Students' expectations of the virtual maternity clinic

The aim for the Virtual Maternity Clinic (VMC) is to engage students in learning about the role of the midwife and care of women during early pregnancy. The VMC, using Deakin Studies Online as a platform, includes LiveSim, videoed characters and Adobe Flash of four pregnant women with diverse issues. From an evaluation distributed to students prior to access of the VMC to identify their expectations, we found that undergraduate students wanted to learn how to interact with women during early pregnancy, whereas postgraduate students wanted strategies to learn about midwifery practice. Further development of the VMC is progressing to include a suite of programs incorporating the care of women during late pregnancy, labour and birth; and the time after birth.

Determinants of maternity leave duration in Australia : evidence from the HILDA survey

We use the first five waves of the Household, Income and Labour Dynamics in Australia survey to examine what determines the maternity leave taken by pre-birth employed mothers of newborn children in Australia. We find that the difficulties faced by mothers in finding appropriate child care in terms of both cost and quality hinder them from returning to the labour market following childbirth. Maternity leave entitlements lead to an earlier return to the labour market following the birth of a child, relative to those who have no leave rights at all. Mothers with higher wages in their pre-birth employment and mothers with higher education levels tend to return to the labour market earlier than their lower wage and less educated counterparts. More flexible pre-birth jobs are associated with an increase in the likelihood of mothers returning to the workforce earlier than the average. Household wealth, however, seems to play a facilitating role in mothers taking a longer period of maternity leave to look after the newborn child. That is, mothers who have higher wealth levels can ‘afford’ to stay on maternity leave longer, to look after their children better during their primary developmental months. We believe that this article provides useful insights into the employment transitions of Australian mothers after having a baby.

Regime change in Australian maternity hospitals

Contemporary attempts to ‘organise’ risk and manage uncertainty are remaking many ‘industrial-era’ institutions – including maternity hospitals. Health policies are encouraging a shift away from hierarchical, medically dominated structures towards new governance systems and ‘women-centred’ care, often led by midwives. To understand the resulting contestation, in this article we argue for a wider conceptual frame than a focus on neo-liberal state regulation of the professions. We utilise theories of the ‘second modernity’, in particular those concerning socio-cultural changes associated with shifts in risk regimes, to interpret findings from qualitative research studies undertaken in Australian maternity hospitals. Whereas analysis confined to macro or institutional levels emphasises stability and hegemony, we demonstrate that when cultural and interactional levels are examined, considerable fluidity and uncertainty in the identification and negotiation of risk is evident, resulting in new work practices with inevitable shifts in professional identities and allegiances.

Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial

Abstract
Background:
Postnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women.
Methods: A feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care. English-speaking women at low risk of medical complications were recruited around 26 weeks gestation to explore their willingness to participate in a study of a new, flexible model of care that involved antenatal planning for early postpartum discharge with additional home-based postnatal care. The earlier women were discharged from hospital, the more home-based visits they were eligible to receive. Program uptake was measured, women’s views obtained by a postal survey sent at eight weeks postpartum and clinical data collected from medical records.
Results: Study uptake was 39% (109/277 approached). Most women (n=103) completed a postnatal care plan during pregnancy; 17% planned to leave hospital within 12 hours of giving birth and 36% planned to stay 48 hours. At eight weeks postpartum most women (90%) were positive about the concept and 88% would opt for the same program again. Of the 28% who stayed in hospital for the length they had planned, less than half (43%) received the appropriate number of home visits, and only 41% were given an option for the timing of the visit. Most (62%) stayed in hospital longer than planned (probably due to clinical complications); 11% stayed shorter than planned.
Conclusions: Women were very positive about individualised postnatal care planning that commenced during pregnancy. Given the hospital stay may be impacted by clinical factors, individualised care planning needs to continue into the postnatal period to take into account circumstances which cannot be planned for during pregnancy. However, individualised care planning during the postnatal period which incorporates a high level of flexibility may be challenging for organisations to manage and implement, and a randomised controlled trial of such an approach may not be feasible.

Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial

BACKGROUND: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.

METHODS: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.

RESULTS: Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).

CONCLUSION: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.