ACM2015 Oral Presentations / Women and Birth 28S (2015) S7S32

examining this new phenomenon of the interaction between

women and birth through this technological interface that gives
direct access to the birthing room experience.
http://dx.doi.org/10.1016/j.wombi.2015.07.044
[O12]
Expecting and connecting: Evaluation of a
collaborative antenatal service
Lauren Kearney 1, Alison Craswell 2,*, Rachel Reed 3
1

University of the Sunshine Coast, Queensland, Australia

University of Wollongong, Wollongong, Australia
3
Independent Midwife and Lecturer, Australia
*Corresponding author.
2

Introduction: A midwifery-led, group antenatal care service,

Expecting and Connecting, was established in 2013 at the
Sunshine Coast on the campus of the local University, in
collaboration with the local health service. Based on the Centering
Pregnancy model, the service incorporates antenatal health care,
education and peer-to-peer support delivered via group facilitation. A key aspect of the service is the integration of midwifery
students and midwifery academics as part of the team providing
care, specically in the context of the continuity of care clinical
experience requirements of their midwifery education.
Methods: A two-phase mixed methods study design was
undertaken to evaluate the program. Qualitative data were
collected from students, midwives and mothers engaged with
the service regarding their experience and perceptions of
Expecting and Connecting. The second phase (ongoing casecontrol study) examines clinical outcomes between Expecting and
Connecting and standard hospital care, specically caesarean
section, preterm and low birth weight, pain relief used in labour,
mode of birth and breastfeeding exclusivity and duration.
Results: Preliminary qualitative ndings are overwhelmingly
positive with all participants agreeing on the value of the service
and a desire for it to continue and expand. Emergent themes
around expansion of role, women centred care and student
learning align with other literature in this area. Quantitative
analysis of a matched cohort set (case-control study) will also be
presented examining health outcomes.
Conclusions: The implications of these ndings for policy
makers are that community based group antenatal care is both
desired and achievable. It also provides important insight into the
student learning experience within this context, specically in the
domain of the continuity of care requirements for their midwifery
degree.
http://dx.doi.org/10.1016/j.wombi.2015.07.045

[O13]
Perineal research in New Zealand midwifery
practice
Robin Cronin
Victoria University of Wellington, Wellington, New Zealand
Introduction: Management of perineal trauma after a normal
birth in New Zealand is ordinarily a midwifery responsibility,
although there is no formal requirement for midwives to update
their perineal knowledge, and little is known about midwives
perineal care.

S11

Aim: To report on part of a survey that was designed to identify

midwives management of second degree perineal trauma,
inuences on their practice, and the level to which their practice
reects best evidence.
Methods: A descriptive approach using an online survey was
used to access the population of 2910 New Zealand midwives
providing current perineal management in 2013; 744 (25%) met
the inclusion criteria. Quantitative data were collected and
associations examined using chi-square and Fishers exact
test.
Results: The presentation will identify midwives management
of the last second degree tear treated. New Zealand midwifery
practice compared favourably to overseas research and perineal
morbidity was uncommon, however, there is potential for
improvement with respect to rectal examination, suturing
technique throughout all layers of repair, choice of analgesia,
and documentation of repair. Training in perineal repair within the
last two years, reported by 54% of midwives, was associated with
an increased likelihood of evidence-based suturing techniques
(p = 0.002), rectal examination during assessment of trauma
(p = 0.019), improved perineal documentation (consent for treatment, p = 0.005; discussion of care, p = 0.005; diagram of tear,
p = 0.007) and visualisation of healing (p = 0.014).
Conclusion: The majority of New Zealand midwives make
appropriate professional judgements in regard to the management of second degree perineal trauma. However, maternal
postnatal health could be enhanced if midwives increased their
use of evidence-based perineal practice, which is more likely
after they have received recent education in perineal management.
http://dx.doi.org/10.1016/j.wombi.2015.07.046
[O14]
The effect of waterbirth on neonatal mortality
and morbidity
Rowena Davies 1,2,*, Deborah Davis 1,2,
Melissa Pearce 2,3, Nola Wong 2,3
1

University of Canberra, Canberra, Australia

The Australian Capital Regional Centre for Evidence Based Midwifery,
Canberra, Australia
3
Centenary Hospital for Women and Children, Canberra, Australia
*Corresponding author.
2

Introduction: The practice of waterbirth remains controversial.

Professional guidelines argue there is insufcient evidence
available to guide waterbirth practice and consider waterbirth
an experimental procedure. Much of the criticism directed at
waterbirth focuses on the potential impact to the neonate.
Aim: To systematically review the evidence regarding the effect
of waterbirth, compared to landbirth, on the mortality and
morbidity of neonates born to low risk women.
Methods: This review considered randomised controlled trials
and observational studies, assessing eligible studies for quality
using Joanna Briggs Institute appraisal instruments. Outcomes
measured included: mortality, resuscitation or respiratory distress
syndrome, infection, APGAR scores at 1, 5 and 10 min, admission to
Neonatal Intensive Care or Special Care Nurseries, cord pH values,
cord avulsion, hyponatremia, hypoxic ischemic encephalopathy
and injury.
Results: Meta-analysis of 5 min Apgar scores showed statistically signicant results favouring waterbirth. This varied from
1 min Apgar score which favoured landbirth, however results
should be interpreted with caution. Data measuring cord pH were

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ACM2015 Oral Presentations / Women and Birth 28S (2015) S7S32

robust and showed negligible difference between groups. No

difference is seen for neonatal mortality, resuscitation with
oxygen, diagnoses of respiratory distress syndrome, mean Apgar
scores and admission to Special Care Nursery. While not
statistically signicant, outcomes trending to better neonatal
outcomes after waterbirth include neonatal infection and admission to Neonatal Intensive Care Units. Apgar scores after 1 min
yielded conicting results.
Conclusion: While waterbirth is associated with an increased
risk of 1 min Apgar score of less than 7, it is not associated with any
other adverse neonatal outcomes including importantly, differences in cord pH. There is little evidence to support policies that
withhold water immersion from low risk women who desire water
immersion for labour and/or birth.
http://dx.doi.org/10.1016/j.wombi.2015.07.047

[O15]
Caseload midwifery in Australia: What access do
women have?
Kate Dawson 1,2,*, Michelle Newton 1,2,
Della Forster 1,3, Helen McLachlan 1,2
1

Judith Lumley Centre, La Trobe University, Melbourne, Australia

School of Nursing & Midwifery, La Trobe University, Melbourne,
Australia
3
The Royal Womens Hospital, Melbourne, Australia
*Corresponding author.
2

Introduction: Caseload midwifery is associated with fewer

childbirth interventions increased, maternal satisfaction and lower
burnout and higher satisfaction for caseload midwives. However,
little is known about the availability of the model of across
Australia. We evaluated the accessibility, availability and
capacity of caseload midwifery in public maternity services in
Australia.
Method: We undertook a cross-sectional survey of maternity
managers in public hospitals throughout Australia. Using an online
survey we explored the availability of the caseload model;
managers views, experiences and intentions regarding the model
in the future; the structure and functioning of existing models.
Results: Managers from 149 of 235 (63%) eligible hospitals
(including all states and territories) responded to the survey. Of all
responding hospitals, 31% had a caseload model in place, and a
further 41% were considering implementing caseload midwifery in
the future. Overall, including all responding hospitals, 8% of
women received caseload care. The majority of hospitals with
caseload offered a low risk only model. Half of all the responding
hospitals with a caseload model were planning on expanding the
availability of their models. Nearly two thirds of these hospitals
also reported that demand for the model was greater than
availability. The vast majority of responding managers agreed that
they had midwives in their organisation that were interested in
working in caseload (96% of those who were planning to
implement the model and 78% of hospitals who had no immediate
intention of introducing a caseload model).
Conclusions: Caseload midwifery care is increasingly being
offered as a model of care in public maternity hospitals in Australia.
Despite strong consumer demand, only 8% of women in public
hospitals receive caseload care. Further research should explore
the factors that can contribute to maternity services capacity to
grow and sustain the model.
http://dx.doi.org/10.1016/j.wombi.2015.07.048

[O16]
A rock and a hard place: Challenges for
midwifery leadership
Bernie Divall
University of Nottingham, Nottingham, United Kingdom
Introduction: Clinical leadership in the English National Health
Service (NHS) has been proposed as a means of establishing the
principles of distributed and shared models of leadership.
However, concerns have been raised within the health professions
around particular challenges involved in moving from clinical to
formal leadership roles, in the UK context and beyond. These
challenges can be related to narratives of identity: how do clinical
leaders construct a cohesive and coherent narrative, and what
challenges do they face in enacting a hybrid identity?
Methods: This single subject, exemplary case study comes from
a wider piece of work exploring the drivers, experiences and future
ambitions of midwifery leaders in the English NHS.Here, the
narrative of a single participant Heather, a hospital matron is
analysed in order to examine the construction of a cohesive selfidentity and to explore the challenges she faces in maintaining a
narrative of I am still a midwife.
Results: Findings suggest an ongoing struggle between selfidentity as midwife and social identity as leader and/or
manager. Heather demonstrates a number of ways in which
she attempts to retain the ongoing narrative as midwife, but
equally describes challenges from both her professional group and
the wider organisation in attempting to do so. Heather describes
being between a rock and a hard place in negotiating competing
professional and organisational discourses, and suggests a number
of ways in which she attempts to negotiate an identity appropriate
to her self-narrative of I am still a midwife.
Conclusion: Negotiating competing discourses results in difculties for clinical leaders when attempting to narrate a cohesive
self-identity. Clinicians moving to leadership roles need organisational and professional group support in establishing positive selfand social-identities.
http://dx.doi.org/10.1016/j.wombi.2015.07.049
[O17]
Maternal mortality, Uganda: Can midwives
make a difference?
Margaret Docking
Wise Choices For Life Inc Melbourne, Australia
Introduction: To reduce maternal mortality in East Africa, a
midwife-led initiative has developed a unique holistic and
culturally sensitive approach to midwifery education, leading to
positive behavioral change. The focus is on empowering Ugandans
with knowledge and life skills to reduce maternal deaths. Uganda
loses sixteen mothers a day through childbirth. A creative
approach is needed to reach the core of the problem not just
treat the symptoms found in the labor ward. Working as a midwife
in Uganda highlighted a need for a community based education
program for men in reproductive health.
Method: Traditional midwifery education focuses on women
and midwives, however Wise Choices For Life engages inuential
non-medical community leaders and decision makers who tend to
be male. Train the trainer workshops using traditional storytelling,
drama and debate encourage objective thinking and decision
making around puberty, conception, pregnancy, birth and contraception. This creates a safe space to question traditional assumptions in the light of scientic truth leading to informed decisions,