian tertiary hospital participated between August 2019 and February 2020. Social media use was widespread (97.4%, n = 299). Associations were identified between age group and eight survey items assessing social media use, knowledge and attitudes. No associations were identified between professional role and social media use, knowledge and attitudes. Content analysis revealed five themes: Maintaining professional boundaries; Avoidance; Protecting self; Responsibilities and consequences; and Social media as a tool. CONCLUSIONS: Midwives and nurses in this study approached social media with caution yet many were curious about its potential. If midwives and nurses are to be held accountable to social media policies and use the benefits social media affords, they must be supported to evolve into proficient users by educators and policy makers. TWEETABLE ABSTRACT: Nurses and midwives must be supported through policy and education to embrace social media as a tool of the future.

Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial.

BACKGROUND: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. OBJECTIVE: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. METHODS: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. RESULTS: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. CONCLUSIONS: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12884-015-0601-5.

Spontaneous vaginal birth following induction with intravenous oxytocin: Three oxytocic regimes to minimise blood loss post birth.

BACKGROUND: No evidence was identified in relation to the downward titration/cessation of intravenous oxytocin post spontaneous vaginal birth, in the absence of postpartum haemorrhage (PPH); suggesting clinicians' management is based on personal preference in the absence of evidence. AIM: To determine the proportion of induced women with a spontaneous vaginal birth and PPH, when intravenous oxytocin was utilised intrapartum and ceased 15, 30 or 60minutes post birth. METHODS: This three armed pilot randomised controlled trial, was undertaken on the Birth Suite of an Australian tertiary obstetric hospital. Incidence of PPH was assessed using univariable and adjusted logistic regression, which compared the effect of titrating intravenous oxytocin post birth on the likelihood of PPH, relative to the 15minute titration group. FINDINGS: Postpartum haemorrhage occurred in 26% (30 of 115), 20% (23 of 116), and 22% (30 of 134) of women randomised to a 15, 30 and 60minute titration time post birth, with no statistically significant differences between groups. CONCLUSION: There was no difference in the incidence of PPH between the three groups. Therefore, we question the benefit of delaying cessation of intravenous oxytocin for 60minutes post birth. Further investigation in this cohort is recommended, to compare the incidence of PPH when intravenous oxytocin is ceased either immediately, or 30minutes post birth. This research is warranted, as an evidence-based framework is lacking, to guide midwives globally in relation to their management of intravenous oxytocin post an induced spontaneous vaginal birth, in the absence of PPH.

Women's experiences with breastfeeding in public: An integrative review.

BACKGROUND: Much evidence around public breastfeeding does not reflect experiences of the key stakeholder, the breastfeeding woman, and focuses upon the audience. Selective evidence has explored breastfeeding experiences revealing challenges with public breastfeeding as a serendipitous finding. Although women's experiences have been explored in specific contexts, insight into commonalities reflective of an international perspective is unknown. OBJECTIVE: to explore, review and synthesise published literature on women's experience with public breastfeeding. METHODS: An integrative review allows inclusion of findings beyond empirical evidence. Whittemore and Knafl's approach was used to capture and analyse evidence from varied sources to provide understanding of a phenomenon from diverse methodologies. PubMed, Medline, Ovid emBase, Scopus, Science Direct, the Cumulative Index of Nursing and Allied Health Literature and PsychINFO were searched. Inclusion criteria included publications in English after 2005 offering descriptions of women's experiences. Data evaluation included assessment of literature quality. A constant comparison approach involved comparing, analysing and drawing similar concepts into themes. FINDINGS: Integration of women's experience with public breastfeeding from 27 publications covering 12 countries revealed two key themes, what women shared as 'enhancing' and 'challenging'. Challenges included four subthemes: 'drawing attention', 'sexualisation of breasts', 'awareness of others' discomfort', and 'efforts not to be seen'. Enhancing incorporated subthemes: 'supportive audience' and 'confidence'. CONCLUSION: Challenges confirm an international commonality that women encounter during public breastfeeding suggesting a multilayered approach addressing community and societal behaviours is required. Insight to enhance public breastfeeding experiences offers direction to improve support.

Helpful and challenging aspects of breastfeeding in public for women living in Australia, Ireland and Sweden: a cross-sectional study.

BACKGROUND: Breastfeeding in public continues to be contentious with qualitative evidence confirming that women face many challenges. It is therefore important to gain understanding of not only the challenges but also what women perceive is helpful to breastfeed in public. METHODS: A cross-sectional study was conducted with women living in Australia, Ireland or Sweden currently breastfeeding or having breastfed within the previous 2 years. Our objective was to explore and compare what women do when faced with having to breastfeed in the presence of someone they are uncomfortable with and what women think is helpful and challenging when considering whether to breastfeed in public. Data were collected in 2018 from an online survey over a 4 week period in each country. Content analysis revealed data similarity and theme names and definitions were negotiated until consensus was reached. How often each theme was cited was counted to report frequencies. Helpful and challenging aspects were also ranked by women to allow international comparison. RESULTS: Ten themes emerged around women facing someone they were uncomfortable to breastfeed in the presence of with the most frequently cited being: 'made the effort to be discreet'; 'moved to a private location'; 'turned away' and 'just got on with breastfeeding'. Nine themes captured challenges to breastfeed in public with the following ranked in the top five across countries: 'unwanted attention'; 'no comfortable place to sit'; 'environment not suitable'; 'awkward audience' and 'not wearing appropriate clothing'. Nine themes revealed what was helpful to breastfeed in public with the top five: 'supportive network'; 'quiet private suitable environment'; 'comfortable seating'; 'understanding and acceptance of others' and 'seeing other mothers' breastfeed'. CONCLUSIONS: When breastfeeding in public women are challenged by shared concerns around unwanted attention, coping with an awkward audience and unsuitable environments. Women want to feel comfortable when breastfeeding in a public space. How women respond to situations where they are uncomfortable is counterproductive to what they share would be helpful, namely seeing other mothers breastfeed. Themes reveal issues beyond the control of the individual and highlight how the support required by breastfeeding women is a public health responsibility.

Gaining insight into the supportive care needs of women experiencing gynaecological cancer: A qualitative study.

AIM AND OBJECTIVES: To gain insight into the supportive care needs of Western Australian women experiencing gynaecological cancer. BACKGROUND: Meeting the supportive care needs of people living with cancer is becoming increasingly important as advances in cancer treatment contribute to growing numbers of survivors. International evidence suggests between 24%-56% of women with gynaecological cancer have unmet supportive care needs and that psychological challenges, information provision and holistic care are priorities. No qualitative investigation has previously explored women's journey of gynaecological cancer within the Australian setting. DESIGN: A qualitative descriptive design was used. METHODS: Women treated for gynaecological cancer were recruited from a tertiary public women's hospital in Western Australia. Thematic analysis was conducted on qualitative data collected from 190 women over 12 months through written open-ended survey responses and telephone interviews. The COnsolidated criteria for REporting Qualitative research (COREQ) guided presentation of results. RESULTS: Analysis yielded five themes and four subthemes: (a) Communication style directs the experience (subthemes: feeling supported; absence of empathy); (b) It's not just about the disease (subthemes: life has changed; holistic care); (c) A desire for information; (d) Drawing upon resilience; and (e) Navigating the system. DISCUSSION: Exploration of the women's needs leads to the discussion of three concepts. Communication styles, harnessing women's resilience and alternative models of care are evaluated for their capacity to improve care and women's quality of life into survivorship. Recommendations are made for further research and possible interventions that can be translated into the clinical setting. CONCLUSION: Women with gynaecological cancer described complex often unmet supportive care needs and interactions with the healthcare system. Insight gained directs suggestions for improved service provision. RELEVANCE TO CLINICAL PRACTICE: Improved patient-centred communication, harnessing resilience as a resource and alternative models of care for follow-up are encouraged as areas of improvement for clinicians and care services.

The practice reality of ward based midwifery care: An exploration of aspirations and restrictions.

BACKGROUND: This paper reports on research that explores the experience of the ward based midwife, as research suggests workplace balance is problematic. AIM: To explore the processes and practices around ward based clinical engagement and its impact in an Australian public tertiary obstetric unit. METHODS: A qualitative descriptive study was undertaken. Focus groups were used to gather data. Groups were audio recorded and transcribed verbatim. Thematic analysis was continued until data saturation was achieved. FINDINGS: Seven focus groups involving 40 midwives were conducted. Midwives' voices suggested tensions arose when their aspirations around core professional values and camaraderie were compromised by the practice realism of the ward. Furthermore, they described frustration with imposed restrictions which governed their working environment. These occurred outside the ward, had a direct impact on how it functioned, and were perceived to be out of the midwives' control. Midwives experiencing emotional distress revealed they were carrying a burden. Two burdens were described: disengagement and what have I missed? CONCLUSION: Thought must be given to how the art of midwifery is practiced on the ward. Ignoring the growing body of literature on this subject will be problematic for both midwives and women, as midwives will be disempowered to foster women's capabilities through tailored, supportive and respectful care.

Midwives' perceptions of women's mobile phone use and impact on care in birth suite.

BACKGROUND: Women's use of mobile phones while in birth suite has been recognised as a common occurrence. However, no evidence has been reported around midwives' perceptions of how women's mobile phone use impacts midwifery care in birth suite. OBJECTIVE: To explore midwives' perceptions of women's mobile phone use and impact on care in the labour and birth environment. METHODS: A qualitative descriptive study was undertaken. Transcriptions from focus groups were subjected to thematic analysis. FINDINGS: Ten focus groups involving 63 Australian midwives were conducted. Four key themes and corresponding subthemes were identified: 'considering consent' which encompassed the subthemes 'establishing boundaries' and 'taken by surprise'; 'competing with the phone' encompassing 'missing the experience' and 'delaying care'; 'being with woman' encompassing 'affecting relationships' and 'not my right to deny'; and finally 'bringing others into the room' with subthemes of 'keeping in touch' and 'seeking a second opinion'. CONCLUSIONS: This is the first study to explore midwives perceptions of women's mobile phone use and the impact on a midwife's ability to provide care in birth suite. Findings suggest that women's mobile phone use can influence the relationship between the midwife and the woman and contributes to delays in providing care. Midwives shared how they experienced tensions around their right to grant permission for their image to be recorded. Finally, mobile phones have allowed others not present in the birth suite to access women and influence their decision making. IMPLICATIONS FOR PRACTICE: It is widely recognised women are bringing their mobile phones into the labour and birth environment. Therefore, it is important we explore midwives perceptions around the tensions and concerns that exist, so they can be addressed.

Process evaluation of a peer-led antenatal breastfeeding class for fathers: perceptions of facilitators and participants.

BACKGROUND: The Parent Infant Feeding Initiative (PIFI) was a factorial, randomised controlled trial that aimed to prolong exclusive breastfeeding by targeting expecting fathers. One of the intervention strategies evaluated was a father-focused breastfeeding class facilitated by a male peer facilitator. The aim of this mixed-methods descriptive study was to 1) evaluate the feedback provided from participants of the class and 2) explore the motivations and experiences of volunteer male peer facilitators trained to deliver the class. METHODS: Father-focused breastfeeding antenatal (FFAB) classes were conducted in six Western Australian hospitals between August 2015 and December 2016. Following each peer facilitated FFAB class, expecting father participants completed an evaluation form to assess their satisfaction with the format, facilitation and content, in addition to whether their expectations and confidence to manage breastfeeding problems had changed. Feedback to open-ended questions was analysed using content analysis to identify learnings and suggestions for improvements. At the completion of PIFI, individual telephone interviews were undertaken with 14 peer facilitators to gain insight into their motivations for volunteering and experiences of conducting the classes. Transcripts from interviews were analysed using Braun and Clarke's six phases for thematic analysis. RESULTS: Participant evaluation forms were completed by 678 of the 697 father participants (98%). Overall satisfaction with class format, facilitation and content was high with 90% or more of fathers either strongly agreeing or agreeing with each positively-phrased evaluation item. Class participants enjoyed interacting with other fathers, appreciated validation of their role, were not always aware of the importance of breastfeeding or potential difficulties, valued the anticipatory guidance around what to expect in the early weeks of parenting and appreciated learning practical breastfeeding support strategies. Peer facilitators indicated they felt well prepared and supported to conduct FFAB classes. Analysis of interview transcripts revealed common experiences of the peer facilitators incorporating four themes: 'Highlights of being a facilitator', 'Challenges', 'Mourning the project completion' and 'Satisfaction with training and support'. CONCLUSION: Father-focused breastfeeding classes supported by volunteer male peer facilitators are a feasible and acceptable way of engaging fathers as breastfeeding supporters. TRIAL REGISTRATION: ACTRN12614000605695 . Registered 6 June 2014.

Women's mobile phone use in birth suite: A West Australian perspective.

Research investigating childbearing women's use of digital technology focuses on pregnancy and parenting, with none examining usage during labour. We explored the importance of having a mobile phone and how it was used in birth suite. This cohort study utilised women on a postnatal ward. Women (n = 300) who felt it was important to have a mobile phone were more likely than those who did not, to use their phone for social media and within an hour of birth. Few women used their phone whilst feeding their baby or felt phone usage would impact on quality time with their baby.

The supportive care needs of women experiencing gynaecological cancer: a Western Australian cross-sectional study.

BACKGROUND: Women diagnosed with gynaecological cancer experience supportive care needs that require care provision to reduce the impact on their lives. International evidence suggests supportive care needs of women with gynaecological cancer are not being met and provision of holistic care is a priority area for action. Knowledge on gynaecological cancer supportive care needs is limited, specifically comparison of needs and cancer gynaecological subtype. Our aim was to identify supportive care needs of Western Australian women experiencing gynaecological cancer, their satisfaction with help and explore associations between participant's demographic characteristics and identified needs. METHODS: A cross-sectional design incorporating a modified version of the Supportive Care Needs Survey - short form (SCNS-SF34) assessed 37 supportive care needs under five domains in conjunction with demographic data. Three hundred and forty three women with gynaecological cancer attending a tertiary public referral hospital completed the survey over 12 months. Statistical analysis was performed using the R environment for statistical computing. A linear regression model was fitted with factor scores for each domain and demographic characteristics as explanatory variables. RESULTS: Three hundred and three women (83%) identified at least one moderate or high level supportive care need. The five highest ranked needs were, 'being informed about your test results as soon as feasible' (54.8%), 'fears about cancer spreading' (53.7%), 'being treated like a person not just another case' (51.9%), 'being informed about cancer which is under control or diminishing (that is, remission)' (50.7%), and 'being adequately informed about the benefits and side-effects of treatments before you choose to have them' (49.9%). Eight of the top ten needs were from the 'health system and information' domain. Associations between supportive care items and demographic variables revealed 'cancer type', and 'time since completion of treatment' had no impact on level of perceived need for any domain. CONCLUSIONS: Western Australian women with gynaecological cancer identified a high level of supportive care needs. The implementation of a supportive care screening tool is recommended to ensure needs are identified and care is patient-centred. Early identification and management of needs may help to reduce the burden on health system resources for managing ongoing needs.

Midwives' experience of their education, knowledge and practice around immersion in water for labour or birth.

BACKGROUND: There is limited research examining midwives' education, knowledge and practice around immersion in water for labour or birth. Our aim was to address this gap in evidence and build knowledge around this important topic. METHODS: This mixed method study was performed in two phases, between August and December 2016, in the birth centre of a tertiary public maternity hospital in Western Australia. Phase one utilised a cross sectional design to examine perceptions of education, knowledge and practice around immersion in water for labour or birth through a questionnaire. Phase two employed a qualitative descriptive design and focus groups to explore what midwives enjoyed about caring for women who labour or birth in water and the challenges midwives experienced with waterbirth. Frequency distributions were employed for quantitative data. Thematic analysis was undertaken to extract common themes from focus group transcripts. RESULTS: The majority (85%; 29 of 34) of midwives surveyed returned a questionnaire. Results from phase one confirmed that following training, 93% (27 of 29) of midwives felt equipped to facilitate waterbirth and the mean waterbirths required to facilitate confidence was seven. Midwives were confident caring for women in water during the first, second and third stage of labour and enjoyed facilitating water immersion for labour and birth. Finally, responses to labour and birth scenarios indicated midwives were practicing according to state-wide clinical guidance. Phase two included two focus groups of seven and five midwives. Exploration of what midwives enjoyed about caring for women who used water immersion revealed three themes: instinctive birthing; woman-centred atmosphere; and undisturbed space. Exploration of the challenges experienced with waterbirth revealed two themes: learning through reflection and facilities required to support waterbirth. CONCLUSIONS: This research contributes to the growing knowledge base examining midwives' education, knowledge and practice around immersion in water for labour or birth. It also highlights the importance of exploring what immersion in water for labour and birth offers midwives, as this research suggests they are integral to sustaining waterbirth as an option for low risk women.

Exploring young pregnant smokers' experiences with a self-nominated non-smoking buddy.

INTRODUCTION: psychosocial interventions can increase the proportion of women who stop smoking in pregnancy. There is limited research exploring self-nominated, non-smoking buddy support, to assist young pregnant smokers to quit. METHODS: this qualitative descriptive study was embedded within a randomised controlled study assisting young (16 to 24 years) pregnant smokers to quit. Women were recruited from two public maternity hospitals in Western Australia. Interviews were performed every two weeks from recruitment to six weeks post birth. The study aim was to explore women's experiences with a self-nominated non-smoking buddy. Thematic analysis was utilised to identify common themes. FINDINGS: a total of 204 interviews were performed with 36 women, who had a mean of six interviews, with four conducted in pregnancy and two post birth. Two themes were revealed. The first 'Challenges of finding the right buddy' reflected the experiences women had in finding a non-smoking buddy to provide support and encompassed three sub themes; 'The only non-smoker I know', 'Reluctance to alter the existing relationship' and 'Limited discussion around expectations of buddy support'. The second theme 'Sustaining the buddy relationship' centred on the continuing relationship the woman had with her buddy and encompassed three sub themes; 'Consistent relationship', 'Changeable buddies' and 'Unofficial buddies'. CONCLUSION: our findings reveal the complexity of incorporating non-smoking buddy support into smoking cessation programs for young pregnant smokers. The characteristics and social environment of individual women may have the capacity to influence their ability to engage and sustain a relationship with a non-smoking buddy.

The perceptions and experiences of women who achieved and did not achieve a waterbirth.

BACKGROUND: There is a gap in knowledge and understanding relating to the experiences of women exposed to the opportunity of waterbirth. Our aim was to explore the perceptions and experiences of women who achieved or did not achieve their planned waterbirth. METHODS: An exploratory design using critical incident techniques was conducted between December 2015 and July 2016, in the birth centre of the tertiary public maternity hospital in Western Australia. Women were telephoned 6 weeks post birth. Demographic data included: age; education; parity; and previous birth mode. Women were also asked the following: what made you choose to plan a waterbirth?; what do you think contributed to you having (or not having) a waterbirth?; and which three words would you use to describe your birth experience? Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis was undertaken to extract common themes from the interviews. RESULTS: A total of 31% (93 of 296) of women achieved a waterbirth and 69% (203 of 296) did not. Multiparous women were more likely to achieve a waterbirth (57% vs 32%; p < 0.001). Women who achieved a waterbirth were less likely to have planned a waterbirth for pain relief (38% vs 52%; p = 0.24). The primary reasons women gave for planning a waterbirth were: pain relief; they liked the idea; it was associated with a natural birth; it provided a relaxing environment; and it was recommended. Two fifths (40%) of women who achieved a waterbirth suggested support was the primary reason they achieved their waterbirth, with the midwife named as the primary support person by 34 of 37 women. Most (66%) women who did not achieve a waterbirth perceived this was because they experienced an obstetric complication. The words women used to describe their birth were coded as: affirming; distressing; enduring; natural; quick; empowering; and long. CONCLUSIONS: Immersion in water for birth facilitates a shift of focus from high risk obstetric-led care to low risk midwifery-led care. It also facilitates evidence based, respectful midwifery care which in turn optimises the potential for women to view their birthing experience through a positive lens.

Obstetric and neonatal outcomes for women intending to use immersion in water for labour and birth in Western Australia (2015-2016): A retrospective audit of clinical outcomes.

BACKGROUND: Research supports water immersion for labour if women are healthy, with no obstetric or medical risk factors. AIMS: To evaluate the obstetric and neonatal outcomes of women intending to use immersion in water for labour or birth. METHODS: Retrospective audit of clinical outcomes for women intending to labour or birth in water conducted between July 2015 and June 2016, at a tertiary maternity hospital in Western Australia. Obstetric and neonatal data were collected from medical records. Multivariable logistic regression was utilised to investigate women who laboured in water stratified by those who birthed in water. RESULTS: A total of 502 women intended to labour or birth in water; 199 (40%) did not and 303 (60%) did. The majority of women using water immersion (179 of 303; 59%) birthed in water. Multiparous women were more likely than primparous to birth in water (73% vs 46%; P < 0.001). Women who birthed in water were at increased odds of: a first stage labour ≤240 min (odds ratio (OR) 2.56, 95% CI 1.34-4.87, P = 0.004); a second stage ≤60 min (OR 3.53, 95% CI 1.82-6.84, P < 0.000); a third stage labour of 11-30 min (OR 2.15, 95% CI 1.23-3.78, P = 0.008); and having an intact perineum (OR 3.10, 95% CI 1.70-5.64, P < 0.000). CONCLUSION: Not all women who set out to labour and birth in water achieve their aim. There is a need for high-quality collaborative research into this option of labour and birth, so women can make an informed choice around this birth option.

Nurses' perceptions of providing psychosexual care for women experiencing gynaecological cancer.

PURPOSE: To gain insight into how Western Australian nurses conceptualise the provision of psychosexual care for women undergoing gynaecological cancer treatment and how this aligns with nurses globally. METHODS: A qualitative descriptive design was chosen to facilitate insight into nurses' perspectives of their reality. Seventeen nurses working at a tertiary women's hospital in Western Australia participated in one-on-one interviews and were asked to describe their perceptions and identify factors that facilitate or challenge psychosexual care provision. RESULTS: Data analysis revealed five themes affecting the provision of psychosexual care: (1) Nurses use strategies to aid the conversation (subthemes: supporting the woman, facilitating engagement); (2) Women have unique psychosexual needs (subthemes: diversity, receptiveness); (3) Nurses are influenced by personal and professional experience and values (subthemes: confidence, values, making assumptions); (4) Systems within the health service affect care (subthemes: being supported by the system, working as a team); and (5) Society influences attitudes around sexuality. Nurses' views differed around whether these factors had a positive or negative impact on the conversation required to provide this care. CONCLUSIONS: Factors influencing nurses' provision of psychosexual care are multifaceted and differ amongst nurses. Recommended strategies to improve service provision include guidelines and documentation to integrate assessment of psychosexual issues as standard care, encouraging shared responsibility of psychosexual care amongst the multidisciplinary team and implementing education programs focussed on improving nurses' confidence and communication skills.

Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education.

BACKGROUND: Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women's knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions. METHODS: Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18-25 years, who were born in the survey country and did not study health sciences (n = 1390). RESULTS: One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women's knowledge of pregnancy and birth increased. CONCLUSION: Education sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women's capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.

Sexual health and sexual trauma in women with severe mental illness: An exploratory survey of Western Australian community mental health services.

Australian women attending community mental health services were surveyed to determine the relationship between sexual trauma, sexual activity, and sexual health seeking behaviors. Self-reported history of "forced sex" was 58.4% (n = 122 out of 220). Latent class analysis revealed a three-class model: "sexually active and health seeking," "low sexual activity and health seeking" and "low sexual activity and not health seeking." An association with general practitioner engagement and sexual health seeking behaviors was found. Rates of self-reported sexual trauma reinforce the need for screening and trauma informed care. Groupings may reflect different aspects of recovery associated with sexual health behaviors.