South Australian rural women's views of their pregnancy, birthing and postnatal care.

INTRODUCTION: This study considered the views and experiences of 85 rural women, most of whom gave birth in two regional South Australian hospitals. METHOD: This descriptive survey used a validated questionnaire, modified for use in rural South Australia, which included open-ended questions to invite further comment. Women were invited to participate while in hospital after giving birth and those who agreed (n = 136) were mailed a questionnaire 6-8 weeks after the birth. Data were collected on demographic and other information including: age, smoking status, model of antenatal and birth care, birth method, women's views of their care in pregnancy, labour and after the birth, breastfeeding uptake and continuance rates, and prevalence of possible depression after birth using the Edinburgh Postnatal Depression Scale. Non-identifiable data were described using descriptive statistics and analysed using t-tests, 2 x 2 contingency tables and relative risks, as appropriate. Where available, comparisons were made with other rural and South Australian data. Qualitative data were themed by consensus. RESULTS: Eighty-five women (63%) returned a completed questionnaire. Rates of spontaneous vaginal birth were significantly lower in the study than for 5257 South Australian rural residents who gave birth in 2006 (n = 38, 45% vs 3057, 58%). While caesarean rates overall were similar, elective caesarean rates were higher (25% vs 15%), while fewer study women smoked throughout pregnancy (9% vs 24%). Overall, women in the study rated their care as 'very good' for antenatal care(59%), for labour and birth care (73%) and postnatal care (53%). More women stayed in hospital for 5 days or more than South Australian women overall (53% vs 40%). Open-ended comments confirmed reasons that were related to their choice. Breastfeeding was commenced by 95% of the women and 69% were breastfeeding at 6 weeks. CONCLUSIONS: The findings confirm Victorian rural women's ratings, and further highlight that in the postnatal period women often feel left to manage on their own, and are less than happy with their care.

The ten steps to successful breastfeeding in Australian hospitals.

Breastfeeding is universally acknowledged as important for the well-being of mothers and babies. The ten steps to successful breastfeeding have been promoted as a means of improving breastfeeding initiation and maintenance. This study aimed to assess the degree of implementation of the ten steps within Australian maternity hospitals and collect breastfeeding rates at discharge. A 55-term questionnaire, modified for Australian conditions, was mailed to all Australian hospitals listed as providing maternity care in the 1998 Hospital and Health Services Yearbook. Of 432 hospitals currently providing maternity care, 387 (90%) responded. High rates of implementation of steps 1a, 3, 4, 5 6, 8 and 9 were reported. The mean rate of women breastfeeding at discharge, from 283 responses, was 88%. Australian hospitals compare favourably with similar studies in international environments. Results from this study may be used to target areas for improvements in steps 1b, 2, 7 and 10. Australia-wide breastfeeding rates at discharge have not changed since 1983.

Clinical, psychosocial, and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women.

BACKGROUND: Day care is increasingly being used for complications of pregnancy, but there is little published evidence on its efficacy. We assessed the clinical, psychosocial, and economic effects of day care for three pregnancy complications in a randomised trial of day care versus standard care on an antenatal ward. METHODS: 395 women were randomly assigned day (263) or ward (132) care in a ratio of two to one, stratified for major diagnostic categories (non-proteinuric hypertension, proteinuric hypertension, and preterm premature rupture of membranes). The research hypothesis was that for these disorders, as an alternative to admission, antenatal day care will reduce specified interventions and investigations, result in no differences in clinical outcome, lead to greater satisfaction and psychological wellbeing, and be more cost-effective. Data were collected through case-note review, self-report questionnaires (response rates 81.0% or higher) and via the hospital's financial system. Analysis was by intention to treat. FINDINGS: All participants were included in the analyses. There were no differences between the groups in antenatal tests or investigations or intrapartum interventions. The total duration of antenatal care episodes was shorter in the day-care group than in the ward group (median 17 [IQR 5-9] vs 57 [35-123] h; p=0.001). Overall stay was also significantly shorter in the day-care group (mean 7.22 [SE 0.31] vs 8.53 [0.44]; p=0.014). The median number of care episodes was three (range one to 14) in the day-care group and two (one to nine) in the ward group (p=0.01). There were no statistically or clinically significant differences in maternal or perinatal outcomes. The day-care group reported greater satisfaction, with no evidence of unintended psychosocial sequelae. There was no significant difference in either average cost per patient or average cost per day of care. INTERPRETATION: Since clinical outcomes and costs are similar, adoption by maternity services of a policy providing specified women with the choice between admission and day-unit care seems appropriate.

The psychosocial outcomes of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women.

BACKGROUND: Although antenatal day care is becoming increasingly common, there is little evidence as to the psychosocial efficacy of this model of care. AIM: We aimed to assess the broader psychosocial impact of antenatal day care compared with admission to hospital. METHODS: We carried out a randomised trial of 395 women, randomly assigned in a 2 : 1 ratio between day care and antenatal ward, stratified for major diagnostic categories (proteinuric hypertension, non-proteinuric hypertension and preterm premature rupture of membranes). Main outcome measures--self-report questionnaires (response rates ranging from 80 to 90%) were sent to women's homes four days after randomisation and seven weeks after delivery. RESULTS: Overall, there were statistically significant differences favouring day care in 12 of 28 items at four days post-randomisation, with no differences in the two groups for the other 16 items. At seven weeks postdelivery, we found differences in eight of 28 items favouring day care, with no differences in the two groups for the other 20 items. The types of items indicating a sustained difference covered a range of aspects of care and included satisfaction with staff, continuity of carer, information transfer, and social support. There were no differences in relation to infant feeding and relationship with the baby. CONCLUSIONS: Day care has an effect on women's satisfaction with care but does not produce broader psychosocial outcomes.