Day 1 :
National University of Singapore, Singapore
Keynote: Breastfeeding intention, initiation and duration among Hong Kong Chinese women: A prospective longitudinal study
Time : 10:00-10:40
Lau Ying holds Bachelor, Master and Doctoral degrees from University of Hong Kong, Hong Kong. She had clinical experience over 15 years in different hospitals. She is an Assistant Professor in Alice Lee Centre for Nursing Studies, Yong Lin School of Medicine, National University of Singapore. She has worked as an International Board Certified Lactation Consultant for 10 years and has published over 80 international peer reviewed papers in journals, professional journals, books, and book chapters.
Objectives of this study are to: estimate the breastfeeding intention, initiation and duration rate; identify the reasons to initiate; and wean breastfeeding and explore predictors of breastfeeding duration. A prospective longitudinal study was used at antenatal clinics of five regional hospitals from four clusters in Hong Kong. A population-based sample of 2098 women in the second trimester of pregnancy was recruited with a systematic sampling method. Three different sets of questionnaires were used. The rates of formula feeding and breastfeeding were 41.1% and 58.9%, while breastfeeding intention and initiation rates were 85.3% and 67.0%, respectively. The breastfeeding duration rates were 11.1%, 10.3%, 10.7% and 26.7%, for the “within < 1week”, “1-3 weeks”, “> 3-6 weeks” and “> 6 weeks” groups. The common reasons for initiating breastfeeding were that breastfeeding is beneficial for both the baby (89.8%) and mother (39.7%). Reasons for weaning breastfeeding were insufficient breast milk (32.7%), tiredness and fatigue (39.7%) and return to work (29.6%). Partner, relatives and nurse midwives were important supportive resources during breastfeeding. Ordinal logistic regression analysis identified five predictive factors of breastfeeding duration. Participants who were working part-time or were housewives (p=0.037), had monthly family income of < HK$10,000 (p=0.034), more than one child (p=0.001), positive breastfeeding intention (p=0.001) and early breastfeeding within the first hour (p<0.0001) were more likely to have longer breastfeeding than their counterparts. The findings are important for a process-oriented breastfeeding training programme for nurse midwives
University of South Australia, Australia
Time : 10:40-11:20
Mary Steen is a Professor of Midwifery at the University of South Australia and Visiting Professor at the Universities of Port Harcourt, Nigeria, Sao Paulo, Brazil and Chester, UK. She is interested in a wide remit of midwifery and family health issues that has led her to undertake research studies in developed and developing countries. She has published her work widely and has written numerous articles, chapters and several books. She has received several awards for clinical innovation, original research and outstanding services to midwifery
Introduction: Engaging with families and communities to promote maternal and infant health and wellbeing is an important aspect of care. Good evidence from around the world clearly demonstrates that when partners, families and local communities are involved, mothers and infants thrive. In addition, when considering the delivery of maternity services to diverse populations, there is evidence to suggest that expectant and new mothers are highly influenced by partner, families, friends and their local communities. Alloparents are significant in families, for example grandparents, other blood relatives and community neighbours who directly provide care and support to mothers and their infants. This supports the concept that ‘it takes a village to bring a child up’. However, implementing family inclusive approaches to maternity care pose challenges.
Aims: The aims of this study are: To gain an insight into how we can engage with families and communities; to explore historical and anthropological evidence that relates to family and community engagement; to describe and discuss some global studies that demonstrate better health outcomes; to describe and discuss studies the presenters has personally been involved with that have included engaging with families and communities; to introduce the Family Included Global Network.
Conclusions: There is an identified need to implement effective approaches to engage with families and communities throughout the world. A Family Included Global Network (FI) has recently been set up to enable health professionals and researchers throughout the world to network, collaborate, unite and pioneer the engagement of families and communities to improve maternal and infant health and wellbeing.
- Midwifery | Women Health | Midwifery Areas of Practice | Midwifery Care
Location: Atlanta, USA
University of South Australia, Australia
Womens & Childrens Health Network, Australia
Erasmus Medical Center, Netherlands
Title: Patients’and professionals’ barriers and facilitators to external cephalic version for breech presentation at term, a qualitative analysis in the Netherlands
Time : 11:40-12:10
AN Rosman has completed her graduation as a Midwife in 1987. Till 2000, she practiced midwifery in a private primary practice in Zwolle (The Netherlands). Thereafter, she started working as a Midwife in secondary and tertiary care and started her PhD in 2009 on External Cephalic Version which she succesfully completed in 2014. Presently, she is working at the University of Rotterdam (Erasmus MC) as Senior Researcher and Project Manager of pre and interconception care, work related risks and pregnancy.
Within the Netherlands there is a professional consensus that external cephalic version (ECV) should be offered to all eliglible women with a fetus in breech presentation, but only up to 70% of these women undergo an ECV attempt. The aim of this study was to identify barriers and facilitators for ECV among professionals advising on ECV and patients who decided on ECV. Semi-structured interviews were held with patients and midwives and obstetricians treating patients with a breech presentation. Based on National Guidelines and expert opinions, we developed topic lists to guide the interviews and discuss barriers and facilitators in order to decide on ECV (patients) or advice on ECV (midwives and obstetricians). Among patients the main barriers were fear, the preference to have a planned caesarean section (CS), incomplete information and having witnessed birth complications whitin the family or among friends. The main facilitators were the wish for a homebirth, the wish to deliver vaginally and confidence of the safety of ECV. Among professionals the main barriers were a lack of knowledge to fully inform and counsel patients on ECV and the inability to counsel women who preferred a primary CS. The main facilitator was an unambiguous policy on (counseling for) ECV within the region. We identified several barriers and facilitators possibly explaining the suboptimal implementation of ECV for breech presentation in the Netherlands. This knowlegde should be taken into account in designing implementation strategies for ECV to improve the uptake of ECV by professionals and patients.
Southern Cross University, Australia
Elizabeth Emmanuel has extensive clinical experience in Clinical Midwifery. She has completed her PhD from Griffith University, Australia. She has joined academia to teach nurses and midwives and pursue her interest in midwifery and women’s health. She has published on maternal role development, maternal distress, social support and quality of life during the childbearing period. She is currently teaching at Southern Cross University, a regional tertiary centre on the Gold Coast.
Maternal expectations entail emotional work and form part of the transition process to motherhood. During pregnancy expectations are associated with excitement, anticipation and planning. For others, these are linked to stress and distress which can affect a mother’s functioning. Various protective factors can cushion this effect and alter the experience for mothers. This study aimed to investigate the effect of maternal expectations on Health-Related Quality of Life (HRQoL) during pregnancy, and to explore maternal distress and its mediating influence. Pregnant women (n=630) at 36 weeks gestation attending antenatal clinics at three metropolitan hospitals were invited to participate in the study. The variables maternal expectations, maternal distress, social support and HRQoL were measured and analysed using multiple linear regression to investigate the relationships. Maternal expectation was found to be significantly related to both physical and mental HRQoL. When entered in the regression model, maternal distress had a mediating influence on the relationship between maternal expectations and many components related to HRQoL (including social functioning, physical and emotional role). Expectations, is an essential part of the transition process during pregnancy. Enhancing this adjustment process can allow for improved HRQoL for mothers, particularly those who are having difficulties. Midwives need to be responsive to maternal expectations, and related emotional work. Taking the time to ask appropriate questions during the antenatal period will highlight issues for mothers and identify how these may affect HRQoL. Educating mothers on realistic perceptions about emotional work, personal lifestyle changes and relationship adjustments can help their HRQoL.
Gannon University, USA
Lisa A Quinn has completed her PhD in Health Education in 2007 from Kent State University in Kent, Ohio. She is an Associate Professor of Nursing and Graduate Advisor to nurse practitioner students at Gannon University in Erie, Pennsylvania.
The initial CDC recommendation specific to folic acid was made in 1992. Following decades of intense scrutiny on the relationship between vitamin intake and neural tube defects, the US Public Health Service made the following recommendation: “All women of childbearing age in the United States who are capable of becoming pregnant should consume 400 cg of folic acid per day; for the purpose of reducing the risk of having a pregnancy affected with spina bifida and other neural tube defects”. Despite increased media campaigns and ongoing educational programs, many women still do not begin taking a folic acid supplement prior to conception. Similar to other relationships between health knowledge and health behavior, there is a gap between awareness of the importance of folic acid supplementation and folic acid use. The purpose of this quantitative, descriptive study conducted in 2007 was to determine among women of childbearing age, whether or not the variables specific to the theory of planned behavior- attitudes, subjective norms and perceived behavioral control- explain folic acid use above and beyond use that is explained by folic acid knowledge and pregnancy status. The childbearing years make up a significant portion of a woman’s life. A message of daily multivitamin intake for all women initiated by health care providers and reinforced by people in the woman’s support system may be one such strategy. Other strategies supported by this research include identifying creative ways to change a woman’s attitude about multivitamin use.
Linkoping University, Sweden
Hanna Grundström has completed her Midwifery education from Linkoping University and is a PhD student since 2013. Her research area is “Women with endometriosis and their experiences of healthcare services”.
Women with endometriosis often have negative experiences when turning to healthcare services. Previous research has focused on diagnostic delay and experiences of encountering general practitioners. To our knowledge, no study has previously examined women’s experiences of healthcare encounters from a broader perspective, including experiences from encountering all professional categories. Therefore, the aim of this study was to identify and describe the experience of healthcare encounters among women with endometriosis. In this study, 9 women aged 23-55 with a laparoscopy-confirmed diagnosis of endometriosis were interviewed. Interviews were conducted using open-ended questions. The interviews were recorded and transcribed verbatim. The data were analyzed using an interpretative phenomenological approach.Two themes were identified in the interview transcripts: being treated with ignorance and being acknowledged. The essence, “the double-edged experience of healthcare encounters” emerged from the themes. The women’s experience was double-edged since it involved contradictory feelings, the encounters were experienced as either destructive or constructive. The findings of this study provided insight into the lives and experience of women with endometriosis. The experience was double-edged: either destructive or constructive for the women. This information is valuable for HCPs encountering these women, as it brings a new level of understanding to how they can improve the care of this group of women.
Redville Medical and Maternity Clinic, Philippines
Melody D Quiratis born in quezon city philippines, july 5, 1976. inquisitive to learn more. had passion reading christian literature books. obtained her rn diploma in mary chiles college of nursing. she has over 13 years of nursing experience. she has worked in areas such as operating/delivery room, pedia and medical ward. for the past 13 years she has served as a nurse in redville medical and maternity clinic. melody has a unique combination of strong maternity nursing skills and strives to provide the best healthcare possible. she believes in building a long lasting and trusting relationships with patients. she seeks to acquire a comprehensive evaluation of every patient by taking time to listen and understand their particular needs. her true desire is to enhance a positive healing experience and confidence to those in need.
The midwife is recognized as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical care or other appropriate assistance and the carrying out of emergency measures. The midwife has an important task in health counseling and education, not only for the woman, but also within the family and the community. This work should involve (antenatal education) and preparation for parenthood and may extend to women’s health, sexual or reproductive health and care for children in the early years of life. A midwife may practice in any setting including the home, community, hospitals, clinics or health units.Midwives work close to women and their newborn infants.
Midwifery services are available and easily accessible to families in the communities where they live. For instance at primary level family planning, as well as postpartum and pre natal care, breastfeeding support, newborn hearing test, and newborn screening can be provided by midwives. Midwives identify pregnancy and childbirth complications early, provide first line management and prompt transfer for hospital for back-up care when needed, reducing delays to the next level of care and allowing for greater efficiency along the continuum.
Midwifery services are designed to fulfill the following guiding principles:
A. Promote the right of all women to professional midwifery care (including emergency obstetric care) that is available, accessible and acceptable, and of good quality.
B. Ensure the continuum of care from adolescence through to care of the newborn and into the early weeks of life.
C. Ensure the continuum of care from home to tertiary hospital
D. Be sensitive to gender and culture and deliver respectful care to all women, their partners and families
E. Be able to provide the set of evidence-based cost-effective and lifesaving interventions for family planning, maternal and newborn health.
Midwifery services caring for women and child’s health has been defined as care where the midwife is the lead professional in the planning, and delivery of care given to a woman from initial booking to the postnatal period.
Erasmus Medical Center, Netherlands
A.N. (Ageeth) Rosman has completed her graduation as a Midwife in 1987. Till 2000, she practiced midwifery in a private primary practice in Zwolle (The Netherlands). Thereafter, she started working as a Midwife in secondary and tertiary care and started her PhD in 2009 on External Cephalic Version which she succesfully completed in 2014. Presently, she is working at the University of Rotterdam (Erasmus MC) as Senior Researcher and Project Manager of pre and interconception care, work related risks and pregnancy
Self-report screen and advice instruments can be used to expedite the first antenatal visit. Their outcome in terms of risk profile and suggested actions alert the caregiver and enables efficient and accountable risk management. A key issue is the inter-observer reliability of the outcomes, which is a prerequisite for efficient use/application of any checklist. In this study, we compared outcomes of standard application of a validated professional interview based checklist with outcomes of a client self-report adaptation of this list. Inter-observer agreement was established and the association (if any) or disagreement with particular risks. Pregnant women entering a first antenatal visit at one midwifery practice in Rotterdam, the Netherlands were asked to fill in the self-report checklist on risks for preterm birth, small for gestational age (SGA), low Apgar scores and congenital anomalies at home and return before the appointment. After returning the R4U to the researchers, patients were informed that the midwife in charge during the first visit would ask the same questions unaware of any result the patient filled in. Agreement of 90% and beyond was defined as reflecting equivalence for practical use (interchangeable). At onset some tested variables were judged to require face-to-face confirmation even if concordance was perfect. Primary outcome was the observed inter-observer agreement with and without chance correction and accuracy. The study showed heterogeneous per domain and per item inter-observer (patient vs professional) reliability. In some domains of agreed high relevance/impact, agreement was unacceptably low in absolute and relative terms, where validity could not be simply decided on.
United States Army, USA
Elizabeth Nutter is an active duty Army Certified Nurse-Midwife. She received her commission in 2001 from the University of Portland, a Master in Nursing from Radford University with a certificate of Midwifery from Shenandoah University and a Doctor of Nursing Practice from Frontier Nursing University. The focus of her doctoral work is on water birth. She has two peer-reviewed articles on water birth and serves as the Army’s subject matter expert on hydrotherapy use during labor and birth. She is currently stationed at Fort Hood Texas where she is the Director of the Army’s OBGYN Nursing Specialty Course
Modern United States obstetrics is characterized by many routine interventions, some without supportive data, despite research demonstrating that unnecessary intervention can impede women’s ability to achieve physiologic birth. Research demonstrates that intrapartum hydrotherapy is a potential antidote which can facilitate physiological childbirth since women who labor and or birth in water are unlikely to experience medical interventions that can disrupt physiologic birth. Intrapartum immersion reduced the use of pharmacological pain relief methods, labor augmentation with synthetic oxytocin and episiotomies. Research demonstrates no increase in infection or other adverse effects on the fetus, newborn or mother and in women who utilized intrapartum immersion during labor and or birth. A growing body of evidence supports the safety of intrapartum immersion; however a myriad of political and cultural issues result in limited use of intrapartum hydrotherapy in United States hospitals compared to other developed nations. Available literature on immersion hydrotherapy provides a considerable amount of information about how to limit risk of harm and incorporate the best available data. Research demonstrates that when trained professionals utilize evidence-based practice guidelines including infection control, adherence to eligibility criteria, waterbirth delivery procedures and management of any cord rupture, outcomes are excellent and risks to healthy women and newborns are rare. The midwifery model of care facilitates shared decision-making and respect for women’s autonomy to make informed choices. Through this lens the choice of intrapartum immersion, including waterbirth, can be supported among women who understand the limited state of science and choose hydrotherapy for pain control in labor
Private Physiotherapy Practitioner, Christie Hospital, UK
Gunnel Berry has become a member of the Chartered Society of Physiotherapy in the United Kingdom having trained at the Middlesex Hospital London in 1974. She completed her MSc degree in Advanced Physiotherapy at the University College, London, in 1995. She has trained as a Reflexologist in 1989 at the Bayly School of Reflexology. In 1999, she has participated in an audit to assess the clinical role of physiotherapy. She is a Clinical Specialist in pain and developed Adapted Reflextherapy in Spinal Pain as a concept and treatment. She has presented and published papers on the subject in Europe and the USA. Although retired from clinical practice, she is the Educational Officer of the Association of Chartered Physiotherapists in Reflex Therapy
Pain in the pelvis, groin and lower back is common during pregnancy. The position of the baby is commonly suggested as the source of pain, as it may rest on nerve tissue within the pelvic girdle. Conventional treatments, where offered, are often found wanting and the pregnant woman may find herself enduring discomfort for months until the baby has been delivered. In a National Health Service Physiotherapy Outpatient department in the United Kingdom it was found that an adapted form of Reflex Therapy, akin to reflexology, alleviated patients of pain within two to four treatments. The Adapted Reflex therapy (AdRx) treatment consisted of applying manual dermal pressure and manipulation to selected areas of the feet. In accordance with the theory of Reflex Therapy including Reflexology, the sites of treatment are feet, ultimate target tissue related to spine and pelvic girdle regions. A working hypothesis of AdRx mode of action involves neural plasticity, a normal, ongoing adaptive process within the nervous system. Reactive adaptations within the nervous system as a result of historic trauma to the spine (for example, road traffic accidents, falls, and deceleration from slipping and landing on the coccyx) may show up as pain in later life, including in pregnancy. AdRx, through its interaction with the nervous system may influence the nerve tissues and the musculo-skeletal tissues they serve. This can be particularly useful where pain is in intimate areas such as the symphysis pubis joint or where direct manipulation may be too painful or impossible during pregnancy. This presentation offers a brief explanation of the principles of AdRx with emphasis on neural adaptations and consequences after physical injury within the context of pregnancy. Hypothetical musculoskeletal reasoning as observed in a clinical situation is also presented