A cost analysis of upscaling access to continuity of midwifery carer: Population-based microsimulation in Queensland, Australia.

Objective: To quantify the economic impact of upscaling access to continuity of midwifery carer, compared with current standard maternity care, from the perspective of the public health care system.

Methods: We created a static microsimulation model based on a whole-of-population linked administrative data set containing all public hospital births in one Australian state (Queensland) between July 2017 to June 2018 (n = 37,701). This model was weighted to represent projected State-level births between July 2023 and June 2031.

The financial impact of offering publicly funded homebirths: A population-based microsimulation in Queensland, Australia.

Background: Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications.

Critiquing the evolution of maternity care preferences research: A systematic mixed studies review.

Objective: Whether women's preferences for maternity care are informed remains unclear, suggesting that maternal preferences may not accurately represent what women truly want. The aim of this study was to understand and critique research on women's maternity care preferences published since 2010.

Design: Systematic mixed studies review.

Being connected: Exploring the needs of mothers during the postnatal period in Queensland, Australia.

This project explored the needs of mothers beyond the immediate postnatal period in Queensland, Australia, for the development of improved models of care. Data were collected through group and individual interviews. A qualitative methodology using thematic analysis captured the experience of 58 participants.

Development of a co-designed, evidence-based, multi-pronged strategy to support normal birth.

Australia's caesarean section (CS) rate has been steadily increasing for decades. In response to this, we co-designed an evidence-based, multi-pronged strategy to increase the normal birth rate in Queensland and reduce the need for CS. We conducted three workshops with a multi-stakeholder group to identify a broad range of options to reduce CS, prioritise these options, and achieve consensus on a final strategy.

Quantifying the differences in birth outcomes and out-of-pocket costs between Australian Defence Force servicewomen and civilian women: A data linkage study.

Objectives: Servicewomen in Defence Forces the world over are constrained in their health service use by defence healthcare policy. These policies govern a woman's ability to choose who she receives maternity care from and where. The aim of this study was to compare Australian Defence Force (ADF) servicewomen and children's birth outcomes, health service use, and out-of-pocket costs to those of civilian women and children.

An interactive decision-making framework (i-DMF) to scale up maternity continuity of carer models.

Background: Low numbers of women in Queensland receive continuity of care across their maternity episode. The Office of the Chief Nursing and Midwifery Officer was tasked with strengthening maternity service delivery by reviewing and improving Maternity Models of Care and Workforce.

Aim: Develop a decision-making framework (DMF) to increase maternity continuity of carer models.

Validating a scale to measure respectful maternity care in Australia: Challenges and recommendations.

Objective: Respectful maternity care is a pervasive human rights issue, but little is known about its realisation in Australia. Two scales, developed in North America, measure key aspects of respectful maternity care: the Mothers on Respect Index and Mothers Autonomy in Decision Making scale. This study aimed to validate these two scales in Queensland, Australia, and to determine the extent to which women currently experience respectful maternity care and autonomy in decision making.

The opportunity costs of birth in Australia: Hospital resource savings for a post-COVID-19 era.

Background: COVID-19 caused significant disruptions to health systems globally; however, restricting the family presence during birth saw an increase in women considering community birth options. This study aimed to quantify the hospital resource savings that could occur if all low-risk women in Australia gave birth at home or in birth centers.

Methods: A whole-of-population linked administrative data set containing all women (n = 44 498) who gave birth in Queensland, Australia, between 01/07/2012 and 30/06/2015 was reweighted to represent all Australian women giving birth in 2017.

Differential access to continuity of midwifery care in Queensland, Australia.

Objective To determine maternal access to continuity of midwifery care in public maternity hospitals across the state of Queensland, Australia. Methods Maternal access to continuity of midwifery care in Queensland was modelled by considering the proportion of midwives publicly employed to provide continuity of midwifery care alongside 2017 birth data for Queensland Hospital and Health Services. The model assumed an average caseload per full-time equivalent midwife working in continuity of care with 35 women per annum, based on state Nursing and Midwifery Award conditions.

Reducing caesarean delivery: An economic evaluation of routine induction of labour at 39 weeks in low-risk nulliparous women.

Background: Clinical interventions known to reduce the risk of caesarean delivery include routine induction of labour at 39 weeks, caseload midwifery and chart audit, but they have not been compared for cost-effectiveness.

Objective: To assesses the cost-effectiveness of three different interventions known to reduce caesarean delivery rates compared to standard care; and conduct a budget impact analysis.

Methods: A Markov microsimulation model was constructed to compare the costs and outcomes produced by the different interventions.

Cost of maternity care to public hospitals: a first 1000-days perspective from Queensland.

Objective This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies. Methods A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services.

Socioeconomic differences in access to care in Australia for women fearful of birth.

Objective Fear of childbirth is known to increase a woman's likelihood of having a Caesarean section. Continuity of midwifery care is known to reduce this risk, but less than 8% of women have access to this relationship-based, primary care model. The aims of this study were to determine whether healthcare use and access to continuity models are equal across different indicators of socioeconomic status for women who are fearful of birth.

Influence of intimate partner violence during pregnancy on fear of childbirth.

Objective: Women are at increased risk of intimate partner violence (IPV) during pregnancy. This may impact women's positive anticipation for birth. Negative feelings around birth often translate to a fear of childbirth.

Improving psychoeducation for women fearful of childbirth: Evaluation of a research translation project.

Background: Psychoeducation counselling delivered by midwives has been demonstrated to reduce maternal fear and improve women's confidence for birth. Translating the evidence in practice presents challenges. A systematic approach to the implementation of evidence and evaluation of this process can improve knowledge translation.

Factors influencing midwives' use of an evidenced based Normal Birth Guideline.

Problem Or Issue: Rates of elective and unplanned caesarean section continue to increase in high income countries. Evidence-based clinical guidelines aim to promote and support normal birth but are rarely evaluated.

What Is Already Known: The Queensland Normal Birth Guideline was developed in consultation with stakeholders and disseminated to public and private hospitals and released in 2012.

An economic evaluation alongside a randomised controlled trial on psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia.

Objective: The rate of caesarean section continues to increase, and there is evidence that childbirth fear is a contributing factor. Insufficient evidence is available on the impact of reducing childbirth fear on health-related quality of life and health service use. We undertook an economic evaluation of a psycho-education counselling intervention offered by midwives to address women's fear of childbirth in Australia.

Empowering midwives to address childbirth fear.

An innovative midwife-led counseling program for women with childbirth fear is being introduced at the Gold Coast University Hospital.

Promoting retention, enabling success: Discovering the potential of student support circles.

Retention of students is critical to education programs and future workforce. A mixed methods study evaluated student engagement within a Bachelor of Midwifery program and connection with career choice through participation in student support circles. Centred on the Five Senses of Success Framework (sense of capability, purpose, identity, resourcefulness and connectedness) and including four stages of engagement (creating space, preparing self, sharing stories, focused conversations), the circles support and develop student and professional identity.

Effects of a midwife psycho-education intervention to reduce childbirth fear on women's birth outcomes and postpartum psychological wellbeing.

Background: High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention.

A cross-sectional study to determine utility of childbirth fear screening in maternity practice - An Australian perspective.

Background: Low intensity anxiety in pregnancy is normal however high levels of fear affect between 20% and 25% of women, with around 10% suffering severe levels. Research from Scandinavian countries includes women with severe levels of fear, with little work undertaken in Australia. This paper explores predictors of fear and the relative benefits of screening women for childbirth fear at high or severe levels.

Factors associated with childbirth self-efficacy in Australian childbearing women.

Background: Childbirth confidence is an important marker of women's coping abilities during labour and birth. This study investigated socio-demographic, obstetric and psychological factors affecting self-efficacy in childbearing women.

Method: This paper presents a secondary analysis of data collected as part of the BELIEF study (Birth Emotions - Looking to Improve Expectant Fear).

How pregnant women learn about foetal movements: sources and preferences for information.

Background: Unexplained late gestation stillbirth is a significant health issue. Antenatal information about foetal movements has been demonstrated to reduce the stillbirth rate in women with decreased foetal movements. Midwives are ideally placed to provide this information to women.

A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women.

Background: Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear.

Methods: Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial.

Prevalence of childbirth fear in an Australian sample of pregnant women.

Background: Childbirth fear is reported to affect around 20% of women. However reporting on levels of symptom severity vary. Unlike Scandinavian countries, there has been limited focus on childbirth fear in Australia.