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- Faulks, Fiona, et al.
(författare)
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Perinatal outcomes of socially disadvantaged women in Australia : a population-based retrospective cohort study
- 2023
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Ingår i: British Journal of Obstetrics and Gynecology. - : John Wiley & Sons. - 1470-0328 .- 1471-0528. ; 130:11, s. 1380-1393
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016.Design: Population-based, retrospective cohort study.Setting: Victoria, Australia.Population or Sample: A total of 1 188 872 singleton births were included.Methods: Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time-trend analysis for perinatal outcomes was performed in relation to area-level disadvantage measures.Main Outcome Measures: Incidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU).Results: Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section.Conclusions: Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.
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| 2. |
- McLardie-Hore, Fiona E., et al.
(författare)
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Comparing the views of caseload midwives working with First Nations families in an all-risk, culturally responsive model with midwives working in standard caseload models, using a cross-sectional survey design
- 2023
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Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799.
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Tidskriftsartikel (refereegranskat)abstract
- Problem: Little is known about midwives’ views and wellbeing when working in an all-risk caseload model.Background: Between March 2017 and December 2020 three maternity services in Victoria, Australia implemented culturally responsive caseload models for women having a First Nations baby.Aim: Explore the views, experiences and wellbeing of midwives working in an all-risk culturally responsive model for First Nations families compared to midwives in standard caseload models in the same services.Methods: A survey was sent to all midwives in the culturally responsive (CR) model six-months and two years after commencement (or on exit), and to standard caseload (SC) midwives two years after the culturally responsive model commenced. Measures used included the Midwifery Process Questionnaire and Copenhagen Burnout Inventory (CBI).Findings: 35 caseload midwives (19 CR, 16 SC) participated. Both groups reported positive attitudes towards their professional role, trending towards higher median levels of satisfaction for the culturally responsive midwives. Midwives valued building close relationships with women and providing continuity of care. Around half reported difficulty maintaining work-life balance, however almost all preferred the flexible hours to shift work. All agreed that a reduced caseload is needed for an all-risk model and that supports around the model (e.g. nominated social workers, obstetricians) are important. Mean CBI scores showed no burnout in either group, with small numbers of individuals having burnout in both groups.Discussion and conclusion: Midwives were highly satisfied working in both caseload models, but decreased caseloads and more organisational supports are needed in all-risk models.
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