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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, Australia2 University of Wollongong, Wollongong, Australia3 Independent Midwife and Lecturer, Australia*Corresponding author.

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 facilita-

tion. A key aspect of the service is the integration of midwiferystudents and midwifery academics as part of the team providing

care, specifically 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 case-

control study) examines clinical outcomes between ‘Expecting and

Connecting’ and standard hospital care, specifically caesarean

section, preterm and low birth weight, pain relief used in labour,

mode of birth and breastfeeding exclusivity and duration.

Results: Preliminary qualitative findings are overwhelmingly

positive with all participants agreeing on the value of the serviceand 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 findings 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, specifically in the

domain of the continuity of care requirements for their midwifery

degree.


[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.

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

midwives management of second degree perineal trauma,

influences on their practice, and the level to which their practice

reflects 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 Fisher’s 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,

anddocumentation 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 treat-

ment, 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 makeappropriate professional judgements in regard to the manage-

ment 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 manage-

ment.


[O14]

The effect of waterbirth on neonatal mortality

and morbidity

Rowena Davies1,2,

*, Deborah Davis1,2

,Melissa Pearce 2,3, Nola Wong 2,3

1 University of Canberra, Canberra, Australia2 The AustralianCapital Regional Centre for Evidence Based Midwifery,

Canberra, Australia3 Centenary Hospital for Women and Children, Canberra, Australia*Corresponding author.

Introduction: The practice of waterbirth remains controversial.

Professional guidelines argue there is insufficient 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, APGARscores at 1, 5 and10 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 statisti-

cally significant 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

ACM2015 Oral Presentations/ Women and Birth 28S (2015) S7–S32 S11

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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 significant, outcomes trending to better neonatal

outcomes after waterbirth include neonatal infection and admis-

sion to Neonatal Intensive Care Units. Apgar scores after 1 min

yielded conflicting 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, differ-

ences in cord pH. There is little evidence to support policies that

withhold water immersion from lowrisk women whodesire water

immersion for labour and/or birth.


[O15]

Caseload midwifery in Australia: What access do

women have?

Kate Dawson 1,2,*, Michelle Newton 1,2,

Della Forster1,3

, Helen McLachlan1,2

1 Judith Lumley Centre, La Trobe University, Melbourne, Australia2 School of Nursing & Midwifery, La Trobe University, Melbourne,

Australia3 The Royal Womens Hospital, Melbourne, Australia*Corresponding author.

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 maternitymanagers 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 thanavailability. 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 publicmaternity hospitalsin 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.


[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 andfuture

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 self-

identity and to explore the challenges she faces in maintaining a

narrative of ‘I am still a midwife’.

Results: Findings suggest an ongoing struggle between self-

identity 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 diffi-

culties for clinical leaders when attempting to narrate a cohesive

self-identity. Clinicians moving to leadership roles need organisa-

tional and professional group support in establishing positive self-

and social-identities.


[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 Ugandanswith 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 influential

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 contra-

ception. This creates a safe space to question traditional assump-

tions in the light of scientific truth leading to informed decisions,

ACM2015 Oral Presentations/ Women and Birth 28S (2015) S7–S32S12
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