Sustainability of rural Victorian maternity services: 'We can work together'.

Background: Rural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service's operations and sustainability.

Aim: To examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services.

Rural maternity and media discourse analysis: Framing new narratives.

Introduction: Continued rural maternity closure across Australia has seen impacts on women and families such as financial pressures, quality and safety concerns, and emotional pressure. This review aimed at understanding how media coverage of rural maternity and closure are presented and what impact this may have on maternity service sustainability.

Objective: This research seeks to examine media discourse and characteristics of online newspaper articles related to rural maternity services.

Language used to describe the Australian midwifery workforce: A change opportunity to improve professional identity.

Background: Tertiary level midwifery educational pathways to achieve registration as a midwife vary in Australia, with a shift from the hospital to the university sector more than 20 years ago. These pathways are often referred to in the workforce setting to distinguish midwives with different academic backgrounds.

Aim: To discuss the genesis of midwifery education in the Australian setting and explore the impact of the language used to describe the educational backgrounds on the professional identity of midwives.

Safer Baby Bundle: study protocol for the economic evaluation of a quality improvement initiative to reduce stillbirths.

Introduction: Stillbirth continues to be a public health concern in high-income countries, and with mixed results from several stillbirth prevention interventions worldwide the need for an effective prevention method is ever present. The Safer Baby Bundle (SBB) proposes five evidence-based care packages shown to reduce stillbirth when implemented individually, and therefore are anticipated to produce significantly better outcomes if grouped together. This protocol describes the planned economic evaluation of the SBB quality improvement initiative in Australia.

Australian maternity service provision: a comparative analysis of state and territory maternity care frameworks.

Objective Healthcare delivery in Australia is managed at state and territory levels. This paper aims to compare the content and structure of publicly accessible Australian maternity service state and territory frameworks which guide the delivery of maternity care. Methods A scoping review was conducted to identify publicly accessible Australian state and territory maternity service frameworks.

Where do low risk women live relative to maternity services across Victoria? Expanding access to public homebirth models across Victoria.

Problem: Currently <1% of Australian women give birth at home.

Background: In Australia there are very few options for women to access public funded homebirth.

Aim: We aimed to use geo-mapping to identify the number of women eligible for homebirth in Victoria, based on the criteria of uncomplicated pregnancies and residing within 15-25kms of suitable maternity services, to plan future maternity care options.

Preventing critical failure. Can routinely collected data be repurposed to predict avoidable patient harm? A quantitative descriptive study.

Objectives: To determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service.

Design: Observational quantitative descriptive study.

Setting: A public hospital maternity service in Victoria, Australia.

Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.

Background: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.

Methods: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010.

The structure and organisation of home-based postnatal care in public hospitals in Victoria, Australia: A cross-sectional survey.

Background: There is limited evidence regarding the provision of home-based postnatal care, resulting in a weak evidence-base for policy formulation and the further development of home-based postnatal care services.

Aim: To explore the structure and organisation of public hospital home-based postnatal care in Victoria, Australia.

Methods: An online survey including mostly closed-ended questions was sent to representatives of all public maternity providers in July 2011.

Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial.

Background: Postnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women.

Methods: A feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care.

Addressing the midwifery workforce crisis: evaluating an employment model for undergraduate midwifery students at a tertiary maternity hospital in Melbourne, Australia.

Background And Aims: In Victoria, maternity services are under significant strain due to increased numbers of women giving birth and critical workforce shortages. Hospitals have experienced challenges in adequately staffing maternity units, particularly on postnatal wards. In 2008, a tertiary maternity hospital in Melbourne introduced a model where undergraduate midwifery students were employed as Division 2 nurses (SMW_Div2) (enrolled nurses), to work in the postnatal area only.

COSMOS: COmparing Standard Maternity care with one-to-one midwifery support: a randomised controlled trial.

Background: In Australia and internationally, there is concern about the growing proportion of women giving birth by caesarean section. There is evidence of increased risk of placenta accreta and percreta in subsequent pregnancies as well as decreased fertility; and significant resource implications. Randomised controlled trials (RCTs) of continuity of midwifery care have reported reduced caesareans and other interventions in labour, as well as increased maternal satisfaction, with no statistically significant differences in perinatal morbidity or mortality.

Pitfalls in pediatric tracheostomy: a case report.

Tracheostomy is required in approximately 22% of children with Goldenhar syndrome because of upper airway obstruction. We report a case of problematic tracheostomy placement in a 24-week-old ex-premature infant with Goldenhar syndrome. This infant had potentially life-threatening ventilatory insufficiency following tracheostomy placement related to tracheostomy tube size and position.

Levobupivacaine spinal anesthesia in neonates: a dose range finding study.

Background: Our aim was to determine the clinical efficacy of levobupivacaine for awake spinal anesthesia in ex-premature infants having lower abdominal surgery. The secondary aim was to determine the minimum local analgesic dose (MLAD) defined as the median effective local anesthetic dose for spinal anesthesia in neonates.

Methods: Fifty neonates < 55 weeks postconceptional age having lower abdominal surgery were enrolled.

Efficacy and safety of nifedipine tablets for the acute treatment of severe hypertension in pregnancy.

Objective: The purpose of this study was to determine whether the slower- and longer-acting nifedipine tablets were as effective and safe as the rapid onset and short-acting nifedipine capsules for the treatment of acute severe hypertension in pregnancy.

Study Design: Sixty-four women in the second half of pregnancy who were not in labor randomly received 10 mg nifedipine tablets (n = 55 studies) or 10 mg nifedipine capsules (n = 74 studies) if blood pressure was > or =170/110 mm Hg. Blood pressure, heart rate, and cardiotocography were monitored over the subsequent 90 minutes.