Welcome to the Faculty of Health Student Placement Accommodation. If you are a current student looking for a place to stay whilst on placement, we have single rooms available in houses and townhouses and in close proximity to the rural campuses and local hospitals in the following locations: Cooma, Bega, Eden, Moruya and Eden.
Please note: accommodation and bookings may be unavailable due to local COVID-19 public health orders and lockdown restrictions.
2 main bathrooms and 4 ensuites
Fully equipped kitchen
4 villas with 3 bedrooms each
One ensuite per villa
Fully equipped kitchen
4 bedrooms with five single beds
Fully equipped kitchen
8 single bedrooms, 10 beds
3 main bathrooms and 1 ensuite
Fully equipped kitchen
6 bedrooms with king singles
1 main bathroom and 2 ensuites
Fully equipped kitchen
Yes, please complete the Booking Enquiry Form. Please note that at busy times priority will be given to UC students.
Yes, please complete the Booking Enquiry Form. Please note that at busy times priority will be given to UC students.
Co-care delivered in single family rooms, aims to keep families together when babies require admission to the special care nursery (SCN) or neonatal intensive care unit (NICU). This care continues after maternal discharge with the adoption of family-integrated care in which the family is considered the primary caregiver and decision makers for their infant. Midwives play an important role in this model of care by providing holistic postnatal care to mothers and babies similar to what would be received on postnatal wards and through home visiting midwife services.
In 2018, one in five infants were admitted to SCN/NICU in Australia. For parents of these babies this time can be stressful, interfere with parental-infant bonding and breastfeeding, cause disempowerment and increase the risk of postnatal anxiety and/or depression. There is increasing evidence to support single family room designs in SCN/NICU which has demonstrated safe and cost-efficient care resulting in better outcomes for babies and improved parental and staff satisfaction.
This policy is aimed at keeping families together by giving all families the opportunity to have co-care in single family rooms and family-integrated care post maternal discharge to improve neonatal and maternal outcomes. The policy has been developed for any new hospital in the ACT, and existing hospitals that redesign their maternity space however, could also be used for hospitals outside of the ACT region.
Outpatient mechanical cervical ripening has been shown to positively influence birthing outcomes, reduce length of hospital stay , benefit midwives and improve women’s induction of labour experiences. The majority of the literature however, states the need for further assessment of the safety and benefits of outpatient mechanical cervical ripening. Therefore, this policy aims to implement a trial of outpatient mechanical cervical ripening through the Australian Capital Territory Public Health maternity system. In this trial, well women with low risk pregnancies having an induction of labour, will able to return home for cervical ripening using balloon catheters. The aim of this policy is to further assess outpatient mechanical cervical ripening and improve holistic outcomes for women having an induction of labour. It also plans to benefit maternity care providers by reducing costs and improving midwife to woman ratios, allowing midwifes better capacity to provide woman-centred care.
As induction of labour rates have steadily risen, hospital costs and the additional workload on midwifery and obstetric staff has also increased. Inpatient mechanical cervical ripening can negatively impact women’s birth experiences by increasing pain, likelihood of instrumental birth, caesarean sections and further obstetric interventions. The negative effects of inpatient mechanical cervical ripening on both women’s experiences and maternity services, impresses the importance of the need to improve the induction of labour process. Offering women alternative options such as, outpatient mechanical cervical ripening, not only benefits women’s induction of labour and birthing experiences, but also empowers women in their perinatal journey.
Australia delivers one of the safest maternity services globally, yet neonatal death occurring within the perinatal period is not uncommon. Six babies per day are stillborn, which is higher than the national road toll.
A high proportion of stillbirths are deemed “unexplained”. However, the ability to assess fetal growth restrictions (FGR) by customised plotting charts has enhanced our understanding of the causes of adverse outcomes. It has shown that in the majority of unexplained deaths, 30% followed an intrauterine growth restriction (IUGR) pattern, which could have been avoided with improved antenatal detection. ACT hospitals are currently using a standardised growth chart, which has proven inaccurate and lead to an over-diagnosis of IUGR. Midwives screen for fetal wellbeing by measuring fundal height to detect IUGR. Therefore, the detection, surveillance and onward referral is the responsibility of all midwives.
This policy proposes implementing the GAP program in the ACT. The GAP program combines customised growth chart software alongside education for midwives and the multidisciplinary team to ensure accuracy in measuring FG during pregnancy. This is done by conducting accreditation training through e-learning, practice workshops and referral pathways to improve antenatal awareness and detection of IUGR.
The ACT is such a culturally heterogeneous society, and there is an increasing need to assess FG on an individual level. This program has been implemented in the UK and has shown better detection rates of IUGR. Not only will this program improve detection rates, but it will also improve the satisfaction of care for women.
Antenatal education classes are a popular way to gain support and learn more about pregnancy, labour, birth and early parenthood for women and their birth partners. For a lot of women, this is where they gain their knowledge and through this knowledge, the ability to better understand how to birth without fear.
The aim of this policy is to better equip midwives to help women gain the knowledge they need to approach birth without fear. Fear surrounding pregnancy, labour, birth and the postpartum period has been shown to increase maternal stress. Between 8-13% of women are diagnosed with anxiety or depression during pregnancy and studies suggest that maternal stress in the prenatal period increase the risk of adverse pregnancy outcomes from the disruption of the maternal immune, endocrine, and nervous systems that support a healthy pregnancy.
Motherhood, Mindfulness-based childbirth education (MBCE) and the Mindfulness-based childbirth and parenting (MBCP) program have adapted mindfulness training for pregnancy, childbirth and the postpartum period. Pregnant women and their partners learn mindfulness skills for coping with anxiety and stress in pregnancy, pain, and fear during childbirth, and developing sensitive parenting. Through these programs they have shown a significant improvement in the way women have dealt with the stressors of pregnancy.
Implementation into the hospital will include incorporating the MBCE and MBCP elements into the already established antenatal education classes run by the Midwives at Calvary Hospital. This would include surveys before, during and 6 weeks postpartum to help evaluate outcomes and improve where needed.
For the conference I intend to present a poster with a three minute discussion regarding midwifery led education for pregnant women in custody and midwifery education for correctional officers supporting women in custody.
The most vulnerable women around the world are often those that are incarcerated in prison. Research suggests that at any given time up to 10% of women in prison worldwide are pregnant and a large proportion are mothers. Considering this it would be an expectation that these women and their babies receive appropriate midwifery care to improve their health and wellbeing whilst in prison. However, these women are not receiving the same midwifery care they would in the community due to current policies and poor management in prison.
Midwifery led education for women in custody with a focus on pregnancy, birthing needs, sexual health and midwifery led education for correctional officers supporting pregnant women in custody is paramount in achieving holistic health care.
The policy is aimed at improving maternal education, sexual health and health outcomes of women and their babies in custody during pregnancy, child birth and the postnatal period. To achieve these outcomes it is pertinent for midwifery led education to be delivered to women in collaboration with correctional officers. This will consolidate important maternal health education and enhance midwifery support to vulnerable women in prison.
Fear of Childbirth (FOC) is a serious clinical issue that midwives may encounter daily. Though difficult to quantify, FOC is described as a continuum ranging from minor concerns to clinical and disabling fear (tokophobia). FOC presents in 31.5 percent of nulliparous Australian women and has been shown to have significant impacts on birthing outcomes. Childbirth related fear has been shown to decrease with increased antenatal education suggesting that FOC is related to poor childbirth knowledge.
The proposed policy is to trial the implementation of a new pathway to measure and address FOC in nulliparous childbearing women at Centenary Hospital for Women and Children. This will be achieved through antenatal screening using the Fear of Childbirth Scale (FOCS). FOCS contains 7 questions inspired by the Wijma-Delivery Expectancy/Experience Questionnaire (WDEQ) and is scored out of 130 with 0-50 indicating low FOC, 50-90 indicating moderate FOC and 90-130 indicating high FOC.
The second component of the FOC pathway is referral. Women scoring high on the FOCS questionnaire will be a continuity of care priority and a referral will be put through to the hospital’s continuity program. For women scoring medium or high, childbirth education classes will be explained and booked during the first antenatal screening appointment. Both will be offered referral to midwifery perinatal mental health services. Women flagged as having high FOC will also be provided with extra resources and home-birth video links to raise awareness of normal, physiological birth and reduce impacts from negative childbirth depictions in the media.
This policy ensures people who experience anxiety and depression gain a place in a specialised midwife-led continuity of care program, available at ACT public hospitals. The perinatal period is a high-risk time for the onset and relapse of mental health conditions and suicide is one of the leading causes of maternal death in Australia. This program aims to reduce the number of maternal suicides by providing gold standard maternity care, in partnership with specialised psychological/psychiatric care when required.
Midwives working in this program will have extra training in caring for pregnant people with mental illness, so they can adapt their practice to ensure equitable care. A specialist training course for midwives would be developed in consultation with the Centre Of Perinatal Excellence. The midwives’ caseload would be reduced to acknowledge the extra work required to care for pregnant people with mental illness. Diagnosis with a pre-existing mental health condition, or a score of 13 or more in the Edinburgh Postnatal Depression Scale (EPDS), during their MOS appointment, would make the pregnant person eligible.
The midwives would also provide extended postnatal visits; up to four weeks. They would then discharge to MACH or the Parenting Enhancement Program. The success of the program would be evaluated via a confidential survey taken at discharge, which would address how supported participants felt perinatally, how confident they feel at discharge, and another EPDS to determine their current mental wellbeing and any suicidal risk factors.
The performance of a fundal rub, also known as uterine massage, is deemed routine practice in preventing a uterine atony postpartum haemorrhage (PPH) following the birth of a placenta. Fundal rubbing is a massage technique used to encourage the uterus to contract after delivery of the placenta and is extremely uncomfortable and can be agonising for the woman.
Current guidelines state the management for PPH is to perform uterine massage continuously until the woman’s uterus is empty and well contracted. There is no recommendation stating that performing a fundal rub will prevent a uterine atony PPH. Research has shown rubbing may worsen normal bleeding when performed as a precautionary measure following active third stage. Therefore, midwives need to be able to accurately measure bleeding quickly to determine if fundal massage is required.
Research shows visual estimation of blood loss is unreliable and midwives need to weigh the loss in order to diagnose a PPH. Research has shown visual estimated blood loss only has a 37.5%-45.4% accuracy rate. Therefore, many women may receive fundal massage when it is not necessary. This policy aims to highlight the benefit of responsive fundal rubbing in order to reduce unnecessary maternal pain and further midwifery practice.
Sterile, clinical room designs which antenatal care is routinely offered are setting the scene for medicalised pregnancies and births.
Redesigning the physical environment in which women receive antenatal care can shift perceptions on the nature and quality of care experienced. This redesign has the potential to increase a women’s sense of agency and provides an early introduction to many of the evidenced-based environmental factors used in the birth space to promote physiological labour and birth.
A qualitative review of literature occurred to understand room design and its impacts in antenatal spaces. Due to limited research available specific to the antenatal environment, comparisons were drawn from birthing and other health care environments designed to create ‘comforting’ spaces. The research supported the proposed hypothesis, helped establish design elements that create soft and welcoming spaces, and described positive impacts patients experienced. The research further highlighted the negative impact that ‘medicalised’ clinical environments can have on health care providers, suggesting that this often came at the detriment of women-centred care.
This poster presentation will outline a policy for Calvary Public Hospital in Bruce that directs the redesign of antenatal clinic rooms and sets guidelines for their management. This redesign will include environmental elements that promote health and wellness such as colour, lighting, the inclusion of nature, and ‘domestication’ of spaces. It will showcase the positive impacts that redesigning antenatal spaces will have on women during their pregnancy and into their labour and birth.
In Australia, six babies are born still each day, a rate which only reduced by 0.4% over 20 years to 2016. While the World Health Organisation defines stillbirth as a baby born with no signs of life at or after 28 weeks, in Australia, a stillbirth occurs when a baby is born after 20 weeks gestation or greater than 400g if gestation is not known. A stillbirth will have an impact on a woman for the rest of her life and will have a particular impact on her during subsequent pregnancies. The risk of stillbirth in a pregnancy subsequent to stillbirth is five times higher than a pregnancy after a livebirth. A previous stillbirth may have an impact on pregnancy care in many ways including, additional testing, timing of birth, medication, mental health and increased surveillance. Having experienced the stillbirth of their baby, pregnant women are 22.5% more likely to experience anxiety and rates of depression are 19.7% higher than pregnant women who have not experienced a stillbirth.
This presentation introduces a possible policy for Calvary Public Hospital and proposes a model of care tailored to the needs of pregnant women who have experienced a stillbirth in a previous pregnancy. Midwifery led, this hub would bring together a multidisciplinary team to meet the women’s complex emotional needs in addition to her medical needs. Provided in a home like environment similar to the Birth Centre, women will have continuity of care from professionals who know them and understand their individual needs.
Over the past 20 years, the number of visible same-sex couples in Australia has more than quadrupled. This increased visibility and acceptance within Australia has encouraged more same sex couples to consider becoming parents. Despite the increased visibility and social acceptance of lesbian parents, heteronormativity and homophobia continue to permeate our health service delivery. Lesbian women report that they continue to experience homophobia including exclusion, heterosexual assumption, inappropriate questioning and even refusal of services.
Evidence exists which demonstrates that lesbian couple’s maternity care satisfaction increases when their care provider is considerate of their unique needs and circumstances. It is therefore my suggestion that the ACT hospitals implement sensitivity training which supports and develops the cultural competency of midwives in delivering equitable, inclusive, accessible and responsive maternity care. The package will be designed by a focus group of lesbian couples who have navigated the maternity care system.
The training will inform midwives of the unique needs and challenges faced by childbearing lesbians, and relevant issues facing lesbians from a broader community and political context. The training will require the midwife to examine their own attitudes and assumptions allowing for self-reflection of practice. The training will be implemented and completed by 80% of midwives, with subsequent lesbian satisfaction reviewed in 12 months and again in 24 months. With this knowledge, midwives can provide lesbian couples with a positive maternity care experience, contributing to the woman’s sense of safety and welcoming into the maternity space.
Advanced maternal age (AMA) is a phrase increasingly being used in maternity care as the trend to delay childbearing continues to rise. The increase in childbearing age can be attributed to both lifestyle choice, as women today have a greater desire to prioritise their education and career, alongside advances in assisted reproductive technology.
Women of AMA are frequently labelled as ‘high risk’ during their pregnancy irrespective of their parity and pre-pregnancy health. The literature is replete with statistics that highlight AMA as an independent risk factor for many adverse perinatal outcomes, notably stillbirth. It should be noted in contrast however, that childbearing women of AMA are more likely to be health conscious, have a higher socioeconomic status and a higher level of education, factors known to greatly reduce the risk of adverse perinatal outcomes.
Current local policies that include recommendations for labour and birth have a tendency to group all AMA women together. Policies such as these leave women with no choice but to receive generic advice. This ultimately compromises their care and has the potential to lead them down a cascade of intervention. This presentation aims to outline a policy focused on the importance of individualised care for women of AMA during labour and birth. It will clearly identify the perinatal risks associated with AMA and provide evidence-based recommendations for health professionals to share with women. A labour and birth policy focused on AMA is essential in a society where the age of childbearing women continues to rise.
Worldwide, one in five women has a history of childhood maltreatment, defined by the World Health Organisation as abuse, neglect, and exploitation occurring before 18 years of age. Mounting evidence shows that childhood maltreatment trauma and its associated mental health sequelae adversely impact perinatal health outcomes, as well as parenting and bonding. Trauma survivors are more likely to have impaired perinatal experiences and are at increased risk for developing post-traumatic stress disorder (PTSD) in the postnatal period.
This policy seeks to reduce the risk of retraumatisation for women by implementing universal trauma-informed care. Midwives are ideally positioned to adopt this policy as there are many similarities between trauma-informed principles and woman-centred care. For trauma-informed care to be employed successfully, it must be universal and should guide the tone at both the organisational and service level. Implementation will be achieved through training clinical and non-clinical staff, fostering a safe workplace culture, and adopting strategies to prevent secondary traumatic stress for clinicians working with trauma survivors. Establishment of a trauma-informed system will create a clinical context in which women can be screened for childhood maltreatment trauma safely.
Application of this policy at the Centenary Hospital for Women and Children will ensure that women receive care that is low risk for traumatisation regardless of whether they have a trauma history, or whether it is disclosed. This policy will create a framework for developing trauma-specific interventions and provide a healthcare context that is safe for all: for staff, and for women and their families.
The medicalisation of maternity care is creating an overwhelming distrust of the physiology of women’s bodies and the childbearing process. This fuels the increasing use of medical interventions and decreases the rates of normal birth. The overuse of intervention contributes to significant maternal and neonatal morbidity and mortality. Midwives have a responsibility to ensure that women have access to woman-centred, evidence-based and safe care. This policy proposes a simple and effective change in the way the first stage of labour is defined, guided by physiology and evidence to reduce unnecessary interventions.
Labour dystocia is a common yet poorly defined diagnosis that results in interventions such as artificial rupture of membranes (ARM), the use of synthetic oxytocin and caesarean section (CS). The current evidence suggests that because of the poorly defined nature of labour dystocia and the outdated evidence that many definitions are based on, these interventions are overused. This results in short- and long-term negative effects on the wellbeing of mothers and babies.
The aim of this policy is to reduce the rates of unnecessary interventions such as ARM, synthetic oxytocin use and CS through the redefinition of normal progress in the first stage of labour and the implementation of a new partogram with a stepped dystocia line based on current evidence. This policy proposes a trial of the new partogram to first assess outcomes before wider implementation. Ultimately, these changes will enable midwives to protect the physiology of childbirth and result in improved outcomes for women and their babies.
Continuity of midwifery led care has proven benefits for women and babies, including lower rates of Caesarean Sections and fewer preterm births. Additionally, midwives in continuity models report high levels of fulfilment, and lower levels of depression and anxiety than their counterparts in the fragmented system. New graduate continuity midwives report feeling more competent in their roles and better supported. Despite these benefits for women and midwives, only 10 percent of women in Australia can access continuity models. Canberra has slightly higher numbers of women in continuity at 30 percent, however, given the benefits, this number should be significantly greater.
Most new graduate midwives working in Canberra hospitals are trained to work in continuity and this is underpinned by the university curriculum. The purpose of this policy is to expand on this training and provide the birthing women of Canberra with greater access to continuity models. To achieve this, a transitional program of supporting new graduates to work directly in continuity is to be implemented by both Centenary Hospital for Women and Children and Calvary Public Hospital. This policy will involve a mentorship program, whereby new graduates will be paired up with an experienced continuity midwife for a minimum of 6 months. During the transition period, new graduate midwives will also work one shift a week in Birth Suite, to maintain skills and knowledge. Facilitating a new graduate pathway into continuity will ensure greater job retention, with more women able to reap the benefits that continuity of care provides.
Australia delivers one of the safest maternity services globally, yet neonatal death occurring within the perinatal period is not uncommon. Six babies per day are stillborn, which is higher than the national road toll.
Sex-education leaves young women with little understanding, let alone appreciation, of their bodies. Young women’s sexual health is framed in terms of managing their risky bodies, bearing the responsibility for avoiding pregnancy and STI’s and reducing the visibility of normal body-changes so that they can move through puberty and adolescence seemingly unscathed. Women are not taught why they menstruate. They are not taught to explore their fertility cues, to know their anatomy, or about how and why their bodies may grow and change during childbearing. It is not surprising then, that women of all ages report experiencing shame, confusion, fear and disconnection from their bodies. This culture of ignorance begets a culture of shame which alienates women from their body-knowledge, undermining their confidence and trust in themselves and in the healthy, normal processes of childbearing.
This policy will ensure that Australian adolescent women are provided sex-education that is woman-centred, wellness focussed, and that transforms their relationship with their bodies. This government policy will mandate the provision of comprehensive women’s sex-education and place midwives in schools as educators. Post implementation review will include frequent informal surveys and a formal review in consultation with consumers every five years.
This policy promotes radical self-knowledge for adolescent women and aims to undo the shame, silence, and disconnection that has enveloped women’s bodies. This creates potential for women to regard their bodies with curiosity, respect, and reverence so that they may be better empowered to manifest their sexual and reproductive goals.
If you’ve spent some time in the Australian maternity system, chances are you’ve heard a comment and thought ‘yikes, that was a bit racist’. This policy aims to eliminate these moments by helping midwives address their unconscious racial bias from the beginning. In the Australian maternity system, women of colour face institutional racism and unconscious race-based bias from midwives every day. Evidence shows us that this leads to mental health challenges and poorer birth outcomes.
The cultural safety training midwives receive is not adequate to address the racism women experience in the Australian maternity setting. We need to go deeper to address the bias many of us don’t know we have and tackle our unconscious racial bias. This can be done most effectively in university, with modules addressing unconscious racial bias in a Bachelor of Midwifery enabling students to confront their bias. These modules will include an online unconscious racial bias test and provide activities for students to reflect on and change their practice in order to provide culturally safe care.
Midwives addressing our unconscious racial bias is just a part of the puzzle in reducing racism in maternity care, but it’s key in improving our care for women of colour. This policy will allow midwives the opportunity to care for women of colour better from the very beginning of their career. Follow up anonymous surveys on women of colour’s experience in the maternity system and online re-testing of students’ unconscious racial bias will provide valuable evaluation for these modules.
Breastmilk is the most nutritional supply of food and the most personalised preventative medicine that one will ever have in their entire lifetime. The World Health Organisation recommends that infants are exclusively breastfed for the first six months of life to achieve optimal health and development. Despite this recommendation, and national health initiatives such as the Baby Friendly Health Initiative, only 15% of mothers achieve the goal of breastfeeding exclusively for six months.
Evidence suggests that experiences in the birthing environment have a direct impact on the establishment of breastfeeding practices. Birth interventions such as caesarean section, forceps and vacuum extraction may disrupt early anatomical function in the baby and physiological processes in lactation. To protect, promote and support exclusive breastfeeding, early evaluation of breastfeeding and intervention to support the mother/baby dyad who have experienced birth interventions is paramount.
The aim of this policy is to improve the clinical care of the mother/baby dyad through the implementation of a modified LATCH Breastfeeding Assessment Tool. This tool supports women and babies who find initiating and maintaining breastfeeding difficult. It will be used in the early postpartum by trained midwives in ACT Health to assess, evaluate and document a breastfeed. The tool will help to target breastfeeding advice and education, and alert midwives to any issues that require referral to a lactation consultant, or specialist in biomechanical anatomy such as an osteopath.
Domestic violence is a universal phenomenon which indiscriminately crosses demographic and social boundaries, which encompasses but is not limited to psychological, physical, sexual, financial or emotional abuse. Domestic violence jeopardises maternal and fetal health and well-being. Presence of domestic violence prior to, during and after pregnancy, labour and birth is associated with adverse health outcomes such as depression, miscarriage, stillbirth, preterm birth, low birth weight and may also affect how a woman interacts and bonds with her baby.
The antenatal period is seen as a “window of opportunity” for domestic violence victims. It has been recognised as a time in which women are motivated for change for themselves, and their unborn child. Ensuring midwives feel confident in their knowledge and skills to safely initiate conversation and pathways relating to domestic violence is a vital step in change.
Studies reveal registered midwives feel incompetent and lack confidence to discuss domestic violence due to various reasons. Student midwives feel they lack a solid foundation of theoretical and practical learning to carry into their career when registered. The policy proposed includes enhanced and regular mandatory training for student and registered midwives in response barriers identified, along with the opportunity for students to be exposed to cases in which domestic violence victims are involved and feel safe and happy to include a student in their care.
I intend to present a poster and three-minute presentation. I aim to implement this policy starting in ACT and slowly reaching nation-wide.
In Australia breech birth presentation occurs in 3-5% of pregnancies at term, however due to high rates of medical intervention only 1% of these are supported vaginal breech births (VBB). Untrained medical staff heighten risks to both women and their babies experiencing a vaginal breech birth due to lack of knowledge and experience.
My policy is to implement an on call competency trained medical team for low risk women wanting a vaginal breech birth. This team will consist of a midwife, registrar and obstetrician trained in VBB who are available to call when the need arises. Having a team on call will benefit both women planning a VBB as well as those women with an undiagnosed breech baby during labour. Successfully implementing this policy would increase safety for women/babies, improve mental health outcomes for women and their partners and increase overall birth satisfaction.
VBB risks are low, and most women desire a vaginal birth over having a caesarean section (CS). Evidence states women feel as though they are fighting the health system and are left reacting to a loss of control and choice. Ensuring women remain safe, feel supported, and advocated for by their care team lays the foundation of trust in the working relationship. By supporting woman’s birth choices and allowing VBB we are encouraging autonomy and decision making for women, can shift negative birth perception and improve maternal mental health outcomes.
A shortage of midwives is a prominent challenge faced across the globe today and entails serious ramifications for the women receiving care during the perinatal period. Exploring the causes and effects of reduced staff retention presents an opportunity to not only identify, but also formulate strategies that increase sustainability and optimise satisfaction in the midwifery profession. This policy aims to identify the main contributors of reduced sustainability in the midwifery profession and promote satisfaction in the midwifery workforce.
The literature presented a common discourse of dissatisfaction amongst midwives deriving not only from their role within an organisation, but the organisation itself. A commonality arose in the literature about midwives’ satisfaction, a positive workplace culture and working “with woman”. Themes of how the provision of continuity of care in a caseload model can facilitate work-life balance and provide significant mental health benefits to midwives also became apparent. Overall, the literature elucidates a need for strategies that optimise satisfaction and sustainability in working midwives.
This state policy entails strategies such as clinical mentorship, exercise, and the reorganisation of maternity care models with a greater focus on case-load continuity models. The policy incorporates self-reflection and reflective practice groups to promote the foundation of safety cultures wherein midwives seek and receive professional feedback whilst embracing adverse events with a propensity to learn.
This policy focuses on reorienting maternity services in a manner that facilitates positive longitudinal relationships between women and midwives, ultimately improving maternal and neonatal outcomes.
During my time as a student midwife, I have experienced childbearing women consenting to aspects of their care without being fully informed and being unaware of their rights in pregnancy.
Informed choice, consent and decision-making during pregnancy has not dominated research over the last 20 years, nor does an extensive scope of literature exist on how we could effectively enhance informing women. Currently, there is no evidence around the influence of increasing time antenatally upon a woman’s ability to feeling informed and having the knowledge to confidently consent to and make informed decisions.
What is indicated throughout existing qualitative studies however are women’s notions expressing uncertainty, un-met information needs and feeling as though their care is not presented as a choice. Therefore, highlighting that women are often unsatisfied with their care.
This policy intends to improve informed consent and choice but most importantly, aims to enhance maternal satisfaction and birth experience.
This policy will be presented as a trial and will meet the expected aim, as well as address the present gap within the literature, through increasing the length of antenatal appointments in non-continuity models of care. Hence, providing women with adequate time for thorough discussion and satisfactory education.
Trialled within the ACT’s public hospitals, the influence of this policy will be assessed qualitatively, surveying women’s experiences before and after its implementation. This will determine if women feel further informed to exercise choice and therefore, actively participate in their maternity care.
The postnatal period for many women can be emotionally and physically challenging. This period after birth can be extremely important in ensuring women are well, feeling supported, bonding with their baby and establishing breastfeeding.
Literature indicates a gap in women’s postnatal care once they transition from hospital to the home setting, extending to the 6-week period. Women have reported experiencing anxiety and fear around early parenting. By offering 6-week midwifery postnatal care, unlike other programs, women will receive woman-centred individualised care by a known midwife specialised in the postnatal period. Overall shown through research to have a positive outcome for women and their babies.
Many factors contribute to a woman’s postnatal experience. Breastfeeding and birth trauma have been identified as key areas women felt they needed more specialised support. Women who experience any type of birth trauma report much higher rates of postpartum depression, postpartum post-traumatic stress disorder and parent-infant bonding disorders. Postnatal debriefing by midwives provides women with the opportunity to make sense of their birth experience and strengthens them psychologically.
Studies show 96% of mothers initiate breastfeeding, however, only 15% are exclusively breastfeeding at 6 months, potentially due to the support they receive in the first 6-weeks.
This policy aims to offer women 6-week midwifery postnatal care, focusing on decreasing postnatal mental health disorders, representations to the emergency department/readmission and increase breastfeeding rates beyond 6-weeks. Midwives working to their full scope of 6-weeks postpartum through home visits, will also offer women continuity of care by a known midwife.
Australian women are starting a family later in life for many reasons. These include choosing to establish a career first, seeking financial stability as a priority, experiencing fertility issues when they do attempt to consciously conceive or simply just continuing their childbearing years. A quarter of pregnant Australian women are over the age of 35, with 30.7 years old being the average age when they become a first-time mother.
In the Australian maternity care system, if women are over the age of 35, this is perceived as a risk. With research siting that the inherent aspects of ageing as a female mean that you are more likely to develop co-morbidities or have an increased likelihood of developing other risks in pregnancy. This narrative has profound impacts on the psychological aspects of preparing for childbirth, leaving women in doubt of their bodies.
We must remember this key point of Professor Hannah Dahlen’s, from Western Sydney University, “While statistically, women over the age of 35 are more likely to develop diabetes and high blood pressure, you can have very unhealthy, overweight 23-year-olds, and very healthy 35 or 40-year-olds with none of those health conditions.”
The advantages of having babies later in life that are yet to be explored in great depth and this policy proposes the best way to start this journey is to treat low-risk women over the age of 35 as low risk.
Sleep positively impacts every aspect of our physiology and wellbeing. For childbearing women, sleep is vital for physical recovery from the work of pregnancy, for supporting mental health and navigating life’s challenges.
Sleep changes in pregnancy are well documented and prevalent. Most women experience some sleep reduction due to physiological changes and discomfort. Additionally, by the third trimester, up to 60% of women experience significant insomnia symptoms with persistent difficulty in initiating or maintaining sleep.
Growing evidence associates ongoing sleep disturbances in pregnancy with potential adverse outcomes for women and babies. Insufficient sleep is a stressor which causes neuroendocrine, metabolic, and inflammatory changes, increasing the risk of GDM, preterm birth, and mental health difficulties for childbearing women. The importance of sleep has largely been omitted from antenatal health conversations. Promoting an appreciation of sleep and supporting those women who are struggling to sleep is a current unmet need in our health system.
Sleeping for Two is a policy for ACT Health which aims to promote and enhance women’s health through simple screening, education, individualised support, and non-pharmacological sleep interventions for women, such as referral to evidence-based online resources and free clinically proven therapies. The policy’s effectiveness will be reviewed through surveys for women and midwives.
The profound transformation of becoming a mother, a time of significant physical and psychological changes, expectedly impacts sleep! Asking each woman how she is sleeping is an opportunity: it provides insight into physical, social, or psychological factors for which midwives can provide support or referral.
Perineal injuries may become severe morbidities for women and can result in adverse effects that significantly impact short term and long-term aspects of their lives. According to current research, perineal injuries and the co morbidities associated may cause further perineal pain, incontinence, isolation and or loss of identity. These aspects and more have negative impacts on a woman’s perceived role as a mother and a woman. Women deserve the chance to grow as mothers and women postnatally without the burden of perineal injuries and the adverse effects that join them. Ample research highlights the increasing rates of perineal Injury however, there is minimal action in place to avoid these significant injuries. Therefore highlighting why it is crucial to avoid the risk of potential perineal injuries for all women during the second stage of labour.
This can be achievable through using a policy supported by evidence to reduce perineal injury, that is designed to delay the initiation of pushing and beginning of the second stage of labour. The policy ensures that the management of the second stage of labour is individualised to reduce the risk of perineal injuries. Importantly, the policy focuses on simple rights for labouring women within a healthcare setting and should be executed with quality care and assurance. Current policies focus on combating the extended duration of the second stage of labour and result in intervention approaches. This policy is designed to allow more opportunity for risk free, intervention free labour and birth circumstances, and ultimately positive outcomes.
The purpose of my policy is to educate the supporting partners of child-bearing women, to generate better healthcare out comes for both mothers and their babies. Research shows women with a strong support network have decreased maternal stress levels, improved wellbeing, reduced risk of preterm labour and are more inclined to attend appointments. Women are more motivated to take part in exercise and improved healthier eating habits with partners support and involvement. For women this means a healthier pregnancy, as well having strong support increases their likelihood to breastfeed. For their babies both the small for gestational age (SGA) rate and pre-term labour birth rates are reduced.
With the implementation of my policy the non-pregnant parent can expect to be educated on coping strategies for women in labour, breastfeeding and what to expect, an opportunity to gain further support from others in the same situation, as well as evidence-based information on pain relief options. My plan for educating the non-pregnant parent would be to create a partner specific class where partners can gain knowledge and education, increase support networks, as well ask questions- in a safe and welcoming environment. I feel these classes will be beneficial to first time parents to gain support and knowledge, however parents of subsequent pregnancies will also find the information within these classes extremely helpful. Our goal as midwives is to empower women, and through educating the non-pregnant parent this person can in turn educate the woman, because through knowledge comes power.
Massage therapy and relaxation techniques have been used for centuries by many different cultures to assist women in facilitating a calm, holistic birthing environment. There is a known correlation between massage and increased oxytocin production in women, therefore a conclusion can be made in regard to routinely bringing these therapies into birthing settings to assist in reducing pain and promoting a spontaneous vaginal birth.
My rational for this policy is to facilitate and encourage women to be as comfortable and confident in their bodies as possible and assist women in managing the pains of labour in a constructive and present way through breathing exercises and massage. These complementary therapies have the potential of reducing the need for pharmacological analgesia and promote spontaneous vaginal birth. This would be conducted via a licensed massage therapist providing in-person education for midwives wishing to develop these skills in a certified foundational workshop. This can then be further developed with more external training.
This policy aims to incorporate complementary therapies into birthing spaces to increase maternal satisfaction, coping mechanisms and increase the maternal pain threshold and therefore reducing the need for pharmacological pain relief. This would give the woman autonomy over her body to manage the difficulties of labour, as well as decrease the cost and pressures currently faced by operating theatres and pharmacological management of pain in these settings. Furthermore, it would upskill midwives into expanding their knowledge of non-analgesic pain management and add more to their toolbox of supporting women in birthing settings.
The International Confederation of Midwives mission is to keep birth normal. This policy removes the recommendation of routine administration of intramuscular oxytocin for low-risk women experiencing a physiological labour and birth in Australia.
Low-risk women giving birth without interventions, augmentation and within normal timeframes should be supported to have a physiological third stage of labour. The recommendation to give intramuscular oxytocin for active management of third stage of labour (AMTSL) for these women is often unnecessary.
A critical analysis of the literature found that AMTSL has been recommended practice for many years for all women. This is based on studies which include women with risk factors and concludes third stage labour to be risky. Very few studies have looked at outcomes specifically of low-risk childbearing women with normal pregnancies.
Despite oxytocin being an affordable prophylaxis for postpartum haemorrhage, the practice of AMTSL is a medical intervention. Adverse effects such as increased blood loss & pain along with breastfeeding challenges have been reported by women. Babies are also disadvantaged by earlier cord clamping.
This policy will ensure physiological third stage of labour is routine practice when certain criteria are met. The policy will include training for care-providers on how to facilitate a physiological third stage of labour safely, preserving important midwifery skills.
This policy will allow us to collect data for more extensive studies to be completed on physiological third stage for low-risk women. The policy will be implemented state-wide and be reviewed annually.
How precious is watching a mother interact and study her newborn baby for the first time? As midwives, we notice a mother’s loving touch, the soft murmurs, and the look of admiration at her baby. We also know how sacred this moment is and how important it is for the mother and baby’s bond and attachment in the future. My 15minute-presentation will explore how midwives can encourage this mother-infant bond in the postnatal period by implementing infant massage classes in the hospital setting.
Evidence shows that the use of touch during infant massage strengthens the mother-infant dyad. Benefits of performing this massage include an increase in mother-infant bonding time and in the mothers’ parenting confidence. This stems from the mother focusing on her baby during the massage and noticing the unique movements they make. Similar to a birthing class, this policy recommends a midwife run the postnatal infant massage class to reinforce the importance of noticing infant cues and encouraging the mother to respond accordingly, while also supporting an opportunity for a mother to bond with her baby.
The aim of this policy is to support a mother to identify her baby’s cues and movements and respond accordingly. By picking up on these cues, the mother will feel more confident in her parenting and ability to bond with her baby. It is expected that by implementing this postnatal class mothers will feel prepared emotionally to satisfy the needs of their baby and satisfied in their own mothering ability.
Induction of labour is a surgical and/or medical interventional process used to stimulate the onset of labour. When used in line with appropriate medical indications, induction can be a beneficial procedure which supports the best outcome for women and their babies. However, research shows that caesarean section is more likely following induction, particularly when it is performed too early and without medical indication.
Recent statistics recorded by The AIHW state that 43.8% of women have their labour induced in Canberra. Nationally, caesarean section rates are at 36% with induction contributing to 29% of these.
The combination of evidence regarding negative outcomes for women and babies [in association with early and unnecessary induction] and suggestions by WHO that there’s no need to induce labour prior to 41 weeks’ gestation, indicates the need to change when induction is offered to low-risk women.
This policy proposes to delay induction until at least 41 weeks’ gestation in promotion of spontaneous labour for low-risk women. The policy and its guidelines will be directed to midwifery and obstetric teams in Canberra to promote collaboration and avoid the provision of conflicting advice and information [based on bias and preference]; instead, it provides for evidence-based information, clarity on the options available, and disclosure of the risks and benefits to women being assessed for induction. These changes will provide more opportunity for women to receive informed, individualised assessment and labour management prior to receiving induction; therefore, potentially reducing rates of induction and caesarean section in Canberra’s hospitals.
Perineal trauma and the consequences that arise from it, are highly significant in a woman’s health and wellbeing. Every year millions of women worldwide sustain perineal trauma when giving birth (around 85%). Most midwives who attend suturing workshops do not complete the accreditation process to become an actively suturing midwife. However, with midwives being significant in providing care and support to women, it is essential that they are educated and practise in such a way to reduce perineal trauma and provide competent, skilled care in their assessment and repair.
Perineal assessment and repair performed by inadequately trained staff can result in incompetent and inappropriate management. Findings suggest that correct clinical assessment of perineal tears and the provision of woman-centred, personalised care by a Midwife during the immediate postpartum period are critical to ensuring positive outcomes for women who experience perineal trauma.
This policy aims to enforce that all Midwives are trained and accredited in standardised management and repair of perineal tears, by making it a standard within APHRA’s registration and renewal process. This would involve the attendance at up-to-date evidence based Inservice’s and face-to-face workshops for continuous professional development and renewal of registration. Inservice’s would comprise of suturing techniques, postpartum care, preventative measures and looking after women in subsequent births following on from severe tears. The objective of this policy is to encourage and improve the qualifications and skills of midwives in perineal repair, and in turn promote woman centred care through consistency of care.
The environment in birthing centres is very different to that of a busy birthing suite. Women without access to a birth centre miss out on continuity of carer as well as promotion of non pharmalogical options for pain relief. Snoezelen rooms promote non pharmalogical pain relief within the birth suite. By incorporating multiple elements designed to stimulate peoples’ senses, Snoezelen rooms have been demonstrated to improve empirical and clinical outcomes for women, their babies, and midwives. .
Women report Snoezelen rooms reduce anxiety, reduce pain intensity, increase partner involvement, increase environmental control, and improve satisfaction. Snoezelen rooms provide no risk to baby and positive effects on the relationship with her partner and baby.
At a time when medical intervention in birth is increasing, alternative settings, like Snoezelen rooms, can increase the chance of spontaneous vaginal birth and reduce the likelihood of medical interventions, oxytocin infusion and caesarean section. Birth environment and sensory distraction also reduce the uptake of intrapartum analgesia. Room design benefits midwives too by reducing stress, increasing feelings of safety, promoting empathy, and providing freedom for adaptive and responsive midwifery practice. Transforming two rooms within Centenary Hospital for Women and Children birth suite to be Snoezelen rooms, women and midwives will achieve benefits. Women can antenatally self identify a preference for using the rooms in labour. ACT Health will provide funding, which is offset by a reduction in medical intervention, analgesia, and caesarean sections. Evaluation will involve quantitative comparison of clinical outcomes and qualitative analysis of women’s experiences of the rooms.
Vaginal examinations should only be performed when there is a clear clinical indication or at maternal request, with consent. Many women experience an urge to push in labour, and it is common practice to ask to perform a vaginal exam to confirm full dilation before encouraging the woman to push. This is because there is a widespread belief that pushing on a cervix that has not fully dilated is harmful and can cause trauma and oedema.
The most up to date evidence does not support the belief that physiological pushing in low risk, spontaneous labours before full dilation causes harm. A randomised control trial found that there was no difference in APGAR scores and no incidence of cervical or severe perineal tearing associated with EPU, and another review found no difference in the instance of cervical tearing.
There is a severe lack of evidence to support current practice. Therefore, a policy of only offering vaginal examinations to confirm full dilation during low risk, spontaneous labours when clearly clinically indicated, should be widely implemented. The aim of this policy is to reduce unnecessary, potentially harmful vaginal examinations, to educate midwives and other staff on the current evidence surrounding EPU and encourage facilitating trust in women’s bodies. This policy would be implemented at both public ACT hospitals. Staff would be educated and encouraged to complete qualitative surveys, and an audit of birth statistics would be carried out pre and post implementation to evaluate outcomes.
In this policy presentation I will discuss the implementation of a Sexual Function pathway within ACT maternity services. Sexual health care is considered to be well within midwifery scope of practice, with the Australian College of Midwives stating midwives provide sexual or reproductive health care. Despite this, it continues to be an aspect of care that is heavily overlooked. Whether it be an insufficiency in midwifery knowledge, or an inadequacy in resources, sexual health care within midwifery fails to be prioritised, and women have poorer outcomes for it.
I am proposing a screening tool to be used in the antenatal and postnatal settings of The Centenary Hospital for Women and Children. Based off of the “Female Sexual Function Index” by Rosen and colleagues in 2005, this tool is designed to screen women for sexual dysfunction and dissatisfaction, start conversations around sexual health during pregnancy and after birth, and prompt accurate referrals. The tool uses six domains to assess function; desire, arousal, lubrication, orgasm, satisfaction, and pain. These domains represent the key aspects of sexual function, and are replicative of the multidimensional nature of a woman’s sexuality. When a woman is identified as high risk for sexual dysfunction and/or dissatisfaction, a referral pathway is to be followed. Staff in-service training is at the forefront of the implementation strategy, as well as a bi-annual review process, collecting data from midwives, women, and other participating health professionals. Women deserve adequate sexual health education and care from their midwives, so let’s talk about sex.
The ever-rising rate of pregnancy, labour and birth interventions, due to our risk adverse society, has resulted in higher instances of induction of labour, instrumental birth, caesarean section and ultimately, more importantly, maternal dissatisfaction.
The evidence clearly shows the levels of fear and anxiety in childbearing women, regardless of parity, are rising, leading to more women choosing to have birth intervention including elective caesarean section. Not only is intervention costing us more, the literature also states women are having negative birth experiences impacting on the post-partum period and their future reproductive health, including the decision to bear more children.
In the absence of access to continuity of care for all women, this policy aims to encourage and empower more women to be well informed and supported in the natural processes of pregnancy and birth, by enhancing the current standard model of antenatal and intrapartum care.
This policy proposes to address the individual needs of women by offering group classes and acknowledging and providing open conversation on fear of childbirth or fear of next birth. In these sessions, ways to manage pain and the first stage of labour can be discussed and individual pathways of care can be established to achieve optimal birth outcomes and maternal satisfaction. Evidence suggests additional antenatal education, a belief in normal birth and the acceptance of key issues contributing to the increasing rate of caesarean sections, can help lower the rate, thereby resulting in better birth outcomes and improving the experiences of women.
Australia is a country built on diversity and women from culturally and linguistically diverse (CALD) backgrounds make up a large demographic of women birthing in Canberra. However, they continue to face cultural and social barriers that negatively impact their mental health during pregnancy and birth. CALD populations are frequently underrepresented in mental health data, suggesting that they are often underreporting mental health struggles. Studies conducted to investigate depressive symptoms antenatally and postnatally have found that CALD women are more likely to report having these symptoms using the Edinburgh Postnatal Depression Scale (EPDS). .
Language barriers, lack of social supports and a lack of understanding around differing cultural norms means that CALD women are left feeling misinformed and unsupported throughout their care. It is paramount that midwives and other healthcare professionals understand and acknowledge the difficulties they face and adapt their care to suit. The literature tells us that essential to bettering care for CALD women is effective referral and collaboration, specialised mental health screening and increased time and resources.
This policy aims at creating a CaTCH program, specifically for women of CALD backgrounds that will allow them to receive continuity of care that is supportive and culturally safe. Mental health outcomes would be assessed postnatally using the EPDS and a survey focused on support and mental health. Midwives – especially those in continuity models – are well placed to recognise the barriers facing CALD women throughout their perinatal period that contributes to ill mental health to ensure early detection and considered care.