Perinatal outcomes

Lyn Watson, Jo Rayner; in collaboration with James King, Royal Women's Hospital; previously in collaboration with Judith Lumley, MCHR; David Henderson-Smart, University of Sydney

This study described the sociodemographic associations of very preterm birth in singletons and twins in Victoria and investigated the contribution of prior reproductive history to very preterm birth (birth between 20 and 32 weeks gestation). Data collection included a semi-structured interview, either face-to-face or by telephone, and medical record data extraction.

The data collection and main analyses were completed by 2008. In 2012, two papers were published, one accepted for publication and one under review.

Funding: NHMRC project grant 2001-2003, SIDS & Kids Victoria 2003-2004 and Faculty Health Sciences Research Enhancement Grant, La Trobe University 2003, Telstra Community Development Fund 2003

Status: Data collection complete, data analysis complete, nine papers published, one under review, one pamphlet distributed

Publications:

• Watson LF, Rayner J-A, Forster D. Identifying risk factors for very preterm birth: a reference for clinicians. Midwifery 2013;29(5):434–9
• Watson LF, Rayner J-A, King J, Jolley D, Forster D. Intracervical procedures and the risk of subsequent very preterm birth: a case–control study. Acta Obstet Gynecol Scand 2012;91(2):204-10
• Watson L, Rayner J. Findings from the early births study. A case-control study of very preterm birth in singletons and twins [Pamphlet]. Melbourne: Mother & Child Health Research, La Trobe University; 2011
• Davey M-A, Watson L, Rayner Jo A, Rowlands S. Risk scoring systems for predicting preterm birth with the aim of reducing associated adverse outcomes. Cochrane Database Syst Rev 2011; (11): Art. No.: CD004902
• Watson LF, Rayner J-A, King J, Jolley D, Forster D, Lumley J. Modelling sequence of prior pregnancies on subsequent risk of very preterm birth. Paediatr Perinat Epidemiol 2010;24(5):416-23
• Watson LF, Rayner J-A, King J, Jolley D, Forster D, Lumley J. Modelling prior reproductive history to improve prediction of risk for very preterm birth. Paediatr Perinat Epidemiol 2010;24(5):402-15
• Watson LF, Lumley J, Rayner J-A, Potter A. Recruitment to research studies in maternity hospitals: An example from the Early Births Study. Midwifery 2008;24(4):509-20
• Watson LF, Lumley J, Rayner J-A, Potter A. Research interviewers’ experience in the Early Births study of very preterm birth: qualitative assessment of data collection processes in a case–control study. Paediatr Perinat Epidemiol 2007;21(1):87-94

Della Forster, Lisa Amir, Helen McLachlan, Anita Moorhead, Helene Johns; in collaboration with Rachael Ford, Royal Women’s Hospital; Kerri McEgan, Mercy Hospital for Women; Chris Scott, Frances Perry House; Kinga Pemo, School of Nursing and Midwifery, La Trobe University

A high proportion of women in Australia initiate breastfeeding but many stop in the early months. Anecdotally more women are leaving hospital feeding their babies expressed breast milk, and are continuing to do so at home. Little is known about the effect of expressing breast milk in terms of breastfeeding outcomes and other factors such as maternal fatigue, stress and anxiety.

We have used three methods to explore this issue. Firstly, we conducted audits at the Mercy Hospital for Women (MHW), the Royal Women’s Hospital (RWH) and Frances Perry House (FPH), and found that only 35% of women having their first baby were leaving hospital fully attaching and feeding from the breast. Sixty percent of those who were not having a first baby were fully attaching and feeding. We subsequently conducted focus groups with midwives from each site to ascertain their views on the expression of breast milk in the early postpartum period, and found two global themes emerged: the normalisation of expressing and the pressured postnatal environment.

We have just completed a prospective cohort study exploring the frequency of breast milk expressing and the effect of expressing on breastfeeding outcomes and other factors. One thousand mothers of healthy term infants who planned to breastfeed were recruited from the same three hospitals (MHW, FPH, and RWH) before discharge home from hospital postnatally. The study involved completion of an initial structured interview to collect demographic details, breastfeeding intentions and current feeding details. Other relevant information was collected from the medical record with the woman’s consent. Structured telephone interviews were conducted at three and six months postpartum. The primary outcome for comparison is feeding any breast milk at six months. Secondary outcomes included exclusive breastfeeding, maternal confidence and satisfaction with infant feeding.

Almost half of the primiparous women owned a breast pump at recruitment and less than half of the whole group had been fully breastfeeding at the breast. A high proportion of women reported very early breastfeeding problems and less than half of the infants had fed only at the breast in the first days of life. Further analysis is underway.

Funding: La Trobe University Faculty Grant, La Trobe University PhD scholarship

Status: Two of three components completed; papers from first two components in preparation; minor thesis completed (KP). Cohort study: analysis and writing up underway; three conference presentations in 2012; one paper accepted, one submitted and one drafted

Publications:

• Johns H, Forster D, Amir LH, Moorhead A, McEgan K, McLachlan H. Infant feeding practices in the first 24 to 48 hours of life in healthy term infants. Acta Paediatrica  Forthcoming 2013

Lisa Amir, Méabh Cullinane; in collaboration with Suzanne Garland and Sepehr Tabrizi, Bio21 Molecular Science & Biotechnology, University of Melbourne; Susan Donath, Murdoch Childrens Research Institute; Catherine Bennett, Deakin University

This project is a descriptive study of 360 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”).

For this study, at the time of recruitment swabs were collected from mothers’ noses, nipples and vagina and a questionnaire asking about previous staphylococcal and candida infections was completed. Following birth, the participating mothers were followed up six times: while still in hospital and then weekly at home until four weeks postpartum. At each of these follow-up meetings participants filled out a questionnaire and swabs were taken from the mother’s nose and nipple as well as the baby’s nose and mouth. Breast milk samples were also taken. At eight weeks postpartum a final telephone interview was held, collecting further information about breastfeeding problems such as nipple and breast pain.

Funding: NHMRC Health Professional Research Fellowship 2006-2010 (LA); NHMRC project grant 2009-2010; NHMRC equipment grant (2009/2010)

Status: Data collection complete; protocol published in 2011; analysis and dissemination underway, outcomes paper published

Publications:

• Amir LH, Donath SM, Garland SM, Tabrizi SN, Bennett CM, Cullinane M, Payne MS. Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia. BMJ Open 2013; 3(3): e002351.
  

More information: see CASTLE webpage

Mary-Ann Davey, Maggie Flood; in collaboration with Susan McDonald and Wendy Pollock, School of Nursing and Midwifery, La Trobe University; Fiona Cullinane, Royal Women’s Hospital

This study will analyse trends in postpartum haemorrhage (PPH) and associated morbidities using data from the Perinatal Data Collection for all births in Victoria, 2003-2010. The frequency and severity of postpartum haemorrhage are increasing, as are rates of known risk factors. Small increases in rates of postpartum haemorrhage—a continuing major cause of maternal morbidity—may potentially impact heavily on women and their families.

This study will provide up-to-date local information on postpartum haemorrhage incidence and risk factors, enabling insights into strategies to reduce these and to inform policy and practice in maternity services to benefit the women of Victoria.

Approval for the study has been obtained from La Trobe University ethics committee and from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM).

Funding: Nil

Status: Awaiting data from CCOPMM

Caroline Homer, University of Technology Sydney;  David Elwood, Canberra Hospital; Jeremy Oats, Royal Women’s Hospital; Maralyn Foureur, University of Technology Sydney; David Sibbritt, University of Technology Sydney; Helen McLachlan and Della Forster; Hannah Dahlen, University of Technology Sydney

In Australia miore than 7,500 babies are born outside conventional labour wards, either in birth centres or at home each year. However, there is limited evidence on the safety of these alternative settings, with concerns being raised about increased risk of stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration, brachial plexus injury, and fractured humerus or clavicle. High quality evidence about the risks and benefits associated with giving birth in different settings should be available to women, policy makers and those responsible for service provision. This study is the first of its kind in Australia and will provide that evidence.

“Birthplace in Australia” is a prospective cohort study which aims to compare the safety of planned birth at home, in birth centres and in stand-alone midwifery units with standard labour wards in Australia, for women at ‘low risk’ of complications at labour onset. Additional data will be obtained regarding transfer to a higher-level service during or after labour.

Funding: NHMRC project grant 2012-2015 awarded to University of Technology, Sydney

Status: Data collection

Lester Jones, Department of Physiotherapy, La Trobe University; Rhonda Small, Mary-Ann Davey, Laura Whitburn

This exploratory study involving 20 participants recruited from Mercy Hospital for Women commenced in 2011. The aim of the project is to examine women’s experience of labour pain within the perspective of modern pain science. Preliminary findings highlight a range of social needs during labour identified as advocacy, expertise, reassurance, encouragement, information, empathy, positivity and an agent to act on the woman’s preferences and desires. Key observations relating to the focus of women’s attention during labour suggest better coping may be determined by a woman’s undistracted attention on the moment and acceptance of the adversity of labour.

Funding: La Trobe University Faculty of Health Sciences Research Grant 2011

Status: Data collection completed; analysis ongoing; conference (ASPOG 2012) and seminar (Mercy Hospital for Women) presentations; PhD candidate (LWh) commenced 2012; three manuscripts in development; abstract for poster presentation accepted (Mindfulness, Science and Practice 2013)

Christine East and Shaun Brennecke, Royal Women’s Hospital; Mary-Ann Davey; Omar Kamlin, Royal Women’s Hospital

This project is a randomised trial of fetal scalp blood sampling for lactate measurement during labour, with a view to reducing the caesarean section rate for apparently non-reassuring fetal status.

Funding: NHMRC project grant 2012-2015, Monash University

Status: Recruiting

Gillian Mitchell, Peter MacCallum Cancer Centre; Bettina Meiser, University of New South Wales; John Wark, Royal Melbourne Hospital; Martha Hickey, Royal Women's Hospital; Mary-Ann Davey

Growing numbers of Australian women are being identified at increased inherited risk of ovarian cancer. Removing the ovaries and Fallopian tubes—bilateral salpingo-oophorectomy or BSO—is currently the only effective prevention and is recommended by the age of 40. This surgery may have profound effects on sexual, physical and emotional health. Our study will be the first to prospectively measure the impact of BSO on these outcomes. Our findings will provide new information to assist decision making and develop evidence-based follow-up protocols.

Funding: NHMRC project grant 2013-2015, University of Melbourne

Status: Recruiting to start in early 2013