Midwifery knowledge of equitable and culturally safe maternity care for Aboriginal women.

BACKGROUND: The Birthing on Noongar Boodjar project (NHMRC Partnership Project #GNT1076873) investigated Australian Aboriginal women and midwives' views of culturally safe care during childbearing. This paper reports on midwifery knowledge of Aboriginal women's cultural needs, their perceptions of health systems issues, and their ability to provide equitable and culturally safe care. METHOD: A qualitative study framed by an Indigenous methodology and methods which supported inductive, multilayered analyses and consensus-driven interpretations for two clinical midwife data groups (n = 61) drawn from a larger project data set (n = 145) comprising Aboriginal women and midwives. FINDINGS: Midwives demonstrated limited knowledge of Aboriginal women's cultural childbearing requirements, reported inadequate access to cultural education, substituted references to women-centered care in the absence of culturally relevant knowledge and consistently expressed racialized assumptions. Factors identified by midwives as likely to influence the midwifery workforce enabling them to provide culturally safe care for Aboriginal women included more professional development focused on improving understandings of cultural birth practices and health system changes which create safer maternal health care environments for Aboriginal women. CONCLUSIONS: Individual, workforce, and health systems issues impact midwives' capability to meet Aboriginal women's cultural needs. An imperative exists for effective cultural education and improved professional accountability regarding Aboriginal women's perinatal requirements and significant changes in health systems to embed culturally safe woman-centered care models as a means of addressing racism in health care.

Identifying psychosocial risk among mothers in an Australian private maternity setting: A pilot study.

BACKGROUND: Psychosocial assessment and depression screening are recommended for all pregnant and postnatal women in Australia. However, women who give birth in private maternity settings remain less likely to participate in psychosocial assessment programs, making it difficult to comment on the potential resource implications. AIMS: To describe the psychosocial profile of a sample of women who had recently given birth in a private hospital and to examine the acceptability and feasibility of introducing psychosocial assessment as a routine component of maternity care. MATERIALS AND METHODS: Two hundred and twenty participants were recruited in a four-month period from a private tertiary hospital located in Murdoch, Western Australia. All participants completed the Edinburgh Depression Scale (EDS) and a Antenatal Risk Questionnaire (ANRQ) prior to discharge via an iPad. RESULTS: The mean total score for the EDS was 4.77 (SD = 3.93), with 5% of women scoring above the recommended cut-off of 13 or more. The mean total score for the ANRQ was 17.73 (SD = 10.72). 45.0% of all women endorsed no significant risk factors. The proportion of women scoring above the recommended ANRQ cut-off of 23 or more was 32.3%. Approximately 11% of women were referred for additional support or treatment. Acceptability of the ANRQ was high at 97.3%. CONCLUSIONS: This study describes the psychosocial profile of a sample of women who recently gave birth in an Australian private maternity hospital and demonstrates that with additional resources, the implementation of psychosocial assessment as a routine component of maternity care was feasible and highly acceptable in this setting.

Promoting the uptake of preventative Aboriginal child health policy in Western Australia.

PROBLEM: Australian Aboriginal children are over-represented on all negative health indicators compared with non-Aboriginal children.Contributing factors to the disparity include the impact of historical events, racism and social determinants of health. Despite the benefits of child health checks, offered through the Medicare Benefit Schedule and community health services, uptake of these is low. DESIGN: In 2012, Western Australia Health implemented the Enhanced Aboriginal Child Health Schedule (EACHS) policy to address specific health needs of Aboriginal children. The Aboriginal Child Heath Project (the Project), was a five-year initiative funded through the Council of Australian Governments. Project staff promoted the profile of preventative child health and the uptake of the EACHS policy across the state by agencies operating in the sector. SETTING: Western Australia. KEY MEASUREMENTS FOR IMPROVEMENT: Reach of the implementation workshop was measured by the number of staff attending policy implementation and the total number for agencies represented. One measure of impact was the number of agencies requesting the EACHS policy who adapted or adopted it to deliver evidence based comprehensive child health programs. STRATEGIES FOR CHANGE: The Project offered policy implementation workshops to health staff delivering services to young Aboriginal children. In addition to the evidence-based policy, a suite of resources were made available to support service delivery. EFFECTS OF CHANGE: The EACHS is a framework used by agencies to deliver consistent care and support governance when providing child health services to Aboriginal families across Western Australia. LESSONS LEARNT: Providing a policy that was consistent with identified service strengths allowed agencies to individually build their capacity to deliver child health checks, using existing resources, at their own pace.

A study of in-hospital midwifery practices that affect breastfeeding outcomes.

Whilst breastfeeding is undoubtedly best for both mother and baby, many factors influence a woman's decision about whether to start and when to cease feeding. This study sought to determine which variables, influenced by midwifery practice, may influence the length of breastfeeding. Mothers who had given birth to a live baby at a Perth private hospital were invited to complete a validated, anonymous questionnaire asking about their breastfeeding experience, both in hospital and following discharge. The response rate was 50% (n=266). Although 94% of women were breastfeeding on discharge from hospital, this rate reduced to 59% at 6 months and 21% at 12 months. The mean duration of breastfeeding was 7.4 months (SD +/- 4.1). Of five variables thought to be associated with an increased length of breastfeeding, only two were found to be statistically significant: whether a mother could independently attach the baby on discharge (p=0.003) and whether or not artificial baby milk was administered in hospital (p<0.001). In order to improve breastfeeding rates, education for both mothers and midwives must be targeted towards ensuring mothers are able to independently attach their baby on discharge from hospital. The findings also support the discouragement of artificial feeding unless there is a medical indication or the mother has made an informed request.

Graduated compression stockings for the prevention of postoperative venous thromboembolism in obstetric patients: a best practice implementation project.

AIMS: The aims of this project were twofold: to compare our current venous thromboembolism management in postoperative Caesarean section patients with the current best evidence on the use of graduated compression stockings and to standardise mechanical venous thromboembolism prophylaxis guidelines where multiple approaches had previously been used. METHOD: Thirty post-Caesarean section patients from a private hospital in Perth, Western Australia, were audited in a three-phase project: (i) the initial audit; (ii) clinical practice change including greater venous thromboembolism awareness and targeted education for midwives, standardised guidelines for mechanical prophylaxis, the development of an online venous thromboembolism module, a venous thromboembolism prophylaxis policy and heightened consumer involvement; and (iii) a follow-up audit. RESULTS: Our initial audit result demonstrated opportunities for improvement across all audit criteria. The interventions were undertaken over a 3-month period from August to October 2010. The follow-up audit results showed pleasing improvements across four audit criteria with one criterion unchanged. CONCLUSION: While the follow-up audit showed significant clinical improvements, the tight time frame for the development and implementation of multiple interventions created major challenges. We believe that given time to embed these changes, further improvements will be seen. Ongoing audits will be conducted to ensure the sustainability of these changes. The change in practice and subsequent improvements demonstrated at this private hospital provide evidence to encourage other midwifery units to pursue best practice in the management of this high-risk patient cohort.