2022 Midwifery Possibilities Conference

Presentation

Rural Women Matter - Establishing midwifery-led continuity of care in Yass

Krista Woods, Sarah Clarke and Bek Messner

The closure of rural maternity care facilities has limited rural women’s choice around models of care and birth location. Travelling to access care and give birth has led to negative social, emotional and safety impacts. Indigenous women are also particularly affected and continuously denied the right to supported cultural birthing practices. Evidence has shown that rural women experience higher rates of preterm birth which may be attributed to the higher proportion of young women and Indigenous women.

Continuity of midwifery care provides better maternal and neonatal outcomes and experiences compared to fragmented care. Positive outcomes include spontaneous vaginal birth of term babies, a positive birth experience, and greater confidence with breastfeeding. Published evidence supports the implementation of caseload midwifery models in rural settings with evaluations showing positive outcomes, especially for women with potential vulnerabilities such as age, socioeconomic status, and Indigenous ethnicity.

Our policy proposal, which will be an oral group presentation, is to utilise the growing body of evidence to implement a midwifery led continuity of care model in Yass, NSW, which currently does not offer birthing services despite increasing consumer demand. We will describe the implementation and evaluation strategies, including data collection and analysis to determine success and sustainably to inform future development of this model in other rural communities. To address the potential barriers of funding, staff shortages and safety concerns, our implementation strategies will include a strong emphasis on workforce recruitment, sustainability, and competency.

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Presentation

An early point evaluation of the perineal protection bundle.

Kerry Moylan

Between 2010 -2015, Australian rates of third- and fourth-degree tears, or obstetric anal sphincter injuries (OASI) for both instrumental, and non-instrumental, births were higher than the average across all Organisation for Economic Cooperation and Development (OECD) countries. In 2019, the ACT rate was 3.7% of all vaginal births. OASI can result in dyspareunia, incontinence, pain, depression and a twenty-fold likelihood of caesarean section with subsequent pregnancies.

Known risk factors for OASI are difficult to modify but given the impact of these injuries, there has been substantial research into determining evidence-based midwifery strategies to reduce the incidence of severe perineal trauma. In 2021, the Canberra Health Services introduced the Women’s Healthcare Australasia Perineal Protection Bundle consisting of five ‘care elements’, to guide clinicians in best practice and, when implemented as a whole, reduce the occurrence of OASI by 13.43%. A review is scheduled for 2025.

Anecdotal evidence indicates considerable variation in the application of midwifery practices suggested by the bundle and an early point evaluation is warranted. An evaluation of the past year’s perineal trauma rates, determining staff interpretation and application of the policy, plus a qualitative examination of women’s perceptions of care, will identify barriers and enablers. Earlier understanding of the effectiveness, limitations and identifying potential solutions to increase utilising the ‘care elements’ is crucial to ensuring the longer-term provision of the highest standard of evidence-based practice and woman-centred care.

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Presentation

Weighing healthy term newborns; are we setting them up for intervention?

Katherine Stock

OWeighing babies when they are born is a common midwifery practice, yet there is minimal research about this being an evidence-based practice. This number may not be an accurate representation of the baby’s state however it is used to plan care which potentially leads to unnecessary monitoring, intervention and ramifications for parenting confidence and postnatal care. There are many mitigating factors that can inflate a baby’s weight at birth. The first weight includes not only the solid body but also the fluid the baby took on board while in utero, such as the fluids given to the mother during labour and the fluids the mother has on board during pregnancy. There is minimal evidence in the midwifery and medical literature to inform the best time to first weigh babies.

Rather than a policy, I am proposing a research study which continues the work of Joy Noel-Weiss, a Canadian RN/IBCLC. She proposed an observational study to examine the associations between maternal fluids, neonatal output and newborn weight loss. An ethics approved research protocol will inform a pilot study of healthy term single pregnancy, spontaneously birthing babies with no maternal or neonatal risk factors. A full breastfeeding assessment will be undertaken within the first 24 hours. Outcomes measured will include management of and/or NICU admissions for weight loss, midwives and paediatrician’s confidence and maternal satisfaction. Data will contribute to the current limited evidence base and support further research to ensure optimal care is provided.

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Poster

Indigenous-led Continuity of Midwifery Care Program

Grace Hindmarch

In Australia, Indigenous women and their families receive inferior quality care resulting in poor outcomes and experiences than those who are non-indigenous. Indigenous women report higher rates of disjointed care throughout their pregnancy, racism and discrimination, a lack of cultural awareness and difficulty accessing services. Midwives report a gap in practicing culturally safe care, particularly within tertiary hospital settings and accessing Aboriginal health workers and liaisons. Aboriginal and Torres Strait Islander women are also more likely to birth prematurely and have higher rates of SGA and low birthweight babies. In 2020, 292 Indigenous babies were born in the ACT.

My policy proposes the implementation of an Indigenous-led all-risk continuity of care program for Aboriginal and Torres Strait Islander women, and women birthing Indigenous babies to improve maternal and neonatal outcomes. Employing 3 fulltime equivalent midwives working in a caseload as part of the C@TCH program at Centenary Hospital will ensure at least 50% of ACT’s Indigenous women’s needs are prioritized. In alignment with the 2021 Close the Gap Health goal of increasing the maternal care workforce, positions should be prioritized to Indigenous midwives with the inclusion of Indigenous student midwives. Implementation includes cultural-safety training to midwives undertaking these positions to address racial bias and improve cultural education around care for Indigenous women and their families.

The outcome of this trial will be evaluated through surveys from women and midwives, and birth note audits. If the evaluation is successful, the program should be extended to all Indigenous women in the ACT.

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Presentation

Prioritising the Health of Women with Gestational Diabetes Mellitus

Georgia Otter

Gestational Diabetes Mellitus is a highly reported health condition occurring during pregnancy with Australian statistics estimating a 15% prevalence. Higher rates of adverse antenatal, intrapartum, and postnatal outcomes, as well as lower rates of breastfeeding are reported. These adverse outcomes greatly increase the risk of mothers and infants developing long-term health complications, including Type 2 Diabetes Mellitus.

Research identifies the significant influence midwifery-led models of care have on optimising pregnancy, intrapartum, postnatal, and breastfeeding outcomes. However, access is often inequitably limited by hospital policy to well, low risk women. Women with any complexity experience a biomedical model, decreased midwifery support, and poorer outcomes.

This policy seeks to address that inequity and maximise the potential for optimal outcomes for women with Gestational Diabetes Mellitus. Upon diagnosis women will be transferred to a midwifery-led continuity of care model. Antenatal, intrapartum, and postnatal care will be provided by a known primary midwife, or team of rostered midwives, working within the full scope of midwifery practice with additional professional development in this condition. This service will act as a fulcrum, connecting and engaging women with obstetric, endocrinological, and dietetic services where needed. Six weeks of postnatal care will ensure a high uptake of a glucose tolerance test, to inform future care provision.

Success will be evaluated by collecting quantitative data on pregnancy, and birth outcomes, as well as qualitative data on women’s experiences. This service has the potential to promote greater public health outcomes for mother infant dyads in this cohort.

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Presentation

Depathologising birth for queer people through a gender-affirming model of care.

Emily Jansch

Not all birthing people are women and not all women are birthing people. There is increasing global recognition that gender-diverse people are birthing and becoming parents, however their invisibility persists in healthcare attitudes, policies, and language.

General healthcare for queer people is routinely pathologised and characterised by dismissive attitudes and negligent misgendering of internal and parental identities. This policy seeks to elevate the perinatal experience for all birthing people by implementing a gender-affirming model of care into local maternity services built on the three interconnected pillars of: accessibility, rights-based, and person-centred care. Midwives are ideally positioned to adopt this policy as the tenets of gender-affirmation parallel those of the midwifery model of care in respect for human dignity and compassion.

Implementation will include upskilling clinical and non-clinical staff in inclusive care practices and strengths-based approaches, and by increasing visibility in diversity of birthing people and their families in perinatal spaces. Evaluation of this policy will measure the success of inclusivity education through qualitative assessment of gender-diverse peoples experiences of maternity care.

Deidentified experiences and outcomes will be formally published as a contribution to building an evidence base for wider implementation and establishment of gender-affirming models of care.

As a public health strategy, this policy aims to reduce wider health inequities for gender-diverse people by empowering providers to deliver individualised and culturally competent perinatal care. This policy reinforces the empowerment of childbearing women alongside supportive care for queer birthing people.

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Presentation

The Power of Paracetamol: Does it impact the duration of the latent phase of labour?

Chloe Dunn and Ali Hicks

Paracetamol is a widely recommended strategy to manage the discomfort experienced during the latent phase of labour. Paracetamol inhibits prostaglandin synthesis, thereby reducing the production of prostaglandins, resulting in reduced sensations of pain. It is well documented that prostaglandins play an integral role in labour by contributing to cervical dilation and uterine contractions and are commonly used in the process of induction of labour. A high level of evidence has been found by various researchers theorising that the prostaglandin inhibitory characteristics of paracetamol may be associated with the anecdotally observed increase in the duration of the latent phase of labour over recent decades. Qualitative evidence has found an association with prolonged latent phases of labour, and reduced satisfaction levels among birthing women.

This presentation will propose an observational cohort research project using a prospective, dual cohort strategy to identify if the use of paracetamol as a pain management strategy during early labour is associated with an increase in the duration of the latent phase of labour. Relevant operational definitions of the latent phase of labour will be determined in consultation with participating midwives and obstetricians. The sample population will be clearly identified as well, term, primiparous women, labouring spontaneously. Data will be collected through the inclusion of relevant mandatory fields in the ACT Health Digital Health Record.

The results of this research will provide an initial evidence base to inform future research and practice regarding recommendations and advice for pain management and coping strategies for the latent phase of labour.

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Presentation

Introducing a Continuity of Care model for young women in Australian Capital Territory.

Brittanie Till

In Australia, young pregnant women continue to be seen as a major health and socioeconomical risk. Even with the pregnancy rate of this demographic decreasing since 1980. In 2019, 7.7% of births in Australia were made up of young women aged 15-19 years, with no specific detail on the care they received. Current maternity options available for these women in the Australian Capital Territory, do not routinely allocate them to a continuity of care program.

Young pregnant women and their babies may experience complexities such as, pre-eclampsia, eclampsia, instrumental births, pre-term births, low birth weight and admission to the Neonatal Intensive Care Unit. Minimal evidence exists within Australia; however, it does show young women who receive continuity of care, experience fewer complexities.

The proposed policy is to introduce a continuity of care program for young women in the Australian Capital Territory. Young pregnant women at 12 weeks’ gestation will be invited to participate in this program, after registering their pregnancy with Canberra maternity option services. The continuity of care program will run and be supported by a small group of midwives, offering more appropriate and tailored education and support, during the antenatal, intrapartum, and postnatal periods. This will decrease the complexities these young women and their babies face.

Once these young women complete the program, at approximately four weeks postpartum. Their experiences will be evaluated and change or enhance the program and meet the needs of young women. Ultimately, offering young women optimal outcomes for their pregnancy journey and beyond.

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Presentation

Midwifery-Led Continuity of Care for well women who have had Assisted Reproductive Technology.

Alison Bakavgas

This policy is designed to ensure that every well woman who has had assisted reproductive technology (ART) is offered a place in a midwifery-led continuity of care program in ACT Public Hospitals. Women who have had ART are often cared for by private obstetricians or Clinic midwives, not offered the opportunity to enter into a continuity of care program. Studies show that women who receive care from a known midwife are more likely to have a positive birth experience.

Operating from both Calvary Public Hospital and Centenary Hospital for Women and Children birth centres, this program would include weekly ‘Mothers Group’ gatherings. These groups give women an opportunity to connect with others on a similar journey, with the focus being on the woman’s transition from a highly medicalised conception to healthy pregnancy, and parenthood with close mental health support throughout. Midwives running this program would have prerequisite knowledge in all forms of ART having undergone additional training and personal development programs. Midwives in this program would also have a reduced caseload in order to allow extra time for women, with increased antenatal and postnatal time spent with women if necessary.

The success of the program would be evaluated by an anonymous questionnaire prior to discharge, birth outcomes, maternal satisfaction relating to their care throughout the experience and feedback.

Well women who have had a medicalised conception, are well women, who should be offered the opportunity for a less medicalised and more nurturing care model throughout their pregnancy, birth and beyond!

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Presentation

The Power of Paracetamol: Does it impact the duration of the latent phase of labour?

Ali Hicks and Chloe Dunn

Paracetamol is a widely recommended strategy to manage the discomfort experienced during the latent phase of labour. Paracetamol inhibits prostaglandin synthesis, thereby reducing the production of prostaglandins, resulting in reduced sensations of pain. It is well documented that prostaglandins play an integral role in labour by contributing to cervical dilation and uterine contractions and are commonly used in the process of induction of labour. A high level of evidence has been found by various researchers theorising that the prostaglandin inhibitory characteristics of paracetamol may be associated with the anecdotally observed increase in the duration of the latent phase of labour over recent decades. Qualitative evidence has found an association with prolonged latent phases of labour, and reduced satisfaction levels among birthing women.

This presentation will propose an observational cohort research project using a prospective, dual cohort strategy to identify if the use of paracetamol as a pain management strategy during early labour is associated with an increase in the duration of the latent phase of labour. Relevant operational definitions of the latent phase of labour will be determined in consultation with participating midwives and obstetricians. The sample population will be clearly identified as well, term, primiparous women, labouring spontaneously. Data will be collected through the inclusion of relevant mandatory fields in the ACT Health Digital Health Record.

The results of this research will provide an initial evidence base to inform future research and practice regarding recommendations and advice for pain management and coping strategies for the latent phase of labour.

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Presentation

Should I choose an epidural in labour? An antenatal decision aid for women

Susan Schemen

A third of labouring women in Australia request an epidural, including women who had not planned to use one. Depending on the woman’s own values, beliefs and preferences, this decision may either negatively or positively affect self-esteem and satisfaction with birth experience. While epidurals are an effective analgesic, they are also associated with significant and cascading risk factors. Pregnant women report finding it difficult to access unbiased epidural information that enables them to work through their own values and what matters most to them. Decision aids have been shown to be useful when there is more than one reasonable option and the best decision for the woman is influenced by personal factors.

The aim of the new policy, therefore, is to offer pregnant women at Centenary Hospital for Women and Children (CHWC) unbiased information by implementing a self-administered decision aid on epidural use in labour. The decision aid will be developed based on the National Institute for Health and Care Excellence (NICE) standards framework for shared decision-making support tools. The NICE standards framework outlines standards for the decision aid development process, plus the content and presentation of the decision aid. Evaluation during the development process will include acceptability testing by CHWC midwives and doctors, and women of childbearing age living in the jurisdiction. Evaluation post-implementation includes periodic review of the evidence.

The policy is important because women have the right to make informed choices that align with their values, beliefs and preferences; and a positive childbirth experience matters to women.

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Poster

Equity in maternity care: Introducing midwifery continuity of care for women from migrant and refugee backgrounds

Amudhini Sivam Rajakumari Elangovan

Over one-third of the mothers birthing in Australia were born overseas, yet strong evidence shows that these women, compared to those Australian-born, are at increased risk of poor maternal and neonatal health outcomes and mental health issues. Migrant and refugee women face many barriers in accessing appropriate maternity care. Cultural differences, language barriers, racism, limited health literacy, and insufficient support influence the availability and utilization of current maternity services, increasing vulnerability and disadvantage.

Studies have demonstrated the importance and benefits of midwifery continuity of care for women from migrant and refugee backgrounds. The purpose of this policy is to provide equity in maternity care by creating a midwifery continuity of care model in ACT health facilities for women from migrant and refugee backgrounds by a primary CALD midwife or a culturally competent midwife.

This model entails strategies such as longer appointments with holistic individualised care, psychosocial and practical culturally tailored support and education, timely access to interpreters, group antenatal classes using interpreters, in-language information, staff education and training in cultural competency, and diversity in the workforce. A notes audit focused on birth outcomes for mothers and babies and surveys on women’s satisfaction and experience of their continuity of care and staff job satisfaction and confidence will be used to evaluate the effectiveness of this policy.

This policy will improve health outcomes of women from migrant and refugee background and their babies, women's experiences of care, and overcome barriers to healthcare access which in turn fosters equity in our maternity system.

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Poster

Hold the epidural! Evaluating the enablers and barriers for midwives in the use of non-pharmacological pain relief in labour

Tatum Zotti

Over 75% of women in Australia use pharmacological and non-pharmacological pain relief in labour. Non-pharmacological measures such as massage, water therapy and acupressure have proven benefits. Using massage in labour has been shown to decrease pain and release oxytocin, while water therapy increases relaxation and endorphin production. Acupressure reduces stress and tension while with the further benefits being less intense pain and less anxiety. Most importantly, overall, these techniques improve women’s satisfaction in labour.

Pharmacological measures are also available. However, women receiving an epidural are twice as likely to report feeling dissatisfied with their birth. The use of epidural analgesia is also linked to a reduction of spontaneous birth, increased instrumental deliveries, episiotomies, and labour dystocia as well as negatively contributing to a woman’s sense of control and satisfaction during labour.

International, national, and local recommendations include using nonpharmacological techniques as the first line of management. Anecdotal evidence suggests that locally, Birth Centre midwives may more commonly use these practices than Birth Suite midwives, despite both following the same practice guideline.

A comprehensive evaluation of the current labour and birth policy will examine how it is being interpreted, identify the enablers and barriers in both birthing settings and help determine strategies to promote standardised practice. The evaluation will inform any necessary redevelopment of the policy. The revised policy will be disseminated using education and in-services. Evaluation of the policy’s implementation ‘success’ using birthing data, staff confidence and maternal satisfaction will be undertaken at regular timepoints.

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Poster

Room for improvement - A freestanding birth centre for Canberra.

Alesia Bradow

Intended place of birth plays a significant role in perinatal outcomes for women and their families. Birth centres that provide midwifery-led continuity of care have less intervention, improved birth outcomes, and higher rates of breastfeeding initiation. At present, only a small percentage of Australians can secure a place within existing birth centre programs. Expanding access to birth centres with this model of care would assist with the nation’s increasing birth intervention and caesarean section rate and contribute towards improved outcomes and experiences for women and their families.

In partnership with The University of Canberra, utilising stakeholder consultation, a purpose-built freestanding birth centre will be commissioned in response to these concerns in the Australian Capital Territory. This facility will enable more women to access the continuity of midwifery led care they desire while delivering additional support for culturally and linguistically diverse women, First Nations families who wish to Birth on Country, and at-risk families. With numerous multi-disciplinary services on offer, this will be a transformative step towards goals outlined in the Australian Capital Territory’s Maternity in Focus plan.

To evaluate success, qualitative and quantitative research will be conducted exploring outcomes and experiences for those who use birth centre services, as well as students and staff involved in its operation.

On evaluation, it is expected the birth centre will have a positive impact on the experiences and outcomes for women and their families and will be a valuable addition to both the healthcare and education landscapes of Canberra and surrounds.

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Poster

Nature’s Lifeline- Optimal Cord Management and Neonatal Resuscitation

Caitlin Guest

Optimal cord management (OCM) is a baby-led approach to the timing of umbilical cord clamping which focuses on respiration, ceasing of cord pulsations and baby behaviour. The benefits of OCM are widely accepted, yet up to 30% of babies have their placental circulation ceased prematurely in order to initiate resuscitation efforts or to allow cord blood sampling. Research shows that babies receiving resuscitation with the umbilical cord intact have better cardio-respiratory stability, improved oxygen saturation and higher Apgar scores. Mother-side resuscitation removes the requirement to cut off this valuable lifeline and has been practised by many midwives, particularly in the home, for centuries.

This policy supports initial neonatal resuscitation efforts being conducted mother-side, with umbilical cord intact for term neonates in the absence of significant risk factors. Multidisciplinary engagement and collaboration will be required for the redesign of birth rooms and acquisition of appropriate portable equipment. Care provider concerns regarding access for resuscitation will be balanced with the dyadic needs of the woman and baby. Training in portable resuscitation equipment will be provided for all intrapartum care providers. Evaluation will include an audit of birth outcomes, staff confidence with altered practice and maternal experience. Policy expansion to all neonates is planned upon positive evaluation.

Mother-side, intact cord neonatal resuscitation returns the focus of care to supporting the family unit and physiological transition to extra-uterine life. Significantly more babies will receive OCM’s benefits with improved clinical outcomes, whilst keeping women and their families at the centre of their care.

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Presentation

Low-risk women over 35 should be treated as low-risk

Sartu Pateman

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.

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Presentation

Sleeping for Two - promoting and supporting women’s sleep in the antenatal period

Kalina Pilat

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.

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Poster

Delaying the second stage of labour to reduce perineal injuries

Alice Pocock

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.

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Poster

Educating the non-pregnant parent- for better health outcomes.

Sarah Porter

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.

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Presentation

Complementary Therapies in Aiding Spontaneous Vaginal Birth

Jesse Prokop

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.

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Presentation

Physiological third stage of labour – is it always risky business?

Kelly-Maree Pyne

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.

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Poster

Massages for everyone: the importance of infant massage

Kaylee Smith

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.

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Presentation

Ready or not, here comes your induction! Delaying induction of labour in low-risk women to reduce caesarean section rates.

Anna Tanswell

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.

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Poster

Increasing Midwifery Participation in Perineal Suturing:

Kelly Taylor

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.

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Poster-Presentation

Snoezelen rooms to promote non pharmacologic approaches for labour

Jennifer Watkins

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.

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Poster

If it’s not broke don’t fix it: Early pushing before full dilation.

Megan Wilkes

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.

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Poster

Let’s Talk About Sex

Emma Williams

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.

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Poster

Promoting birth as normal – Reducing the rate of birth intervention and caesarean section

Cat Williams

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.

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Poster

Alice Yeadon

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.

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