"Make it better for the women and babies who come after me": Findings from women in Australia completing the international Babies Born Better survey.

BACKGROUND: Woman-centered maternity service delivery is endorsed by Australian federal health policy. Despite this, little evaluation of maternity care is conducted through the lens of women. We examined the responses of women birthing in Australia to the international Babies Born Better 2018 (Version 2) open-response survey. METHODS: An online international survey was distributed primarily by means of social media for women who had given birth in the last 5 years. In addition to closed-ended questions to describe the sample, a series of open-ended questions recorded women's experiences and satisfaction with their maternity care and place of birth. RESULTS: Of 1249 women who reported birthing their most recent baby in Australia and speaking English, 84% responded to at least one open-ended evaluation question. We thematically analyzed the data to identify three related themes of safety, choice, and respect for women. Women's experiences of these were closely tied to their model of care; those birthing at home with a private midwife more so reported positive experiences than those discussing obstetric care or, to a lesser extent, midwifery-led care in a hospital. There was a strong preference and need for (1) access to affordable care with a known practitioner from early pregnancy to postpartum, and (2) individualized care with the removal of restrictive hospital policies not aligned with woman-centered practice. DISCUSSION: This is the first Australian national study of women's maternity experiences and evaluations. Consistent with previous state-based research, women birthing in Australia continue to report maternity "care" that is physically and emotionally harmful. They also stated a need to address the psychosocial aspects of becoming a mother, in addition to the biological ones. Women and other birthing people must be at the center of defining quality maternity health service delivery, and services must be accountable for preventing and addressing harm, as defined by all birthing people.

Proceedings of the 2022 NHLBI and OASH state of the science in transfusion medicine symposium.

BACKGROUND: State of the Science (SoS) meetings are used to define and highlight important unanswered scientific questions. The National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, and the Office of the Assistant Secretary for Health (OASH), Department of Health and Human Services held a virtual SoS in transfusion medicine (TM) symposium. STUDY DESIGN AND METHODS: In advance of the symposium, six multidisciplinary working groups (WG) convened to define research priorities in the areas of: blood donors and the supply, optimizing transfusion outcomes for recipients, emerging infections, mechanistic aspects of components and transfusion, new computational methods in transfusion science, and impact of health disparities on donors and recipients. The overall objective was to identify key basic, translational, and clinical research questions that will help to increase and diversify the volunteer donor pool, ensure safe and effective transfusion strategies for recipients, and identify which blood products from which donors best meet the clinical needs of specific recipient populations. RESULTS: On August 29-30, 2022, over 400 researchers, clinicians, industry experts, government officials, community members, and patient advocates discussed the research priorities presented by each WG. Dialogue focused on the five highest priority research areas identified by each WG and included the rationale, proposed methodological approaches, feasibility, and barriers for success. DISCUSSION: This report summarizes the key ideas and research priorities identified during the NHLBI/OASH SoS in TM symposium. The report highlights major gaps in our current knowledge and provides a road map for TM research.

A systematic review of the cost-effectiveness of maternity models of care.

OBJECTIVES: In this systematic review, we aimed to identify the full extent of cost-effectiveness evidence available for evaluating alternative Maternity Models of Care (MMC) and to summarize findings narratively. METHODS: Articles that included a decision tree or state-based (Markov) model to explore the cost-effectiveness of an MMC, and at least one comparator MMC, were identified from a systematic literature review. The MEDLINE, Embase, Web of Science, CINAHL and Google Scholar databases were searched for papers published in English, Arabic, and French. A narrative synthesis was conducted to analyse results. RESULTS: Three studies were included; all using cost-effectiveness decision tree models with data sourced from a combination of trials, databases, and the literature. Study quality was fair to poor. Each study compared midwife-led or doula-assisted care to obstetrician- or physician-led care. The findings from these studies indicate that midwife and doula led MMCs may provide value. CONCLUSION: The findings of these studies indicate weak evidence that midwife and doula models of care may be a cost-effective or cost-saving alternative to standard care. However, the poor quality of evidence, lack of standardised MMC classifications, and the dearth of research conducted in this area are barriers to conclusive evaluation and highlight the need for more research incorporating appropriate models and population diversity.

A review of the prevalence, trends, and determinants of coexisting forms of malnutrition in neonates, infants, and children.

OBJECTIVE: Coexisting Forms of Malnutrition (CFM) refers to the presence of more than one type of nutritional disorder in an individual. Worldwide, CFM affects more than half of all malnourished children, and compared to standalone forms of malnutrition, CFM is associated with a higher risk of illness and death. This review examined published literature for assessing the prevalence, trends, and determinants of CFM in neonates, infants, and children. METHODS: A review of community-based observational studies was conducted. Seven databases, (CINAHL, Cochrane Library, EMBASE, Medline, PubMed, Scopus, and Web of Science) were used in December-2021 to retrieve literature. Google, Google Scholar and TROVE were used to search for grey literature. Key stakeholders were also contacted for unpublished documents. Studies measuring the prevalence, and/or trends, and/or determinants of CFM presenting in individuals were included. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for prevalence and longitudinal studies. RESULTS: The search retrieved 14,207 articles, of which 24 were included in this review. The prevalence of CFM varied by geographical area and specific types. In children under 5 years, the coexistence of stunting with overweight/obesity ranged from 0.8% in the United States to over 10% in Ukraine and Syria, while the prevalence of coexisting wasting with stunting ranged from 0.1% in most of the South American countries to 9.2% in Niger. A decrease in CFM prevalence was observed in all countries, except Indonesia. Studies in China and Indonesia showed a positive association between rurality of residence and coexisting stunting with overweight/obesity. Evidence for other risk and protective factors for CFM is too minimal or conflicting to be conclusive. CONCLUSION: Evidence regarding the prevalence, determinants and trends for CFM is scarce. Apart from the coexistence of stunting with overweight/obesity, the determinants of other types of CFM are unclear. CFM in any form results in an increased risk of health adversities which can be different from comparable standalone forms, thus, there is an urgent need to explore the determinants and distribution of different types of CFM.

Reproducing fear: the effect of birth stories on nulligravid women's birth preferences.

OBJECTIVE: Preference for caesarean birth is associated with higher fear and lower self-efficacy for vaginal birth. Vicarious experience is a strong factor influencing self-efficacy in nulligravid women, and is increasingly accessible via digital and general media. This study assessed the effect of exposure to different birth stories on nulligravid women's childbirth preferences and the factors mediating these effects. METHODS: Nulligravid women (N = 426) were randomly allocated to one of four conditions exposing them to written birth stories. Stories varied by type of birth (vaginal/caesarean) and storyteller evaluation (positive/negative) in a 2 × 2 design. Childbirth preference, fear of labour and vaginal birth, and self-efficacy for vaginal birth were measured before and after exposure via a two-way between groups analysis of covariance. Hierarchical regression models were used to determine the mediating effects of change in childbirth fear and childbirth self-efficacy. RESULTS: Variations in type of birth and storyteller evaluation significantly influenced childbirth preferences (F (1, 421) = 44.78, p < 0.001). The effect of vaginal birth stories on preference was significantly mediated by fear of labour and vaginal birth and self-efficacy. Effects of exposure to caesarean birth stories were not explained by changes in fear or self-efficacy. CONCLUSIONS: Childbirth preferences in nulligravid women can be significantly influenced by vicarious experiences. For stories about vaginal birth, the influence of birth stories on women's fear and self-efficacy expectancy are partly responsible for this influence. The findings highlight the importance of monitoring bias in vicarious experiences, and may inform novel strategies to promote healthy childbirth.

Variations in outcomes for women admitted to hospital in early versus active labour: an observational study.

BACKGROUND: There is no available evidence for the prevalence of early labour admission to hospital or its association with rates of intervention and clinical outcomes in Australia. The objectives of this study were to: estimate the prevalence of early labour admission in one hospital in Australia; compare rates of clinical intervention, length of hospital stay and clinical outcomes for women admitted in early (< 4 cm cervical dilatation) or active (≥4 cm) labour; and determine the impact of recent recommendations to define early labour as < 5 cm on the findings. METHODS: We conducted a retrospective cohort study using medical record data from a random sample of 1223 women from live singleton births recorded between July 2013 and December 2015. Analyses included women who had spontaneous onset of labour at ≥37 weeks gestation whilst not a hospital inpatient, who had not scheduled a caesarean section before labour onset or delivered prior to hospital admission. Associations between timing of hospital admission in labour and clinical intervention, outcomes and hospital stay were assessed using logistic regression. RESULTS: Between 32.4% (< 4 cm) and 52.9% (< 5 cm) of eligible women (N = 697) were admitted to hospital in early labour. After adjustment for potential confounders, women admitted in early labour (< 4 cm) were more likely to have their labour augmented by oxytocin (AOR = 3.57, 95% CI 2.39-5.34), an epidural (AOR = 2.27, 95% CI 1.51-3.41), a caesarean birth (AOR = 3.50, 95% CI 2.10-5.83), more vaginal examinations (AOR = 1.73, 95% CI = 1.53-1.95), and their baby admitted to special care nursery (AOR = 1.54, 95% CI = 1.01-2.35). Defining early labour as < 5 cm cervical dilatation produced additional significant associations with artificial rupture of membranes (AOR = 1.41, 95% CI = 1.02-1.95), assisted vaginal birth (AOR = 1.96, 95% CI = 1.12-3.41) neonatal resuscitation (AOR = 1.73, 95% CI = 1.01-2.99) and longer maternal hospital stay (AOR = 1.21, 95% CI = 1.04-1.40). CONCLUSIONS: Findings provide preliminary evidence that a notable proportion of labouring women are admitted in early labour and are more likely to experience several medical procedures, neonatal resuscitation and admission to special care nursery, and longer hospital stay.

Factors promoting or inhibiting normal birth.

BACKGROUND: In response to rising rates of medical intervention in birth, there has been increased international interest in promoting normal birth (without induction of labour, epidural/spinal/general anaesthesia, episiotomy, forceps/vacuum, or caesarean section). However, there is limited evidence for how best to achieve increased rates of normal birth. In this study we examined the role of modifiable and non-modifiable factors in experiencing a normal birth using retrospective, self-reported data. METHODS: Women who gave birth over a four-month period in Queensland, Australia, were invited to complete a questionnaire about their preferences for and experiences of pregnancy, labour, birth, and postnatal care. Responses (N = 5840) were analysed using multiple logistic regression models to identify associations with four aspects of normal birth: onset of labour, use of anaesthesia, mode of birth, and use of episiotomy. The probability of normal birth was then estimated by combining these models. RESULTS: Overall, 28.7% of women experienced a normal birth. Probability of a normal birth was reduced for women who were primiparous, had a history of caesarean, had a multiple pregnancy, were older, had a more advanced gestational age, experienced pregnancy-related health conditions (gestational diabetes, low-lying placenta, high blood pressure), had continuous electronic fetal monitoring during labour, and knew only some of their care providers for labour and birth. Women had a higher probability of normal birth if they lived outside major metropolitan areas, did not receive private obstetric care, had freedom of movement throughout labour, received continuity of care in labour and birth, did not have an augmented labour, or gave birth in a non-supine position. CONCLUSIONS: Our findings highlight several relevant modifiable factors including mobility, monitoring, and care provision during labour and birth, for increasing normal birth opportunity. An important step forward in promoting normal birth is increasing awareness of such relationships through patient involvement in informed decision-making and implementation of this evidence in care guidelines.

Talking Points: Women's Information Needs for Informed Decision-Making About Noninvasive Prenatal Testing for Down Syndrome.

Adequate knowledge is a vital component of informed decision-making; however, we do not know what information women value when making decisions about noninvasive prenatal testing (NIPT). The current study aimed to identify women's information needs for decision-making about NIPT as a first-tier, non-contingent test with out-of-pocket expense and, in turn, inform best practice by specifying the information that should be prioritized when providing pre-test counseling to women in a time-limited scenario or space-limited decision support tool. We asked women (N = 242) in Australia to indicate the importance of knowing 24 information items when making a decision about NIPT and to choose two information items they would most value. Our findings suggest that women value having complete information when making decisions about NIPT. Information about the accuracy of NIPT and the pros and cons of NIPT compared to other screening and invasive tests were perceived to be most important. The findings of this study can be used to maximize the usefulness of time-limited discussions or space-limited decision support tools, but should not be routinely relied upon as a replacement for provision of full and tailored information when feasible.

Choosing a Model of Maternity Care: Decision Support Needs of Australian Women.

BACKGROUND: Access to information on the features and outcomes associated with the various models of maternity care available in Australia is vital for women's informed decision-making. This study sought to identify women's preferences for information access and decision-making involvement, as well as their priority information needs, for model of care decision-making. METHODS: A convenience sample of adult women of childbearing age in Queensland, Australia were recruited to complete an online survey assessing their model of care decision support needs. Knowledge on models of care and socio-demographic characteristics were also assessed. RESULTS: Altogether, 641 women provided usable survey data. Of these women, 26.7 percent had heard of all available models of care before starting the survey. Most women wanted access to information on models of care (90.4%) and an active role in decision-making (99.0%). Nine priority information needs were identified: cost, access to choice of mode of birth and care provider, after hours provider contact, continuity of carer in labor/birth, mobility during labor, discussion of the pros/cons of medical procedures, rates of skin-to-skin contact after birth, and availability at a preferred birth location. This information encompassed the priority needs of women across age, birth history, and insurance status subgroups. CONCLUSIONS: This study demonstrates Australian women's unmet needs for information that supports them to effectively compare available options for model of maternity care. Findings provide clear direction on what information should be prioritized and ideal channels for information access to support quality decision-making in practice.

Venous access for hematopoietic progenitor cell collection: An international survey by the ASFA HPC donor subcommittee.

PURPOSE: Hematopoietic Progenitor Cell (HPC) collection by apheresis is performed in patients and donors to obtain HPCs for transplantation. Although studies have shown these procedures to be safe, successful collection cannot be performed without establishment of venous access. This project's objective was to ascertain the current practices of donor vein assessment and central venous catheter (CVC) usage. METHODS: The American Society for Apheresis (ASFA) HPC subcommittee created an electronic survey about precollection vein assessment and line placement, care, and removal in autologous and allogeneic donors. It was distributed to >5,000 possible participants, with one response analyzed per institution. RESULTS: One hundred centers performing autologous and/or allogeneic procedures provided adequate responses for analysis. Donor vein assessment is most often performed by apheresis staff more than 1 week prior to collection. For patients with questionable access, the next step performed most often is secondary assessment for autologous procedures and CVC placement for allogeneic procedures. Most centers use interventional radiology to place CVCs in jugular veins on collection day with placement verification through electronic medical records. Verbal and written postinsertion CVC care instructions are routinely provided. The apheresis team frequently provides postinsertion CVC care for autologous patients. Heparin is used most often for CVC lock. When used, tissue plasminogen activator is usually instilled for up to 60 min. CONCLUSION: These data summarize the largest single survey of donor vein assessment at institutions performing HPC collections by apheresis. The variations identified in donor venous access practice warrant further investigation and consensus to establish best practices. J. Clin. Apheresis 31:529-534, 2016. © 2015 Wiley Periodicals, Inc.

Randomized Controlled Trial of an Improved Version of MobileMums, an Intervention for Increasing Physical Activity in Women with Young Children.

BACKGROUND: Women with young children (<5 years) are an important group for physical activity intervention. PURPOSE: The objective of the study was to evaluate the feasibility, acceptability, and efficacy of MobileMums-a physical activity intervention for women with young children. METHODS: Women were randomized to MobileMums (n = 133) or a control group (n = 130). MobileMums was delivered primarily via individually tailored text messages. Moderate to vigorous physical activity (MVPA) was measured by self-report and an accelerometer at baseline, end of the intervention (13 weeks), and 6 months later (9 months). Changes were analyzed using repeated-measures models. RESULTS: MobileMums was feasible to deliver and acceptable to women. Self-reported MVPA duration (minutes/week) and frequency (days/week) increased significantly post-intervention (13-week intervention effect 48.5 min/week, 95 % credible interval (CI) [13.4, 82.9] and 1.6 days/week, 95 % CI [0.6, 2.6]). Intervention effects were not maintained 6 months later. No effects were observed in accelerometer-derived MVPA. CONCLUSIONS: MobileMums increased women's self-reported MVPA immediately post-intervention. Future investigations need to target sustained physical activity improvements (ACTRN12611000481976).

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.

Women's Perceptions of Communication in Pregnancy and Childbirth: Influences on Participation and Satisfaction With Care.

In this study, 3,531 Queensland women, who had recently given birth, completed a questionnaire that included questions about their participation in decision making during pregnancy, their ratings of client-centered care, and perceived quality of care. These data tested a version of the Linguistic Model of Patient Participation in Care, adapted to the maternity context. The authors investigated how age and education influenced women's perceptions of their participation and quality of care. Hierarchical multiple regressions revealed that women's perceived ability to make decisions, and the extent of client-centered communication with maternity care providers, were the most influential predictors of participation and perceived quality of care. Participation in care predicted perceived quality of care, but the influence of client-centered communication by a care provider and a woman's confidence in decision making were stronger predictors of perceived quality of care. Age and education level were not important predictors. These findings extend and support the use of Linguistic Model of Patient Participation in Care in the maternity context.

Keeping it Natural: Does Persuasive Magazine Content Have an Effect on Young Women's Intentions for Birth?

Information in the popular media tends to be biased toward promoting the benefits of medicalized birth for low-risk pregnancies. We aimed to assess the effect of communicating the benefits of non-medicalized birth in magazine articles on women's birth intentions and to identify the mechanisms by which social communication messages affected women's intentions for birth. A convenience sample of 180 nulliparous Australian women aged 18-35 years were randomly exposed to a magazine article endorsing non-medicalized birth (using either celebrity or non-celebrity endorsement) or organic eating (control) throughout June-July 2011. Magazine articles that endorsed non-medicalized birth targeted perceived risk of birth, expectations for labor and birth, and attitudes toward birth. These variables and intention for birth were assessed by self-report before and after exposure. Exposure to a magazine article that endorsed non-medicalized birth significantly reduced women's intentions for a medicalized birth, regardless of whether the endorsement was by celebrities or non-celebrities. Changes in perceived risk of birth mediated the effect of magazine article exposure on women's intentions for a medicalized birth. Persuasive communication that endorses non-medicalized birth could be delivered at the population level and may reduce women's intentions for a medicalized birth.

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.