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Randomised trial of pre-pregnancy information and counselling in inner-urban Melbourne Aim: To evaluate whether providing information before pregnancy results in a better outcome for the baby. Part of the overall program offered by the Pre-Pregnancy Information Service situated in Richmond until June 1993. 1200+ mothers recruited through the Maternal and Child Health Service were visited at home by a midwife five months or more after the birth of their first baby. Data collected from all women included information about their pregnancy, birth and postnatal period. Half the women, those randomised to the intervention, received information which might assist in a healthier start for their next pregnancy. Recruitment and home visiting ceased in 1993. Extensive follow-up of all participants was completed in 1994. Research Team: Information about the timing of use of ultrasound for fetal anomaly scanning was collected as additional data within the perinatal forms of the Victorian Perinatal Data Collection Unit in 1991-92. In those years 97% of women received ultrasonography during pregnancy with virtually all having either one or two scans. Close to 70% of women were scanned at the usual gestation for detection of fetal anomalies. Mothers of higher parity and those who were born outside Australia in a country where English was not the most common spoken language were less likely to be scanned at all, and less likely to be scanned at the stage of pregnancy where a number of serious birth defects can be recognised. An additional study component involved a review of scan reports and hospital medical records for all births, or terminations of pregnancy, with a malformation 'potentially diagnosable' by ultrasound at 16-20 weeks gestation, and for an equivalent number of births without birth defects. The study was partially replicated in 2000 - using information available within the Victorian Perinatal Data Collection - for births and terminations of pregnancy in 1997 to see what changes had occurred in the timing and method of prenatal diagnosis over the decade. Information on the extent of use of ultrasound was collected in the Victorian Survey of Recent Mothers 2000. MCHR is very grateful to the staff of the Victorian Perinatal Data Collection Unit, especially Dr Jane Halliday and Ms Merilyn Riley for facilitating this project in 2000 and to Fiona Bruinsma, and the members of the project's Scientific Advisory Committee (Dr Christine Acton, Dr Peter Renou, Dr Hugh Robinson, and Dr Leslie Sheffield). Research Team:
Aim: To investigate the childbirth and early postnatal experiences, satisfaction with care, and physical and emotional health of a representative sample of Victorian women who gave birth in 1999. The study builds on two earlier Victorian surveys of recent mothers conducted in 1989 and 1994. The Victorian Survey of Recent Mothers 2000 was commissioned by the Victorian Department of Human Services to inform the continuing development of the Maternity Services Program . The survey was mailed to all Victorian women who gave birth in two weeks in September 1999. 1616 women took part in the survey, a response fraction of 67%. In general, results for private maternity care were more favourable than for public models of care. Women attending public hospital antenatal clinics were the least likely to be very happy with their care. Women participating in shared antenatal care gave more positive feedback about this model of care compared with the results of the previous survey conducted in 1994. Feedback regarding postnatal care remains concerning with only 51% of women indicating they were very happy with care in hospital in the first few days after giving birth. The findings of the 2000 Survey indicate that while a majority of women rate the quality of maternity care as very good, ratings of specific aspects of care - in particular the extent to which care is sensitive and understanding, the degree to which concerns are taken seriously, how readily women are able to access information and support, and the degree to which women are involved in making decisions about their care - did not reach high standards. In general women were more positive about private maternity care than about public models of care. Papers compare the findings of the 2000 Survey with the results of previous surveys covering women's views of care and outcomes of early discharge,and examine women's views of different models of public antenatal care. A series of invited talks providing feedback on the study findings were given at regional and metropolitan hospitals. Research Team: Having a baby in Victoria 1989-2000: women's views of public and private models of care Over the past decade researchers at MCHR have undertaken three population-based postal surveys of representative samples of Victorian women who had recently given birth. The first survey was undertaken in conjunction with the Victorian Ministerial Review of Birthing Services in 1989. The second and third surveys were undertaken in 1994 and 2000 respectively. The three surveys provide a rich source of data on women's experiences and views of their maternity care. Fiona Bruinsma analysed key items from each survey to compare and contrast women's views of antenatal, intrapartum and postnatal care across the decade and to chart changes in the provision of maternity care. This project extended analyses undertaken for the Department of Human Services in reporting the outcomes of the 2000 Survey of Recent Mothers. Research Team: Continuity of care: does it make a difference to women's views and experiences of care? Preliminary analysis of data from the Survey of Recent Mothers 2000 showed wide variation in the extent to which women in different models of maternity care saw the same caregiver antenatally, and more importantly, the extent to which they felt the caregivers got to know them and remembered them and their progress from one visit to the next. Women's overall rating of antenatal care was strongly associated with these two measures of continuity. Further analysis of the 2000 Survey is being undertaken, adjusting for social and reproductive characteristics, model of care, and specific aspects of care such as waiting time (Mary-Ann Darcy). Research Team: A new approach to supporting women in pregnancy (ANEW) Psychosocial risk assessment during antenatal care is becoming more common in public maternity care. Implementation of psychosocial risk assessment has brought to light a number of practical problems, including: the inclusion of very diverse risk factors and outcomes such as homelessness, violence from an intimate partner, depression, substance misuse, lack of social support and serious mental illness under the umbrella of psychosocial risk; the reluctance of many women to disclose risk factors and fears about future events; and the reluctance of staff providing maternity care to ask women directly about difficult psychosocial issues. The result has been the development of psychosocial risk assessment tools and the implementation of antenatal screening. This project seeks to implement and evaluate an alternative approach to screening. Aim: To enhance the skills of antenatal care providers to support vulnerable women and their families. The study uses a pre-test/post-test design to evaluate a multifaceted educational intervention which aims to increase care providers' active listening skills and ability to pick up on cues in consultations; provide support to enable care providers to offer non-directive, problem solving counselling during routine antenatal care; and ensure that care providers have access to up to date evidence regarding the prevalence and management of common psychosocial issues for pregnant women. 584 women completed the baseline survey - a response fraction of 76%. The educational intervention was conducted from August to December with 24 midwives and nine medical staff participating. Analysis of the baseline women's survey and the health professionals' feedback is underway. Recruitment to the women's outcome survey commenced in January 2003. Research Team: Evaluating practice and organisation of care at Southern Health and Sandringham Hospital (EPOCS) Reviews of maternity care have identified a number of problems with traditional public maternity care. Southern Health (formerly Southern Health Care Network) wished to implementing a new approach to maternity care that addressed some of these problems. These new initiatives included the promotion of
The EPOCS study examined the outcomes of these new initiatives in terms of women's experiences of care. A postal survey of over 1800 women who had given birth three months prior to the survey at four hospitals (Monash Medical Centre, Clayton and Moorabbin campuses; Dandenong; Sandringham) was completed in 1999. The survey provides baseline data prior to the commencement of the initiatives in late 1999. 1256 women took part in the survey, a response fraction of 65%. Feedback from this survey was compared to women's responses to the post-implementation survey conducted over 2001-2002. 1050 women responded to the second survey, a response fraction of 57.4%. This 'before and after' approach to evaluation was used to determine the impact of the implementation of the innovations in care. Process evaluation involving telephone interviews with women who had recently given birth at one of the four hospitals (n = 107) and interviews with managers, midwives and medical practitioners (n = 25) was conducted over 2000-2001. Feedback to staff about the process and progress of implementation of the initiatives resulted in several modifications to the maternity enhancement strategies, prior to the second survey. In addition, 75 women who were born in Vietnam participated in home interviews. Women were recruited during their postnatal hospital stay at Southern Health and interviewed in their own language three months following the birth. This component of the study will provide important feedback about the views and experiences of non-English speaking women following implementation of the initiatives. Monitoring of hospital readmissions and casualty attendances of mothers and infants is in progress. This evaluation provided valuable information for the planning and organisation of maternity services at the four participating hospitals and across Victoria. We are grateful to Glenda McDonald, Suong Nguyen, Tuyet Cao, Liem Pham, Donna Trickey, Angela Fanzone and members of the project reference group for their practical support and assistance throughout the fourth year of EPOCS. Research Team: This project arose from the finding in the 1989 Survey of Recent Mothers of an association between operative delivery (elective and emergency caesarean section, forceps or vacuum extraction) and maternal depression 8-9 months after birth. This finding is supported by a number of prospective studies. The trial
Health outcomes for all women were assessed at six months postpartum via a postal questionnaire. Women completed the Edinburgh Postnatal Depression Scale and the SF-36, a self-report health status measure. They were also asked questions relating to pregnancy, labour and birth and the postnatal stay, as well as about aspects of life with a baby in the first six months postpartum. The response to the postal questionnaire was exceptionally high, with 88.1% (917/1041) of trial participants returning completed questionnaires. Briefly, the trial found that:
Research Team: Health and recovery after operative birth project (HARP) Aims: To contribute to the current debate about the benefits of elective caesarean section compared with vaginal birth for healthy women at term by following up a large cohort of women, all of whom had an assisted delivery, to provide a more complete and a longer term comparison of the maternal health sequelae. It will identify health problems and symptoms after caesarean delivery; assess recovery from the new health problems which followed the earlier birth and identify new health problems after any subsequent birth; measure general health status; investigate reasons for non-disclosure of the problems to primary care practitioners; identify the extent of advice, referral, investigations, and treatment; measure voluntary and involuntary infertility since the birth; and describe early fetal losses and complications of subsequent pregnancies. A postal survey was mailed in April 2002 to the 1039 women who had participated in the debriefing trial four to six years earlier. In June, questionnaires had been returned from only 31.6% of women. By the end of December, 522 questionnaires had been returned, representing just over 50% of the original cohort. A PhD scholarship was awarded to Michelle Kealy, who commenced her candidature in September 2002 and has been working on the development of the qualitative study component of HARP, exploring women's health and recovery after caesarean section. Research Team: An exploratory study of domiciliary support during the first days following childbirth Aim: To explore and describe the structure, aims and scope of postnatal domiciliary midwifery support services offered by health service agencies in the Melbourne metropolitan area. Data collection involved a survey of metropolitan maternity hospitals to obtain an overview of services offered, including the number and characteristics of women receiving domiciliary visits, and guidelines for determining eligibility. The survey was followed by interviews with maternity department managers at selected hospitals and health service agencies. Interviews and a postal survey were used in the second phase of the study to explore the perspectives of midwives providing postnatal domiciliary care. Research Team: Attachment to the breast and family attitudes towards breastfeeding (ABFAB) Despite the relatively high proportions of women who choose to breastfeed in Victoria, the duration of breastfeeding is still much briefer than recommended by the World Health Organization and falls well short of Australia's goals and targets. As well as marked social differences in breastfeeding, there are a number of factors that have been shown to influence women's decision to breastfeed and for how long they choose to breastfeed their babies. These include practical skills, such as attachment of the baby to the breast, and attitudes of the woman and her family towards breastfeeding. ABFAB aimed to investigate whether breastfeeding education in the middle of pregnancy focusing on these factors, influenced breastfeeding duration. Women having their first baby and who were booked into the Royal Women's Hospital were invited to participate in the research project. Women were enrolled in the project around the middle of the pregnancy (approximately 18 weeks) and randomly allocated to one of three groups: a control group or one of two interventions. One intervention was an antenatal breastfeeding class that focused on practical aspects of breastfeeding such as correct attachment and positioning of the baby. The other intervention included two antenatal breastfeeding classes that explored family attitudes to breastfeeding. The classes took place between weeks 20-25 of pregnancy. All women, including those in the control group as well as the intervention groups, were offered regular childbirth education at the Royal Women's Hospital. 981 women (327 in each group) were enrolled in the study between May 1999 and August 2001. Data were collected by questionnaire at recruitment, at interview in hospital after the birth and by telephone interview six months later. Data collection was complete in July 2002. The response fractions were 100% at recruitment, 93.9% soon after birth and 93.3% six months later. Research Team: Interventions to facilitate smoking cessation during pregnancy The review includes more than 70 trials, with over 60 contributing to the formal overview. When combined they demonstrate a significant reduction in continued smoking during pregnancy, a reduction in preterm birth and in low birthweight, and an increase in mean birthweight, associated with the interventions. A narrative review of the process for developing the interventions and for implementing them identified a lack of attention to several outcomes which are of concern to women themselves. Research Team: Early postnatal discharge from hospital for healthy mothers and term infants Since the 1970s there has been a steady decline in Western countries in the length of time mothers spend in hospital after giving birth. The primary objectives of this review are to determine whether a policy of early postnatal discharge is safe for healthy mothers and term infants, and to assess the effectiveness of a policy of early postnatal discharge in terms of important maternal, infant and paternal health and related outcomes. Eight trials were identified involving 3600 women. The findings were inconclusive. There is no evidence of adverse outcomes associated with policies of early postnatal discharge for healthy mothers with term infants, but the methodological limitations of included studies mean that adverse outcomes cannot be ruled out. Making comparisons between studies is problematic because of differing levels of primary and specialist support available in the different countries and settings where studies were conducted. It remains unclear how important midwifery or nursing support at home is to the safety and acceptability of early discharge programs. The study was completed in 2002. Research Team: Consumer information group on pregnancy and childbirth - folate supplementation information Robin Bell, Shaun Brennecke, Max Watson, Department of Perinatal Medicine, Royal Women's Hospital; Necia Burford, Public Health Branch, Victorian Department of Human Services; Jane Halliday, Victorian Perinatal Data Collection Unit, Victorian Department of Human Services, and Murdoch Institute, Royal Children's Hospital; and Lyn Watson Pregnancy care/team midwifery project Mary-Anne Biro (awarded a doctoral thesis), Jan Pannifex, Christine Tippett, Monash Medical Centre; Ulla Waldenström, Karolinska Institute, Sweden; and Stephanie Brown A final report has been submitted to Victorian Department of Human Services. |
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| Content Approved by: Director, Mother and Child Health Research Page maintained by: Administrator Last Updated: 2 September 20047 |
