UC HDR Bazaar

Sport Integrity Research Lead, Faculty of Health, University of Canberra

Associate Professor Catherine Ordway

Associate Professor Catherine Ordway is an international expert in the field of integrity in sport, and has specialised in anti-doping policy for more than twenty years, as well as playing competitive sport at a national level. Catherine is a sports lawyer, having acted for the Australian Olympic Committee in a legal capacity in the lead up to the Sydney 2000 Olympic Games. She has consulted on projects including the Rio 2016 Olympic Games Bid, the Budapest 2024 Olympic Games Bid, and the Gold Coast 2018 Commonwealth Games.

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.

Download full abstract and bibliography

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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