• a postal questionnaire to all women in the cohort sent 4-6 years after the index birth;
• a review of health information records for the index birth and all subsequent births for all participants who provided written consent in responding to the postal questionnaire; and
• a qualitative sub-study exploring women’s experiences of health and recovery following caesarean birth.

In 2007, one paper on the methods used for the health information record review and the challenges encountered was accepted for publication and the qualitative sub-study was completed, with the submission and passing of Michelle Kealy’s doctoral dissertation (see Postgraduate Projects). Papers from the thesis are in preparation.

Funding: NHMRC Project grant 2001-2003
Status: One paper published, one in press; PhD completed, papers in preparation

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Women’s health and recovery after caesarean section – a sub-study of HARP (Health And Recovery after operative birth Project

Michelle Kealy and Rhonda Small in collaboration with Pranee Liamputtong, School of Public Health, La Trobe University

Caesarean section has for many years contributed to reduction in maternal and perinatal mortality. There is recent evidence however, that the escalating caesarean section rate has the potential for more harm than the benefits offered, especially when caesareans are performed in the absence of medical reasons. This qualitative study sought to explain women’s experiences of caesarean section, whether undertaken as a planned or unplanned procedure, and as a first or subsequent birth. Analysis has involved exploring women’s participation in the decision to have a caesarean, and women’s intra-operative and post-operative experiences including the early postpartum period. The study also examined some longer-term issues for women after caesarean section.

Funding: PhD scholarship within NHMRC project grant for HARP study (2002-2005)
Status: PhD passed, publications in progress

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Prevalence and prevention of mastitis in lactating women

Lisa Amir and Judith Lumley in collaboration with Suzanne Garland, Royal Women’s Hospital

Mastitis is a common problem during lactation; approximately 20% of women experience at least one episode. The first part of the study was a breastfeeding survey of women giving birth in the Family Birth Centre (FBC) and Frances Perry House (FPH, private patients). One hundred and twenty eight women were recruited from the FBC and 202 from FPH. The second part of the project was a trial to prevent mastitis: ROBIn – Reduction of Breast Infection. Very few women with cracked nipples were identified and recruitment ceased in late 2002.
A third project, a case-control study investigating possible risk factors for mastitis was completed in 2004. CAMEO, Cases of Mastitis: Evaluating Occurrences, involved women attending the Royal Women’s Hospital, Mercy Hospital for Women and maternal and child health centres in Moreland, Darebin Melbourne and Port Phillip. The main research question is “Are women with mastitis more likely to be nasal carriers of S. aureus than other breastfeeding women?”

Funding: NHMRC Public Health scholarship 2000-03 (LA); Medical Research Foundation for Women and Babies
Status: Doctoral thesis awarded (LA), eight papers published

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Peer support for breastfeeding – feasibility study

Della Forster, Mary-Ann Davey, Judith Lumley and Lisa Amir in collaboration with Helen McLachlan, Division of Nursing and Midwifery, La Trobe University; and Lisa Gold, School of Social Health and Development, Deakin University

Breastfeeding has health benefits for both mother and baby and exclusive breastfeeding is recommended for the first six months of life, followed by continued breastfeeding (along with other food) into the second year of life. Women often stop breastfeeding sooner than they would like because of inadequate support. Low income women in particular are less likely to continue to breastfeed and less likely to seek support.  Many strategies aimed at increasing the duration of breastfeeding have failed.  Trials in Canada and the Philippines have achieved increased duration of breastfeeding by providing women with support from a peer who has herself successfully breastfed. Before introducing such a program in Australia, it is important to explore local women’s views about using peer supporters, and women's views about acting as peer supporters. We are conducting a feasibility study to explore the idea that telephone peer support in the early postnatal period might increase breastfeeding duration. We will explore the acceptability of peer support for breastfeeding from the perspective of breastfeeding women and potential peer supporters. We will also explore whether the proposed model would be a viable option for women with a Vietnamese background, given the low rates of both initiating and continuing breastfeeding among Vietnamese-born women in our community.

Funding: La Trobe University Faculty of Health Science Research Grant 2006, MCHR grant 2006
Status: Feasibility study underway; five focus groups conducted, report being drafted

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CASTLE study
The role of micro-organisms (S. aureus & C. albicans) in the pathogenesis of breast pain and infection in lactating women
Lisa Amir, in collaboration with Suzanne Garland and Sepehr Tabrizi, Royal Women’s Hospital; Susan Donath, Murdoch Childrens Research Institute; and Catherine Bennett, Deakin University.

This project is a descriptive study of 400 breastfeeding women, recruited from the Royal Women’s Hospital and Frances Perry House. The aim of the study is to investigate the role of micro-organisms in nipple and breast pain in breastfeeding women. At present, there is controversy about whether burning nipple pain associated with radiating breast pain is caused by fungal infection (Candida albicans, known as “thrush”) or bacterial infection (Staphylococcus aureus, known as “golden staph”).

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The experience of postnatal depression in a rural Australian community

Sue Armstrong and Rhonda Small
This project aims to investigate pathways to care in a Victorian rural community for women experiencing depression after childbirth. The study has been undertaken in three phases in a rural shire in Gippsland, where routine screening for postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) has been in operation for the last ten years, but not previously evaluated.
Phase one consisted of an audit of all women potentially eligible for screening to identify more clearly the proportion of women screened and the results of screening. Phase two consisted of interviews with maternal and child health nurses (MCHNs) and local general practitioners (GPs) with the aim of finding out how the program worked and the outcome of referrals for women identified as probably depressed. A second more recent audit was also completed to determine whether feedback to nurses about the screening program had resulted in any changes to the proportion of women screened. Phase three involved a postal survey of an annual cohort of recent mothers (n=265), telephone follow-up with 85 women and in depth interviews with 20 women about their experiences of the screening program for postnatal depression and of their first postnatal year.

Funding: La Trobe University Research Scholarship (2007-2008), Diamond Consortium Seed and Capacity Building Grant (2006-2007)
Status: Phase one complete, paper published; phase two data analysis in progress with feed back to service providers ongoing; phase three survey and interviews with women completed and analysis and writing up in progress

MOSAIC (MOtherS’ Advocates In the Community): a community randomised trial

Angela Taft, Rhonda Small and Judith Lumley, in collaboration with Kelsey Hegarty, Department of General Practice, University of Melbourne

MOSAIC is a cluster randomised trial to reduce or prevent partner violence and depression among pregnant or recent mothers. It also aims to strengthen women’s health and wellbeing and attachment to their children by offering abused or at risk women who are identified by their GPs or maternal and child health (MCH) nurses, support from trained mentor mothers for up to a year after recruitment. Mentor mothers are trusted and compassionate community women with additional training including partner violence, depression and parenting support. The project draws from evidence that home visiting can enhance mothers’ and children’s health and that partner abuse can be reduced if it is directly addressed in peer support strategies which continue well after childbirth. MOSAIC includes an additional sub study with the Vietnamese community. The research team acknowledges the continued support of Women’s Health West, Women’s Health in the North and Berry Street Family Violence Services.
MOSAIC was launched in December 2005 and commenced in full in 2006. It involved the randomisation of 24 general practices (28 GPs) and six MCH nurse teams from suburbs in Melbourne’s north-western region. Two further MCH teams from that area were randomised in 2007 to assist with additional recruitment. Referrals were closed at the end of 2007 with 258 women referred to the study, of whom 32 (12%) were Vietnamese.
An interim telephone evaluation with participating MCH nurses (n=74, 81%) and GPs (13, 46%) early in the year about their involvement and experiences to date, led to additional upskilling and support sessions provided in 2007. MOSAIC was very pleased that seven women from the Western Women’s Domestic Violence Network joined current MOSAIC mentors, bringing those available to over 60. Thanks to additional support from beyondblue, mentoring and data collection will continue to the end of 2008.

Funding: NHMRC, VicHealth, Victorian government Community Support Grants Fund
Status: Recruitment closed and one paper published

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Violence against young Australian women and reproductive health

Angela Taft and Lyn Watson, in collaboration with Women’s Health Australia, University of Newcastle

Using the data from the 1996 and 2000 surveys of the Young Women’s cohorts from the Australian Longitudinal Women’s Health Study (Women’s Health Australia) this analysis aimed to:

• provide descriptive summary statistics of the population of young women who had one or more terminations, including socio-demographic characteristics, area of residence/location, and use of contraception, comparing them within age strata with (i) women who have not had a termination, and (ii) those who have not had any pregnancy (ii);
• examine the changes in reported terminations from the 1996 to the 2000 survey, and describe their relationship to other pregnancy outcomes in the same time period, for the whole young women’s cohort;
• compare the reported rate of terminations in these surveys with age-specific rates from 1996 to 2000 collected through the mandatory reporting systems in  South Australia and the Northern Territory, both of whom produce annual reports; and
• subsequent analysis examined factors associated with women reporting terminations, violence status and depression.

Funding: VicHealth and La Trobe University
Status: Ongoing; one paper published and another under review

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Long-term health and psychosocial effects of hormone treatment to reduce the adult height of tall girls

Judith Lumley, Fiona Bruinsma, Jo-Anne Rayner and Lyn Watson in collaboration with Alison Venn, Menzies Research Institute, University of Tasmania; Priscilla Pyett, Onemda VicHealth Koori Health Research and Community Development Unit, Centre for the Study of Health and Society, University of Melbourne; Penelope Jones, the Alfred Hospital;  George Werther, Centre for Hormone Research, Royal Children’s Hospital; George Patton, Centre for Adolescent Health; and Chris Bayly, Royal Women’s Hospital

This study aimed to examine the long-term health and psychosocial effects of oestrogen treatment to reduce the adult height of tall girls.  Treatment with synthetic oestrogens to reduce the adult height of tall girls has been available in Australia and elsewhere since the 1950s, though its use has been uncommon in recent years. Studies of treated tall girls have described occasional short-term side-effects of treatment including menstrual irregularities, nausea, weight gain, limb pains, thrombosis and ovarian cysts.  The relatively young age and small numbers of women in the follow-up studies reported to date mean that little is known about long-term outcomes for women, particularly with respect to reproductive health.
The cohort was made up of a group of 1,432 women who were treated or assessed for treatment by Australian paediatric endocrinologists from the late 1950s through to 1993. 1,243 (87%) of the eligible cohort were traced and 846 (68%) completed questionnaires. The questionnaires used both quantitative and qualitative research methods to examine a range of health outcomes including reproductive health, mental health, general health status and satisfaction with the outcome of treatment.  Analysis of fertility outcomes showed that treated women were more likely to have had a lower rate of conception and a history of infertility than untreated women.  Overall, the vast majority of untreated women (95.5%) were satisfied with the decision not to be treated. Satisfaction levels were high in untreated women no matter how tall they became. A comparison of mental health outcomes in treated and untreated tall women showed that the two groups were similar in their history of depression. Compared with the general population of women of the same age, however, study participants were more likely to have experienced depression.

Funding: NHRMC consultancy contract 2000-2003
Status: Three papers published, one in press, two papers in preparation

For more information, go to Tall Girls

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An exploration of parent-daughter relationships and depression in adulthood within the social context of treating tall stature in adolescent girls over three decades

Jo Rayner and Judith Lumley in collaboration with Priscilla Pyett, Centre for Health and Society, University of Melbourne, Alison Venn, Menzies Research Institute, University of Tasmania and Jill Astbury, School of Psychology, Victoria University

In light of the high prevalence of major depression found among women participating in the Tall Girls Study this project aimed to examine the experiences of tall women who as adolescent girls were assessed and/or treated with synthetic oestrogens to reduce their estimated adult height. Data collection included: two in-depth interviews each with 35 tall women: 25 from the Tall Girls Study cohort and 10 women never assessed or treated for tall stature; a discourse analysis of the medical literature on treatment of tall stature published over the three decades treatment was at its peak in Australia; examination of the empirical literature on height; and analysis of data collected in the Tall Girls Study postal survey. Findings suggest that socially enforced notions of femininity created body image issues for ‘tall’ girls and subsequently increased their risk for depression when their height was problematised by parents and peers and medicalised by the use of synthetic oestrogens.

Funding: NHMRC Public Health PhD scholarship (2005-2007)
Status: PhD thesis submitted; one paper drafted

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SYSTEMATIC REVIEWS

Interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse: a collection of Cochrane systematic reviews

Angela Taft leading Screening interventions review collaborating with Jean Ramsey, Gene Feder and Yvonne Carter, Department of General Practice and Primary Care, Barts and the London School of Medicine and Dentistry; Leslie Davidson and Joseph L Mailman, Department of Population and Family Health, School of Public Health, Columbia University;  Kelsey Hegarty, Department of General Practice, University of Melbourne;  and Alison Warburton, Centre for Women’s Mental Health Research, Department of Psychiatry and Behavioural Sciences, Manchester University

FFunding: UK NHS, Cochrane Collaboration (Health Promotion), VicHealth
Status: Advocacy protocol published in Cochrane Library; screening protocol for publication Feb. 2008; advocacy systematic review completed and currently being revised

Debriefing for the prevention of psychological trauma in women following childbirth

Rhonda Small with Maria Helena Bastos, Debra Bick, Catherine Rowan, and Kirstie McKenzie-McHarg

Funding: None
Status: Protocol under review with the Cochrane Collaboration, Depression, Anxiety and Neurotic Disorders Group

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COLLABORATIVE WORK

WEAVE (Women’s Evaluation of Abuse and Violence Care in General Practice): A cluster randomised trial

Angela Taft in collaboration with Kelsey Hegarty and Jane Gunn, Department of General Practice, University of Melbourne; Gene Feder, University of London; Jill Astbury, Department of Psychology, Victoria University; and Stephanie Brown, Healthy Mothers, Health Families, Murdoch Childrens Research Institute

The weave study aims to develop and evaluate a multi-faceted, practice-based intervention consisting of screening for intimate partner abuse, health provider education and guidelines, brief counselling and organisational changes in general practice. The primary aims are to increase:

• abused women’s safety behaviours by 2 behaviours and planning from 10% to 40%;
• quality of life by 10 points (1/2 a standard deviation)
• mental health status by 5.5 (1/2 a standard deviation)

The secondary aims are to determine if the intervention results in:

• a decrease in abused women’s psychological distress;
• an increase in abused women’s readiness for change with regard to the abuse;
• an increase in abused women’s comfort to discuss intimate partner abuse with GPs and/or practice nurses (PNs) from 30% to 60%;
• an increase in GPs’ and/or PNs’ inquiry about the safety of women and children from 7% to 30%; and
• is cost effective.

Funding: NHMRC
Status: Ethics application submitted and protocol drafted

WEAVE: Women’s Evaluation of Abuse and Violence Care in General Practice

Angela Taft in collaboration with Kelsey Hegarty, Rhian Parker and Gail Gilchrist, Department of General Practice, University of Melbourne

WEAVE’s main objective is to evaluate the international consensus partner abuse guidelines on whole family care in general practice from a consumer perspective. It aims to answer the following questions:

• what do women who have experienced partner abuse during their lifetime think about how general practitioners should manage partner abuse in the context of whole family care?
• how they describe their pathways to recovery? and
• how have GPs contributed to this pathway?

WEAVE has conducted three focus groups and interviewed 10 of the 20 proposed interviewees recruited from the DIAMOND depression study.

Funding: Beyondblue 2005-2006
Status: Ongoing

The Diamond consortium

Judith Lumley (Steering Committee) with Rhonda Small and Angela Taft are participating in this Consortium, which is led by Jane Gunn, Department of General Practice, University of Melbourne

The DIAMOND consortium brings together a multidisciplinary team with expertise in complex primary care and mental health research and evaluation across the life cycle, clinical expertise, and links to other service providers to build mental health research and service capacity in Victoria. The focus is on the management that occurs within primary care and the interface between that care, the community and the public and private mental health services. The DIAMOND consortium comprises the commitment from consumers (Health Issues Centre, Relationships Australia, Surfcoast Life Activity Club); practitioners (general practitioners, nursing, community health, primary mental health team, a specialist mental health service The Bouverie Centre, Divisions of General  Practice); policy makers (Community health policy); and researchers (universities and centres of excellence) across rural and metropolitan settings.

Funding: beyondblue
Status: Ongoing

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