2023 Midwifery Possibilities Conference

About Bonnie Jones's work

Professional Indemnity Insurance for Private Midwives Within the ACT: Pilot Program

In Australia, privately practicing midwives are at constant risk of litigation as there is no insurance product that covers them for intrapartum care at home. Research indicates that midwives without access to indemnity insurance are more likely to increase their use of defensive practices. When facing litigation midwives are more likely to report a decrease in self-confidence, self-worth and experience ill health. These outcomes decrease the number of practicing private midwives in the workforce and negatively impact the quality of midwifery care that childbearing women receive. Research has shown that the typical home birth in Australia costs $4802.00 compared to $5463.00 for the woman to receive the same clinical care within a hospital setting.

The purpose of this project is to increase the support for privately practicing midwives in the ACT. It is proposed that a three-year pilot program be implemented which includes an insurance product for intrapartum care provision for appropriately endorsed midwives. To evaluate the effectiveness of the program, maternal and neonatal outcome measures, a cost-benefit analysis and satisfaction survey will be conducted at two time points, 18 months and 3 years. If this program proves to be effective, it could be expanded Australia wide. Private midwives will be encouraged to practice, knowing they are not in financial danger if they were to be involved in litigation and this increases womens’ options for care.

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About Cara Hession's work

Is This Safe? Educating Health Professionals on Medication Safety During Lactation

Continued breastfeeding is important for mothers and their babies with long term benefits for both. Further benefits include a decreased burden on the health care system and the subsequent decreased public spending. However, health professionals’ knowledge of medication safety during lactation has been shown to be a barrier to breastfeeding initiation and duration.

Conservative, non-individualised, inconsistent, or non-evidence-based information provided by healthcare workers to breastfeeding women has been demonstrated to negatively affect the breastfeeding journey. Inappropriate advice contributes to either the early cessation of breastfeeding or women opting against necessary medical treatment to continue breastfeeding. Specific education for all health professionals will help improve the provision of medication safety information during lactation.

To improve the quality and accuracy of medication information given to breastfeeding women a pilot in-service education program, based in a maternity unit with access for all health professionals, is proposed. A representative group will volunteer to take part in two education sessions during work hours to increase course uptake and to encourage course completion. Education and interprofessional activities will focus on medication safety during lactation for common medications and where to find up-to-date evidence. Pre- and multiple timepoint post- questionnaires will assess the effectiveness of the program as an intervention to improve health professionals’ knowledge, understanding and practice in the short and longer term.

Improving the quality and accuracy of information midwives and other health professionals provide to breastfeeding women will increase confidence in combining necessary medication with lactation, consequently improving both maternal and infant outcomes.

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About Emily Boyd's work

Outpatient Induction of Labour using Balloon Catheters

As induction of labour rates rise, women report poorer inpatient experiences. In 2020, 35.5% of Australian women who gave birth had an induction of labour. Additionally inpatient labour inductions have risen alongside hospital costs, and workload of midwives and obstetric staff.

Evidence indicates outpatient settings for balloon catheter inductions are safe and acceptable for women with low-risk pregnancies. Eligible women require low-risk, singleton pregnancies, cephalic presentation, intact membranes, induced for post-term pregnancies, fetal macrosomia, or gestational diabetes. However, data for high-risk pregnancies remain insufficient.

Outpatient induction of labour using balloon catheters are a feasible option for women, and inpatient facilities. It provides women with the advantage of greater comfort, the ability to relax, rest, and sleep by allowing them to initiate the labour process in a familiar environment, facilitating a more empowering experience.

Women have unique perspectives on what constitutes a safe and comfortable environment. This policy allows women booked for induction of labour to have balloon catheters placed and continue their cervical ripening at home. As a desired option among women, balloon catheter induction is considered a more natural intervention. Being able to experience the initial stages of labour through mechanical dilation and appropriate environments is preferred among women, as it emulates spontaneous early labour. By introducing an outpatient induction of labour using balloon catheters policy to the ACT can enrich women’s induction experiences while addressing staffing and cost efficiency.

Success will be evaluated through qualitative data collection on women’s preferences and experiences, alongside their labour and birth outcomes. The cost-effectiveness and staffing impact of the service will be gathered through quantitative measures.

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About Erin Griffin Danby's work

Midwife Burnout: Safeguarding Sleep Health Through Fatigue Risk-Management Rostering

Midwife burnout is a global concern, affecting midwives, birthing people, families, and healthcare systems. It leads to poor staff retention, increased workloads, and reduced wellbeing, ultimately negatively impacting care and experiences for pregnant and birthing people. Myriad (often cyclical) determinants of burnout exist. Staff shortages and shiftwork are significant contributors. Current rostering recommendations and guidelines are often unfeasible due to understaffing.

Research in other shiftwork industries show fatigue risk-management (FRM) rostering prioritising sleep health reduces burnout levels. A gap exists in the literature on burnout solutions for midwives, and no studies explore FRM rostering.

A two-phase study examining core rostering concerns, followed by a rostering trial based on FRM principles for midwives in Canberra, is proposed. This presentation will focus on the first phase.

Phase one would be mixed-methods study to understand midwives’ perceptions of rostering, and barriers and facilitators of FRM rostering. Data would be gathered via surveys, focus groups and / or interviews to inform phase two. Phase two will be the design and implementation of an FRM rostering trial for midwives. Evaluation of phase two will be through further surveys and interviews.

Although rostering alone cannot solve midwife burnout, it is hoped this research will underscore its significance by addressing the gap in the literature, highlighting the importance of midwives’ sleep health. 24-hour maternity care is essential. Shiftworking midwives report the highest burnout levels. The initial phase of this research sets the stage for phase two, and potential future research into safeguarding the sleep health of midwives.

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About Lara Jurkiewicz's work

Evening Primrose Oil for Cervical Ripening

In Australia in 2021, 44% of primiparous women had their labour induced. Recent research reveals induction of labour (IOL) is associated with a cascade of interventions, increased epidural rates together with higher rates of operative birth, perineal trauma, and neonatal morbidities.

International research with level one findings suggests that Evening Primrose Oil (EvPO) aids in cervical ripening, resulting in significantly improved Bishop’s scores, reduced labour duration, fewer caesareans and inductions using syntocinon. There are also no outpatient induction methods available in Australia. EvPO could allow women control over their induction and the ability to relax in their own homes during the latent phase of labour. Australian research on EvPO’s effects is lacking.

The purpose of this translational research project is to examine the outcomes of using EvPO for cervical ripening among primiparous women with a view to altering current policy and practice.

An ethics-approved locally based double-blind randomised controlled trial with a multifaceted approach will evaluate the effects of EvPO on cervical ripening of low-risk primiparous women at term. Clear exclusion criteria will ensure patient safety. Maternal and neonatal outcomes will be monitored. Potential benefits include reduced hospital admission times, decreased hospital overheads, improved birth outcomes and maternal satisfaction with care.

The trial’s findings will inform local policy and create opportunities for future evidence-based research opportunities. In a maternity model that puts timelines on gestation, and with increasing IOL rates, EvPO may be an effective, safe, and affordable method to achieve cervical ripening prior to birth.

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About Lucy Armitage's work

Mindfulness in Pregnancy: a feasibility study

Half of all pregnant women experience anxiety, expressed as fears about pregnancy, childbirth, and psychological distress. Increased perinatal anxiety is associated with significant comorbid short and long-term complications affecting both mother and baby. In Australia, increasing rates of birth interventions, including caesarean section, epidural analgesia use and induction of labour impact birth outcomes and the way in which women experience pregnancy, birth and manage early parenting.

As researchers explore ways to support wellbeing, mindfulness has been scientifically verified to support wellness in a range of conditions. Mindfulness in Pregnancy (MIP) is taught by trained facilitators sharing techniques and daily practices, additional to routine antenatal care. Studies from the UK, Sweden, the Netherlands, and the US report reduced perinatal anxiety and distress, reduced birth interventions, and improved maternal fetal bonding through MIP program participation.

To transfer MIP’s evidence-based research into program implementation, a feasibility study is being proposed to be conducted in an Australian maternity care setting. A MIP feasibility study will determine critical aspects of the program through planning and implementation and, by focussing on stakeholder engagement, recruitment and attrition, and evaluation of outcomes, experiences, and cost analysis.

MIP is evidence based to support the health and wellbeing of women by reducing perinatal anxiety, reducing birth interventions, and improving women’s experiences of pregnancy, birth, and early parenting. The potential of MIP, through a feasibility study within the Australian maternity care setting extends to improved consumer engagement and cost benefits to healthcare providers.

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About Susannah Christensen's work

Sharing Decisions for a Better Birth Experience

Between 14-30% of those who give birth in Australia experience their births as negative and traumatic experiences, with up to 12% going on to develop clinical symptoms of post-traumatic stress disorder. Traumatic birth experiences have negative impacts on birthing people’s mental health, infant bonding and early parenting.

In research, a lack of clear communication, autonomy, and involvement in decision making is identified as contributing to a traumatic birth experience. Decision aids are tools used to promote shared decision-making in medical scenarios by presenting in an unbiased summary of information about options, benefits and risks for medical procedures, through written and visual explanation. Decision aids have been implemented in a range of maternity care scenarios where multiple medically reasonable options are available, and have shown to reduce decisional conflict and regret, while increasing knowledge. However, their implementation has largely been confined to antenatal care contexts.

This project is a pilot program to be based in an ACT maternity service, which will develop and implement decision aids related to intrapartum procedures, to be made available to birthing people both antenatally and intrapartum. Consumer and clinician engagement and input will identify three intrapartum procedures to be addressed within the scope of this program. The maternity service will provide training for midwives and other clinicians on the appropriate and effective use of the decision aids.

The primary aim of this pilot program will be to examine the impact of a decision aid on rates of traumatic and negative birth experience.

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About Susan Richardson's work

Integrating birth mapping into childbirth education classes for primigravida women

Many women in Australia have a negative or traumatic birth experience. A poor birth experience is a risk factor for postnatal mental health disorders and can have significant economic and emotional impacts on families. Research has shown that a lack of autonomy or feeling unheard, uninformed, or unsupported in their choices during birth, can lead women to experience childbirth as traumatic.

Birth plans made in collaboration with healthcare providers are associated with women having positive childbirth experiences. A birth map goes beyond a birth plan as it features several possible pathways with a focus on making pre-considered informed decisions. A pilot program is proposed to integrate birth mapping into childbirth education classes for primigravida women receiving standard antenatal care over a 2-year period. In this program, women will attend childbirth education sessions run by specifically trained midwives and be supported to develop an individualised birth map. The purpose of this program is to provide a potential strategy for improving women's birth experiences.

The program will be evaluated through follow-up interviews at 6 weeks postpartum. Women’s birth outcomes, such as rates of intervention, birth satisfaction and experiences of birth trauma will be compared to a similar cohort of women who did not access this program or its contents over the same timeframe.

Women having their first baby often don’t know what they don’t know. This program aims to help women think about the unknown, find the information they need and improve their birth experiences.

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