tag:theconversation.com,2011:/ca/topics/maternity-services-6812/articlesMaternity services – The Conversation2023-08-22T14:52:07Ztag:theconversation.com,2011:article/2077532023-08-22T14:52:07Z2023-08-22T14:52:07ZSix pregnancy terms you probably won’t hear again, including ‘high risk’ and ‘failed’<figure><img src="https://images.theconversation.com/files/542983/original/file-20230816-17-towf59.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C5152%2C3435&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The language midwives use is an important part of the care they provide.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-pregnant-woman-visit-gynecologist-doctor-1404770729">Blue Planet Studio/Shutterstock</a></span></figcaption></figure><p>Medical terminology evolves alongside our understanding of medicine. As time goes by, new terms are adopted while others are abandoned. In midwifery, there should always be a strong emphasis on the language we use, particularly in pregnancy.</p>
<p>In 2020, the Royal College of Midwives launched an initiative to discover the impact language has on women. The aim of the <a href="https://www.rcm.org.uk/rebirth-hub/">Re:Birth</a> project was to find language around pregnancy that could be understood both by people delivering maternity care and those receiving it. </p>
<p>It was the first project of its kind to consult the maternity community (including new mothers and healthcare professionals) directly on their preferred language to describe labour and birth. The findings of the project supported the fact that many women were less concerned about the way their baby was born but with whether they had a positive experience and felt safe and listened to.</p>
<p>Last year, the Royal College of Midwives published a <a href="https://www.rcm.org.uk/media/6234/re_birth_summary_.pdf">report</a> outlining their findings and a new pocket guide is being issued to midwives this year. </p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<p>Here are six maternity terms you are now unlikely to hear:</p>
<h2>1. Delivery</h2>
<p>The term “birth” has now been accepted, rather than the term “delivery”, which has commonly been used in the past. Women and health professionals also wanted accurate, specific descriptions as far as possible to describe what had happened in the labour and birth. For example, “birth with forceps” or “birth with ventouse”. This also includes “caesarean birth”.</p>
<h2>2. Low risk / high risk</h2>
<p>“Universal care needs” is being used rather than “low risk”. While “additional care needs” is now the preferred term for “high risk”. The word “risk” is associated with uncertainty and it is vital that women feel comfortable and confident during their pregnancy.</p>
<h2>3. Normal</h2>
<p>“Normal birth” is a term that has long been used by midwives and other healthcare professionals to describe a spontaneous, physiological vaginal delivery. But what counts as “normal”? Does this label someone as “abnormal” if they did not experience what we classify as “normal” birth?</p>
<p>The new preferred term, “spontaneous vaginal birth”, covers spontaneous labour without significant medical interventions such as induction and oxytocin. It also covers spontaneous vaginal birth without the need for instruments, such as forceps. </p>
<h2>4. Emergency caesarean</h2>
<p>The new overarching term for an operative caesarean section is “caesarean birth”. This replaces the word “emergency”, which is a term that may cause alarm. The term “unplanned caesarean birth” is now preferred over “emergency caesarean”. </p>
<h2>5. Incompetent cervix</h2>
<p>“Incompetent cervix” has connotations of personal failure. So, the preferred term is now “cervical insufficiency”. </p>
<h2>6. Failure / failed</h2>
<p>During the Re:Birth project, women were keen to share how terms such as “failure to progress” can contribute to feelings of failure and trauma. “Delayed progress in labour” or “slow labour” are now preferred terms.</p>
<p>We can apply the same logic to terms such as “failed induction” or “failed homebirth”. “Induction of labour, with delay and followed by operative birth” and “transfer in during planned homebirth” are favoured, respectively. </p>
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<img alt="A pregnant woman wearing a yellow top clutches her belly." src="https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543009/original/file-20230816-17-ku8n22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Language matters.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-african-american-woman-doing-morning-1842709132">Prostock-studio/Shutterstock</a></span>
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<p>Language which infantalises pregnant women, such as “good girl” or “you are allowed/not allowed to” should also be avoided, as should language which has connotations of blame. Examples of this include “poor maternal effort” and “refused”. </p>
<p>During pregnancy and birth, which is a vulnerable time for many, the role of the midwife is to empower women and to value their autonomy over their care decisions. </p>
<p>The Nursing and Midwifery Council’s <a href="https://www.nmc.org.uk/globalassets/sitedocuments/standards/standards-of-proficiency-for-midwives.pdf">standards of proficiency for midwives</a> document states that midwives provide universal care for all women and new-born infants. Midwives support physical, psychological, social, cultural and spiritual safety. The emphasis on psychological care is clear, therefore, with language having a profound impact on wellbeing.</p>
<p>Healthcare professionals must acknowledge that the language we use is an important part of the care we provide. Improved psychological safety and wellbeing is closely linked to improved safety, positive outcomes and future experiences. Language matters.</p><img src="https://counter.theconversation.com/content/207753/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Aubrey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Several familiar maternity terms have been abandoned after a consultation with pregnant women and healthcare professionals.Sarah Aubrey, Lead Midwife for Education, University of South WalesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059192023-08-14T20:00:06Z2023-08-14T20:00:06Z1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies<figure><img src="https://images.theconversation.com/files/539721/original/file-20230727-18363-k1nhbm.jpg?ixlib=rb-1.1.0&rect=115%2C49%2C5390%2C3615&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-pregnant-woman-worried-about-her-2210916539">Shutterstock</a></span></figcaption></figure><p>When Sophie was pregnant with her first baby, she had an <a href="https://www.ncbi.nlm.nih.gov/books/NBK279331/#:%7E:text=Oral%20glucose%20tolerance%20tests%20(OGTT,enough%20by%20the%20body's%20cells.)">oral glucose tolerance</a> blood test. A few days later, the hospital phoned telling her she had gestational diabetes.</p>
<p>Despite having only a slightly raised glucose (blood sugar) level, Sophie describes being diagnosed as affecting her pregnancy tremendously. She tested her blood glucose levels four times a day, kept food diaries and had extra appointments with doctors and dietitians. </p>
<p>She was advised to have an induction because of the risk of having a large baby. At 39 weeks her son was born, weighing a very average 3.5kg. But he was separated from Sophie for four hours so his glucose levels could be monitored. </p>
<p>Sophie is not alone. About <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">one in six</a> pregnant women in Australia are now diagnosed with gestational diabetes. </p>
<p>That was not always so. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827530/">New criteria</a> were developed in 2010 which dropped an initial screening test and lowered the diagnostic set-points. Gestational diabetes diagnoses have since <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">more than doubled</a>.</p>
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<span class="caption">Gestational diabetes rates more than doubled after the threshold changed.</span>
<span class="attribution"><span class="source">AIHW</span>, <span class="license">Author provided</span></span>
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<p>But <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">recent</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33704936/">studies</a> cast doubt on the ways we diagnose and manage gestational diabetes, especially for women like Sophie with only mildly elevated glucose. Here’s what’s wrong with gestational diabetes screening.</p>
<h2>The glucose test is unreliable</h2>
<p>The test used to diagnose gestational diabetes – the oral glucose tolerance test – has poor reproducibility. This means subsequent tests may give a different result.</p>
<p>In a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2214956">recent Australian trial</a> of earlier testing in pregnancy, one-third of the women initially classified as having gestational diabetes (but neither told nor treated) did not have gestational diabetes when retested later in pregnancy. That is a problem. </p>
<p>Usually when a test has poor reproducibility – for example, blood pressure or cholesterol – we repeat the test to confirm before making a diagnosis. </p>
<p>Much of the increase in the incidence of gestational diabetes after the introduction of new diagnostic criteria was due to the switch from using two tests to only using a single test for diagnosis.</p>
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<img alt="Pregnant woman cooks dinner with her child" src="https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Women with only mildly elevated glucose levels are being diagnosed with gestational diabetes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-pregnant-woman-cooking-her-daughter-2019300152">Shutterstock</a></span>
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<h2>The thresholds are too low</h2>
<p>Despite little evidence of benefit for either women or babies, the current Australian criteria diagnose women with only mildly abnormal results as having “gestational diabetes”. </p>
<p>Recent studies have shown this doesn’t benefit women and may cause harms. A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">New Zealand trial</a> of more than 4,000 women randomly assigned women to be assessed based on the current Australian thresholds or to higher threshold levels (similar to the pre-2010 criteria). </p>
<p>The trial found no additional benefit from using the current low threshold levels, with overall no difference in the proportion of infants born large for gestational age. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sixteen-pound-baby-born-in-brazil-heres-what-increases-the-risk-of-giving-birth-to-a-giant-baby-198423">Sixteen-pound baby born in Brazil: here's what increases the risk of giving birth to a giant baby</a>
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<p>However, the trial found several harms, including more neonatal hypoglycaemia (low blood sugar in newborns), induction of labour, use of diabetic medications including insulin injections, and use of health services. </p>
<p>The study authors also looked at the subgroup of women who were diagnosed with glucose levels between the higher and lower thresholds. In this subgroup, there was some reduction in large babies, and in shoulder problems at delivery. </p>
<p>But there was also an increase in small babies. This is of concern because being small for gestational age can also have consequences for babies, including long-term health consequences.</p>
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<img alt="" src="https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">NEJM</span>, <span class="license">Author provided</span></span>
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<h2>Testing too early</h2>
<p>Some centres have begun testing women at higher risk of gestational diabetes earlier in the pregnancy (between 12 and 20 weeks).</p>
<p>However, a <a href="https://pubmed.ncbi.nlm.nih.gov/37144983/">recent trial</a> showed no clear benefit compared with testing at the usual 24–28 weeks: possibly fewer large babies, but again matched by more small babies.</p>
<p>There was a reduction in transient “respiratory distress” – needing extra oxygen for a few hours – but not in serious clinical events. </p>
<h2>Impact on women with gestational diabetes</h2>
<p>For women diagnosed using the higher glucose thresholds, dietary advice, glucose monitoring and, where necessary, insulin therapy has been shown to reduce complications during delivery and the post-natal period. </p>
<p>However, current models of care can also cause harm. Women with gestational diabetes are often denied their preferred model of care – for example, midwifery continuity of carer. In rural areas, they may have to transfer to a larger hospital, requiring longer travel to antenatal visits and moving to a larger centre for their birth – away from their families and support networks for several weeks. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-you-at-risk-of-being-diagnosed-with-gestational-diabetes-it-depends-on-where-you-live-112515">Are you at risk of being diagnosed with gestational diabetes? It depends on where you live</a>
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<p>Women say the diagnosis often dominates their antenatal care and their whole <a href="https://pubmed.ncbi.nlm.nih.gov/32028931/">experience of pregnancy</a>, reducing time for other issues or concerns. </p>
<p>Women from culturally and linguistically diverse communities <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03981-5">find it difficult</a> to reconcile the advice given about diet and exercise with their own cultural practices and beliefs about pregnancy.</p>
<p>Some women with gestational diabetes <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2745-1">become</a> extremely anxious about their eating and undertake extensive calorie restrictions or disordered eating habits.</p>
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<img alt="Woman stands in garden looking at her pregnant belly" src="https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some pregnant women become extremely anxious after being diagnosed with gestational diabetes.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gYnEka3-tCI">Unsplash/Jordan Bauer</a></span>
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<h2>Time to reassess the advice</h2>
<p>Recent evidence from both randomised controlled trials and from qualitative studies with women diagnosed with gestational diabetes suggest we need to reassess how we currently diagnose and manage gestational diabetes, particularly for women with only slightly elevated levels.</p>
<p>It is time for a review to consider all the problems described above. This review should include the views of all those impacted by these decisions: women in childbearing years, and the GPs, dietitians, diabetes educators, midwives and obstetricians who care for them.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/had-gestational-diabetes-here-are-5-things-to-help-lower-your-future-risk-of-type-2-diabetes-114298">Had gestational diabetes? Here are 5 things to help lower your future risk of type 2 diabetes</a>
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</em>
</p>
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<p><em>This article was co-authored by maternity services consumer advocate Leah Hardiman.</em></p><img src="https://counter.theconversation.com/content/205919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Glasziou receives funding from an NHMRC Investigator grant.</span></em></p><p class="fine-print"><em><span>Jenny Doust receives funding from NHMRC and MRFF. </span></em></p>About one in six pregnant women in Australia are now diagnosed with gestational diabetes. Rates have more than doubled since the thresholds for diagnosis were changed.Paul Glasziou, Professor of Medicine, Bond UniversityJenny Doust, Clinical Professorial Research Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1706412022-03-23T02:53:15Z2022-03-23T02:53:15ZBirthing on Country services centre First Nations cultures and empower women in pregnancy and childbirth<figure><img src="https://images.theconversation.com/files/453467/original/file-20220322-23-1il36u9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-feet-moms-hand-on-white-177099479">Shutterstock</a></span></figcaption></figure><p>Many Australian women rely on and trust maternity services to see them through pregnancy, labour and the early stages of new parenting.</p>
<p>But for First Nations women, these same services can be confronting and can result in poor outcomes. Many women must travel far from family and community to birth. And if they don’t, they often feel misunderstood and judged by mainstream health services. </p>
<p>There is another way. <a href="http://www.birthingoncountry.com">Birthing on Country</a> means First Nations women give birth on their ancestral country. It acknowledges First Nation peoples’ continued ownership of land and unique birthing practices.</p>
<h2>What can Birthing on Country services do?</h2>
<p><a href="https://doi.org/10.1016/j.wombi.2019.06.013">Birthing on Country services</a> centre First Nations values, and are designed to meet First Nations people’s social, emotional, cultural and health needs. The services are embedded within larger health service networks.</p>
<p>Our <a href="https://www.cdu.edu.au/mwrc">team</a> works in partnership with First Nations communities to deliver Birthing on Country maternity services that address health inequities. </p>
<p>Our partners in one urban setting saw a <a href="https://doi.org/10.1016/S2214-109X(21)00061-9">profound reduction</a> in preterm birth and increased antenatal attendance and breastfeeding. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/birthing-on-country-could-deliver-healthier-babies-and-communities-31180">Birthing on Country could deliver healthier babies and communities</a>
</strong>
</em>
</p>
<hr>
<p>This was achieved through integrating within a wraparound <a href="https://doi.org/10.1071/PY19038">system of care</a>, designed as a one-stop-shop in an Aboriginal community controlled setting. </p>
<p>It also involved <a href="https://doi.org/10.1016/j.wombi.2019.06.013">redesigning the service</a> using a <a href="https://doi.org/10.1016/j.wombi.2020.09.017">successful blueprint</a> that prioritises investing in the workforce, strengthening families’ capabilities, and embedding First Nations governance and control in all aspects of maternity service planning and delivery. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1354285611528589313"}"></div></p>
<p>However, Birthing on Country services are yet to be trialled in regional and remote Australia. So there is much work to do to ensure all First Nations women can access these services.</p>
<p>Here are five ways to work towards this:</p>
<h2>1. Acknowledge safe childbirth is a human right</h2>
<p>Australia is a signatory to the <a href="https://www.un.org/development/desa/indigenouspeoples/declaration-on-the-rights-of-indigenous-peoples.html">United Nations Declaration on the Rights of Indigenous Peoples</a> which states Indigenous people have the right to:</p>
<ul>
<li>quality, culturally safe health care</li>
<li>be self-determining and participate in the design of health services</li>
<li>include and revitalise cultural practices, languages, and medicines. </li>
</ul>
<p>Birthing on Country services are one example of how this can be achieved. </p>
<p>Commitment to uphold the UN declaration requires resourcing and monitoring to support and celebrate the world’s <a href="https://www.nature.com/articles/nature22968">oldest</a> midwifery practices and cultures.</p>
<h2>2. Acknowledge how health systems fail First Nations people</h2>
<p>First Nations people and cultures are <a href="https://press-files.anu.edu.au/downloads/press/n2140/pdf/ch05.pdf">wrongly blamed</a> as the cause of health inequities, rather than focusing on how the health system <a href="https://doi.org/10.5694/j.1326-5377.2005.tb06891.x">continues to fail First Nations families</a>. </p>
<p>Racial bias has been identified as a <a href="https://www.abc.net.au/news/2021-08-31/naomi-williams-mother-calls-out-ongoing-indigenous-bias-health/100417522">contributing factor in First Nations maternal deaths</a>. This includes health services dismissing women’s concerns and turning them away from hospital when seeking care – even when they have life-threatening symptoms. </p>
<p>This can make First Nations families feel unsafe and uncomfortable accessing maternity health services. </p>
<p>Large organisations make Western ways of “knowing and doing” dominant in every work practice. This often results in institutionalised racism and dismisses other forms of knowledge suggesting we should or could be doing things differently. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/microaggressions-arent-just-innocent-blunders-research-links-them-with-racial-bias-145894">Microaggressions aren't just innocent blunders – research links them with racial bias</a>
</strong>
</em>
</p>
<hr>
<h2>3. Ensure there is ‘nothing about us without us!’</h2>
<p>Australia’s health system was <a href="https://doi.org/10.1080/14443058.2020.1796754">designed</a> to serve those who designed it. </p>
<p>First Nations people have been explicitly excluded from decision-making about the services provided to them. </p>
<p>First Nations people want and need to be at the decision-making table, and ensure “nothing about us” is decided “without us”. </p>
<figure class="align-center ">
<img alt="Woman looks at a screen while having an ultrasound." src="https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452678/original/file-20220317-8547-184xk46.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">First Nations people need to be involved in designing health services.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-partner-having-4d-ultrasound-155730335">Shutterstock</a></span>
</figcaption>
</figure>
<p>Participatory action research is <a href="https://www.lowitja.org.au/content/Document/Lowitja-Publishing/LI_Discussion_Paper_P-Dudgeon_FINAL3.pdf">one evidence-based</a> way to work collaboratively with stakeholders to respond to needs identified by the community. </p>
<p>First Nations people value the process as it aligns with principles of self-determination and equity. And it privileges the voices of those often marginalised in research. </p>
<p>Engaging community in design, implementation and evaluation of maternity services brings local knowledge, <a href="https://doi.org/10.1016/j.socscimed.2015.12.019">community activation and investment</a> that leads to lasting change.</p>
<h2>4. Recognise how First Nations peoples can improve health care for everyone</h2>
<p>Our colleagues in Aotearoa (New Zealand) found maternity systems that <a href="https://doi.org/10.1002/ijgo.13855">privilege whiteness</a> cannot provide equitable health care for all. </p>
<p>All people can benefit from ethical knowledge systems that have safely guided childbirth and the flourishing of First Nations people for millennia.</p>
<p>Relationality – being connected with all human and non-human beings – is at the centre of First Nations values, ways of knowing, doing and being. It ensures our responsibility to be in good relations with each other, whether with community, Country or our research partners. </p>
<p>The current system does not embed relationality in its design; rather encourages capitalism and competition for scarce resources over genuine partnership and equitable care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-need-to-support-aboriginal-womens-choice-to-give-birth-on-country-53804">Why we need to support Aboriginal women’s choice to give birth on country</a>
</strong>
</em>
</p>
<hr>
<p>Our task is to re-centre good relations in our everyday work to make health and wellness gains. We do this by:</p>
<ul>
<li>ensuring our work is community-driven</li>
<li>using methodologies that represent First Nations views</li>
<li>presenting and defending findings at community forums</li>
<li>ensuring our research leads to action at the local, state and national level.</li>
</ul>
<h2>5. Share findings in accessible ways</h2>
<p>The <a href="https://www.birthingoncountry.com/caring4mum">Caring for Mum on Country</a> project is a community-driven action research project piloting doula (birthing companion) training and exploring reproductive health literacy. </p>
<p>It has shown the power of grassroots community activation in finding Yolŋu solutions to local needs. </p>
<p>Charles Darwin University researchers Sarah Ireland (a co-author of this article) and Ḻäwurrpa Maypilama (in partnership with the <a href="https://www.australiandoulacollege.com.au/">Australian Doula College</a> and <a href="https://www.yalu.org.au/">Yalu Aboriginal Corporation</a>) used community action research to pilot <a href="https://www.sciencedirect.com/science/article/abs/pii/S0266613819300889?via=ihub">First Nations doula</a> training, locally known as djäkamirr–caretakers of pregnancy and birth. </p>
<p>They made a <a href="https://www.birthingoncountry.com/djakamirr">documentary</a> about their project:</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1408213441760972803"}"></div></p>
<p>Film is an impactful way to discuss research. Finding creative and accessible ways to share research findings is imperative to bringing learnings to people who can benefit from and enact change.</p>
<p>Health inequities in childbirth will persist until health systems relinquish control and acknowledge the value of First Nations knowledge systems centred on relationality and wellness. </p>
<p>We must work in partnership with First Nations communities to redesign health services and work differently with communities in their journeys to implementing Birthing on Country maternity services.</p><img src="https://counter.theconversation.com/content/170641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Ireland receives funding from NHMRC Partnership Grant 2021: “To Be Born Upon a Pandanus Mat" APP2010289. </span></em></p><p class="fine-print"><em><span>Yvette Roe receives funding from NHMRC .
CI A Prof Yvette Roe, NHMRC Centre of Research Excellence: 2020 Redesigning maternal, newborn and child health services for the best start in life for First Nations families. APP1197110
CI A Prof Yvette Roe, NHMRC Partnership Grant 2021: “To Be Born Upon a Pandanus Mat”. APP 2010289
</span></em></p><p class="fine-print"><em><span>Sophie Hickey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Birthing on Country services acknowledge First Nation peoples’ continued ownership of land and unique birthing practices.Sophie Hickey, Postdoctoral researcher, Charles Darwin UniversitySarah Ireland, Medical anthropologist, nurse, midwife, researcher, Charles Darwin UniversityYvette Roe, Professor of Indigenous Health, Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1267092019-11-12T12:03:20Z2019-11-12T12:03:20ZLabour’s maternity leave boost is a major step forward, but it won’t do anything for gender equality<figure><img src="https://images.theconversation.com/files/301123/original/file-20191111-194628-fv7clv.jpg?ixlib=rb-1.1.0&rect=24%2C41%2C5521%2C3650&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-holding-baby-while-sitting-on-fur-bean-bag-698878/">Pexels</a></span></figcaption></figure><p>Mothers will be given maternity pay for a full year after the birth of their children under a package of new measures <a href="https://labour.org.uk/press/labour-launches-major-package-of-reforms-to-deliver-a-workplace-revolution-for-women/">announced by Labour</a>. The proposals that aim to change the way women are treated at work would involve an increase in <a href="https://www.gov.uk/maternity-pay-leave">statutory maternity pay</a> – from nine to 12 months. This would allow all working mothers or parents to spend a full year with their new-born babies before going back to work.</p>
<p>Mothers are currently allowed up to 52 weeks maternity leave – but are only paid for nine of them. The first six weeks is paid at 90% of the woman’s average weekly earnings before tax. The remaining 33 weeks is paid at £148.68 per week or 90% of their average weekly earnings, whichever is lower. </p>
<p>Under the current system, mothers going on maternity leave are faced with the challenge of low maternity pay, <a href="https://www.workingmums.co.uk/workingmums-annual-survey-2017/">expensive childcare</a> and <a href="https://www.personneltoday.com/pr/2018/11/more-than-90-of-maternity-returners-say-they-get-no-support-at-work-when-they-go-back-reveals-mmb-survey/">lack of support on their return to work</a>, so it’s great that the Labour party recognises and plans to resolve the discrimination women face in the workplace. But, as it stands, Labour’s plan of <a href="https://www.bbc.co.uk/news/election-2019-50338831">extending maternity leave pay for another three months</a> at the statutory rate doesn’t do enough to address gender inequality – at both work and home.</p>
<h2>Maternity discrimination</h2>
<p>Women have suffered various forms of maternity discrimination in the UK over the years, such as <a href="https://www.parliament.uk/documents/commons-committees/women-and-equalities/Correspondence/Consultation-response-1-5-19.pdf">redundancy</a>, <a href="https://www.equalityhumanrights.com/en/our-work/news/pregnancy-and-maternity-discrimination-forces-thousands-new-mothers-out-their-jobs">loss of job</a>, and being <a href="https://www.thejournal.ie/maternity-leave-discrimination-2172443-Jun2015/">overlooked for promotions</a>. And many UK employers see pregnancy as an <a href="https://www.equalityhumanrights.com/en/our-work/news/employers-dark-ages-over-recruitment-pregnant-women-and-new-mothers">unnecessary burden</a> in the workplace – with little incentive for employers to support pregnant women, or women going on maternity leave.</p>
<p>Indeed, <a href="https://www.bbc.co.uk/news/election-2019-50338831">Labour’s maternity proposal</a> highlights how slow and late the UK is compared to other <a href="https://journals.sagepub.com/doi/abs/10.1177/0958928709352541">countries</a> in making family-friendly policies that foster equality at home and in the workplace. And, even now, this extension of maternity pay, still falls short. This is because it endorses the <a href="https://www.myfamilycare.co.uk/resources/news/shared-parental-leave-two-years-on/">cultural perception of fathers being the breadwinners</a> of the family and mothers the caregivers – highlighting the fact that women in the UK are not considered contributors to the labour market in the same way as men.</p>
<p>The proposal also fails to recognise the importance of a father’s involvement in parenting. This is despite increasing numbers of dads sharing parenting responsibilities and the <a href="http://www.modernfatherhood.org/">breadwinner role</a> in modern families. </p>
<p>Labours proposal also seem to ignore the <a href="http://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=DELSA/ELSA/WD/SEM(2012)11&docLanguage=En">benefits</a> of dads involvement in the care of their children. This is despite the fact that research has shown that having two parents involved in parenting from a young age is more beneficial for the child – and the couple. </p>
<h2>Lessons from Sweden</h2>
<p>In this sense then, Labour’s proposal can be considered a missed opportunity to bring the UK in line with other countries that have better policies on gender equality. </p>
<p><a href="https://www.europarl.europa.eu/RegData/etudes/ATAG/2019/635586/EPRS_ATA(2019)635586_EN.pdf">Sweden, for example, is ranked</a> the best place in the world to raise a family because of its generous parental leave policy. Reduced working hours for parents with young children, high-quality childcare and extensive out-of-school-hours care at a low prices are just some of the benefits available in <a href="https://www.oecd.org/els/family/swedenssupportforparentswithchildreniscomprehensiveandeffectivebutexpensive.htm">family-friendly Sweden</a>.</p>
<p>For more than 40 years, Sweden has recognised that mothers and fathers should have <a href="http://www.oecd.org/fr/els/famille/swedenssupportforparentswithchildreniscomprehensiveandeffectivebutexpensive.htm">equal parenting roles</a> – and policies aim to balance gender equality at home and in the workplace. The government gives each parent 240 days paid leave at about 80% of their salary – plus bonus days in cases of twins. Of that leave, 90 days are reserved for each parent and are non-transferable – making Sweden the country with the <a href="https://www.thelocal.se/20190614/sweden-ranked-among-worlds-best-places-raise-a-family-unicef-report">the highest amount of leave reserved for dads</a>. </p>
<p>The 480 days in total does not expire until the child is eight years old. And the generous family-friendly policies also have a positive impact on breastfeeding rates. Sweden has one of the <a href="https://theconversation.com/uk-has-one-of-the-lowest-breastfeeding-rates-in-the-world-heres-how-to-change-this-126238">highest breastfeeding rates</a> in the world – unlike the <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-019-0230-0">UK, which has one of the lowest</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/301124/original/file-20191111-194646-d28m5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/301124/original/file-20191111-194646-d28m5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/301124/original/file-20191111-194646-d28m5h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/301124/original/file-20191111-194646-d28m5h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/301124/original/file-20191111-194646-d28m5h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/301124/original/file-20191111-194646-d28m5h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/301124/original/file-20191111-194646-d28m5h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Do it like the Swedes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU3MzUxMjM3MiwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTExMDM2OTI0OCIsImsiOiJwaG90by8xMTEwMzY5MjQ4L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJYQ01Da2J6UlVTSGRkZWgwVDdrR3poSVB1clUiXQ%2Fshutterstock_1110369248.jpg&pi=33421636&m=1110369248&src=ee9d7779-7f60-4a86-b206-e244e9c750a5-1-19">Shutterstock/PERO studio</a></span>
</figcaption>
</figure>
<p>So for Labour to really make a difference to gender equality and “the way women are treated at work” the rate of maternity pay also needs to be increased – because well-paid parental leave is associated with improved female retention, higher female employment, less gender stereotyping at work and <a href="https://www.ft.com/content/03ecde34-85e1-11e9-a028-86cea8523dc2">lower gender pay gaps</a>. </p>
<p>Paternity leave duration should be increased to at least 12 weeks and the pay increased – in line with what’s on offer for mothers. And shared parental leave pay must also be boosted to further encourage dads’ involvements in parental responsibilities. This is important, because ultimately, the more dads get involved in parenting, the more gender stereotypes will reduce.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/300096/original/file-20191104-88414-1yh2yvf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/300096/original/file-20191104-88414-1yh2yvf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=140&fit=crop&dpr=1 600w, https://images.theconversation.com/files/300096/original/file-20191104-88414-1yh2yvf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=140&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/300096/original/file-20191104-88414-1yh2yvf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=140&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/300096/original/file-20191104-88414-1yh2yvf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=176&fit=crop&dpr=1 754w, https://images.theconversation.com/files/300096/original/file-20191104-88414-1yh2yvf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=176&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/300096/original/file-20191104-88414-1yh2yvf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=176&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p><em><a href="https://theconversation.com/uk/newsletters/the-daily-newsletter-2?utm_source=TCUK&utm_medium=linkback&utm_campaign=TCUKGE2019&utm_content=GEBannerB">Click here to subscribe to our newsletter if you believe this election should be all about the facts.</a></em></p><img src="https://counter.theconversation.com/content/126709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ernestine Gheyoh Ndzi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What about the dads?Ernestine Gheyoh Ndzi, Senior Lecturer, Law Department, York St John UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1022692019-09-24T00:56:01Z2019-09-24T00:56:01Z1 in 3 new mums struggle to get their baby to sleep, but some women have a tougher time<figure><img src="https://images.theconversation.com/files/260879/original/file-20190225-26162-cqz2dn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parents have lost the village it takes to raise a child and this is taking a toll on new mothers and their babies. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/S8BW-Wx9G8I">Alex Pasarelu</a></span></figcaption></figure><p>Becoming a parent is a wonderful experience but it can also be incredibly daunting. There is no qualification or test you can take to make sure you’re ready; you have to rely on life experience, advice from friends, family and experts, and trial and error. </p>
<p>But while most of the time we get parenting right, some people need more support than others. </p>
<p>Our research, published today in the journal <a href="https://bmjopen.bmj.com/content/9/9/e030133">BMJ Open</a>, found that while every baby is different, some factors increase the likelihood new mothers will experience difficulties with early parenting. These include the mother’s mental health, birth intervention or emergencies during labour, and lack of support.</p>
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Read more:
<a href="https://theconversation.com/i-didnt-know-who-i-was-anymore-myths-vs-realities-of-early-parenthood-31574">'I didn't know who I was anymore' – myths vs realities of early parenthood</a>
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<h2>Australia has a unique health system</h2>
<p>More than 30% of new mothers in Australia report <a href="https://www.ncbi.nlm.nih.gov/pubmed/23159161">severe</a> problems getting their baby to <a href="https://www.ncbi.nlm.nih.gov/pubmed/17207059">sleep and settle</a>. This often results in exhaustion, and poorer <a href="https://www.ncbi.nlm.nih.gov/pubmed/29700867">mental</a> and physical health. </p>
<p>Poor physical and mental health during pregnancy and after birth can also have significant short- and longer-term impacts on the <a href="https://www.ncbi.nlm.nih.gov/pubmed/19401723">health and development of the child</a>. So treatment is vital.</p>
<p>Australia has a unique health system in place to support new parents who struggle to cope and their babies, including residential parenting services – sometimes referred to as “sleep schools” – such as <a href="https://www.tresillian.org.au/?gclid=Cj0KCQjwidPcBRCGARIsALM--eO3lBy6nN99wAqptwhpdbiDkL4jqstTb2I-Bh1DOvMDPQkSZb5WMiUaAgkoEALw_wcB">Tresillian</a> in New South Wales and Tweddle Child and Family Health Service in Victoria.</p>
<p>These services provide structured programs to help develop parenting skills. Parents attend and stay in the facility for three to four days and are guided through sleep, settling and feeding skills and strategies. </p>
<p>These services are mostly publicly funded and there are often waiting lists due to high demand.</p>
<h2>Our research</h2>
<p>We studied why some women and their partners end up requiring admission to residential parenting services in the first year after birth.</p>
<p>We looked at all births in NSW over 12 years and randomly analysed <a href="https://www.ncbi.nlm.nih.gov/pubmed/29700867">300 medical records</a> from women and babies who had a stay in residential parenting services in NSW. We then did in-depth interviews with <a href="https://www.ncbi.nlm.nih.gov/pubmed/28666701">women</a> who used the services and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13478">focus groups</a> with staff who worked there.</p>
<p>The primary reason women sought <a href="https://www.ncbi.nlm.nih.gov/pubmed/29700867">support</a> in residential parenting services was for sleep and settling (83%). </p>
<p>Over half had a history of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.14497">mental health</a> issues. </p>
<p>During their stay, women used a number of services, including social workers (44%), psychologists (52%) and psychiatrists (4.5%). </p>
<p><a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">Intervention in birth</a> can leave women with negative feelings about the birth, leading to struggles with early parenting and depression. This can alter the way women engage with their baby, which can <a href="https://www.ncbi.nlm.nih.gov/pubmed/18211728">impact on the baby’s development</a>. </p>
<p>One in ten women said they had mental health issues <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.14497">related to the birth</a> and many were <a href="https://www.ncbi.nlm.nih.gov/pubmed/28666701">traumatised</a> by their births, especially where unexpected intervention had occurred, such as a caesarean section, forceps or vacuum, or the baby needing resuscitation or intensive care. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">So your birth didn't go according to plan? Don't blame yourself</a>
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<p>Around one in three babies (36%) admitted to residential parenting services had a history of reflux. We have found a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808415/">strong link</a> between reflux and intervention in birth, babies being born early and maternal mental health issues, particularly anxiety.</p>
<p>We also found women admitted to the service were more likely to:</p>
<ul>
<li>be admitted as a private patient</li>
<li>be born in Australia </li>
<li>have had their first baby</li>
<li>have experienced intervention during the labour and birth (induction, forceps or vacuum birth, caesarean section, epidural and episiotomy)</li>
<li>have twins</li>
<li>have a boy</li>
<li>have a baby who needed to be resuscitated at birth, go to intensive care, or who experienced birth trauma (particularly to the scalp)</li>
<li>be aged in their 30s</li>
<li>have <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.13478">little support</a>.</li>
</ul>
<h2>How the health system can support new parents</h2>
<p>Screening and support for psychological and social vulnerabilities needs to be routine. </p>
<p>Depending on the state or territory, most women in the public sector receive a <a href="http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2010_004.pdf">“psychosocial” assessment</a> from midwives when they first book in for care during pregnancy and again from child and family health services after they have had the baby. This screens for depression, anxiety, childhood abuse, domestic violence, support and stress. </p>
<p>But this is still not done routinely in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26515785">private sector</a> where 25% of women give birth. This urgently needs to be prioritised, so all women can receive appropriate support.</p>
<p>Women need support to prepare for birth, which may include having a <a href="http://www.ethics.org.au/on-ethics/blog/august-2016/don%E2%80%99t-throw-the-birth-plan-out-with-the-bath-water">birth plan</a> and <a href="https://theconversation.com/parent-education-and-complementary-therapies-reduce-birthing-risks-62417">quality childbirth education</a>. This gives couples tools to manage the pain of labour, avoid unnecessary intervention and <a href="https://www.popsugar.com.au/parenting/Benefits-Preparing-Childbirth-44542606?utm_medium=redirect&utm_campaign=US:AU&utm_source=direct">prepare for parenthood</a>. </p>
<p>They also need health providers they know and trust. Women who have a <a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">midwife they know through the pregnancy, birth and postnatal period</a> have fewer interventions, better outcomes and greater satisfaction than those who are allotted whoever is on duty that day. </p>
<p>Relationship-based care gives women the opportunity to discuss what happened afterwards and debrief. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">Call the Midwife: playing catch up with Australia's maternity care </a>
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<h2>It takes a village to raise a child</h2>
<p>Parents have <a href="https://constructiveparenting.com/blog-reclaiming-your-village/">lost the village</a> it takes to raise a child and increasingly feel isolated and unsupported. </p>
<p>We need to have conversations with parents about how important this village will become and to start <a href="https://www.bubhub.com.au/hubbub-blog/it-takes-a-village-to-raise-a-mother/">putting this support in place</a> before the baby comes. This may be moving closer to your parents, finding a good parenting network, connecting with positive online support networks, and not feeling pressured to go back to work before you’re ready. </p>
<p>Sharing the parenting and work arrangements as a couple can also help.</p><img src="https://counter.theconversation.com/content/102269/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from ARC, NHMRC, NSW Health. Hannah also has close ties to the Australian College of Midwives </span></em></p><p class="fine-print"><em><span>Cathrine Fowler has a sponsored clinical chair at Tresillian Family Care Centres. </span></em></p><p class="fine-print"><em><span>Virginia Schmied receives funding from ARC. She is affiliated with Australian College of Midwives. </span></em></p>Almost one in three new mothers report severe problems getting their baby to sleep and settle. Every baby is different but some women are more likely to struggle – here’s why.Hannah Dahlen, Professor of Midwifery and Higher Degree Director, Western Sydney UniversityCathrine Fowler, Professor & Tresillian Chair in Child & Family Health, Faculty of Nursing, Midwifery & Health, University of Technology SydneyVirginia Schmied, Professor, School of Nursing and Midwifery, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/568552016-07-27T02:06:42Z2016-07-27T02:06:42ZWhy fear of childbirth must be studied in the US<figure><img src="https://images.theconversation.com/files/127826/original/image-20160622-7165-8wxa2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Afraid?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-164535368/stock-photo-mid-adult-pregnant-woman-with-ctg-monitor-on-belly.html?src=OeftPYNNYkwyuuJqaRgj-Q-24-4">Pregnant woman via www.shutterstock.com.</a></span></figcaption></figure><p>Approximately <a href="http://www.cdc.gov/nchs/fastats/births.htm">four million women give birth each year</a> in the United States. Most women have some level of fear about labor and birth; it is considered part of the normal experience of childbirth. </p>
<p>For some women, that fear may be about whether she and the baby will be healthy. Other women may fear that their health care providers are not going to treat them with respect or kindness. While many women are able to cope with it, for some women this fear is more difficult to manage and may impact their birth.</p>
<p>As a midwife and clinical assistant professor in nursing, I wanted to explore what we actually knew about fear during childbirth and its effects on outcomes for women and their newborns in the United States. The answer: not much. </p>
<h2>Research about fear of childbirth in the U.S. is limited</h2>
<p>Research from Scandinavian countries demonstrates that from <a href="http://www.ncbi.nlm.nih.gov/pubmed/13679545">5-20 percent of women</a> have <a href="http://dx.doi.org/10.1016/j.midw.2008.07.003">significant fear of childbirth</a>. Other research from Scandinavia has found that women with <a href="http://www.ncbi.nlm.nih.gov/pubmed/9435734">fear of childbirth</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/22734617">experience longer</a> and more challenging labor, are more likely to need medication to make progress, <a href="http://dx.doi.org/10.1080/00016340902998436">may need to have</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/25676793">more cesareans</a>, have more <a href="http://dx.doi.org/10.1016/j.wombi.2011.06.001">dissatisfaction with their birth</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21959041">take longer to adjust</a> after their birth. </p>
<p>However, because most of the research about fear of childbirth comes from Scandinavia, this research does not provide a lot of insight into what is happening in the United States. Scandinavian countries have very different health and maternity care systems. </p>
<p>So what does the research say about fear of childbirth here?</p>
<p>One small study says potentially as many as <a href="http://www.ncbi.nlm.nih.gov/pubmed/11191169">50 percent of women</a> in the U.S. experience significant fear of childbirth. But that study is one of just <em>three</em> on <a href="http://www.ncbi.nlm.nih.gov/pubmed/9046762">fear of childbirth</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/17880311">in the U.S.</a> These studies mostly included well-educated white women, which limits how much information they give us about the rest of the population in the United States.</p>
<p>Our disjointed maternity care system is the likely reason so little research on fear of childbirth has been done in the U.S. While obstetricians and midwives consider the emotional needs of women to be an important part of health and wellness during pregnancy, the length of prenatal care visits and the expectation for high-volume practices mean that very few clinicians are actually spending the time addressing psychosocial concerns of pregnancy, like fear of childbirth. </p>
<h2>Measuring fear of childbirth in the U.S.</h2>
<p>Around the world, many studies use surveys to measure fear of childbirth. I took one of the most commonly used surveys, the Wijma Delivery Expectancy Questionnaire (WDEQ), to see if it could capture the concerns that expectant mothers in the U.S. have.</p>
<p>As a first step in looking at fear of childbirth in the U.S., I <a href="http://www.sciencedirect.com/science/article/pii/S0884217515000064">held a series of focus groups</a>, involving 22 women who were pregnant or had give birth in the last five years, and asked them to take the WDEQ survey and talk about their reaction to the questions.</p>
<p>Since the handful of studies examining fear of childbirth in the U.S. mostly included white, well-educated women, I wanted to make sure that the focus groups were more diverse. Six of the participants identified as African-American, one as biracial, one as Middle Eastern and the remaining 14 as Caucasian. </p>
<p>Many of the themes that emerged in the focus group corresponded with previous research on fear of childbirth, such as fear for the baby’s health and fear of complications during the delivery. </p>
<p>However, women reported many other fears that had not been seen in previous research – and were not covered by the questionnaire. This is likely a reflection of the difference between maternity care systems in the United States and Scandinavian countries. It also suggests that we know very little about women’s fear of childbirth and how to address it appropriately. </p>
<p>Most of these fears were related to women’s interactions with health care providers, or the health system overall. Women reported fear of not having their decisions respected or fear that they would be abandoned or treated poorly by their provider. One woman said: </p>
<blockquote>
<p>“I had a friend who was just alone in the bed, by herself. They took her baby away and she didn’t have any updates. That really scares me.”</p>
</blockquote>
<p>Another said:</p>
<blockquote>
<p>“People say ‘oh you’re a woman, you’re supposed to know what to do’ and it isn’t like that. Everything about it is terrifying and even though you may have a baby daddy or some family everyone is still looking at you and I just didn’t know; I didn’t know what to do.”</p>
</blockquote>
<p>Women also alluded to larger societal constructs that affected their birth experience and contributed to their fear. For many women this was linked to the images they saw of birth in the mainstream media. As one woman said:</p>
<blockquote>
<p>“You have the most intense relationship of your life with your body during pregnancy and instead of doing that in a world that honors it all we do it as a terrifying made for TV lifetime movie.”</p>
</blockquote>
<p>I would like to continue this research and look at how fear of childbirth may vary by race, class and sexual orientation. I just finished another group of focus studies examining how fear of childbirth is informed by social identities. I’m also currently working on a project piloting a revised WDEQ survey that better reflects the ideas and language that women in the U.S. use to describe their fears and worries about childbirth. I hope to use this revised survey to look at the role that fear of childbirth plays in outcomes and disparities in women’s health.</p><img src="https://counter.theconversation.com/content/56855/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lee Roosevelt received funding from the Center for the Education of Women & Blue Cross, Blue Shield of Michigan Foundation</span></em></p>We don’t know much about fear during childbirth and its effects on outcomes for women and their newborns in the United States.Lee Roosevelt, Clinical Assistant Professor of Nursing, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/413192015-05-06T15:25:47Z2015-05-06T15:25:47ZWhy isn’t the UK a safer place to give birth?<figure><img src="https://images.theconversation.com/files/80679/original/image-20150506-10927-lo5ejt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The UK came 24th in a recent study of the best places to be a mother.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>It has been a week of contrasts. The world’s press has been focused on the safe birth of <a href="https://theconversation.com/royal-baby-its-a-girl-and-thank-heavens-she-wasnt-born-in-1516-40812">one tiny princess</a> at the same time as hundreds of babies are being born into an <a href="https://theconversation.com/earthquake-orphans-what-nepal-can-learn-from-haiti-41165">earthquake-devastated Nepal</a>. It is tempting to consider that neither of these two extremes have much real impact on the lives of the majority of families in the UK.</p>
<p>But it is against this backdrop that Save the Children’s 16th <a href="http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.8585863/k.9F31/State_of_the_Worlds_Mothers.htm">State of the World’s Mothers</a> report was published. It extensively analyses a range of indicators of women’s and children’s health to rank the experience of being a mother in 179 countries.</p>
<p>This report is welcome not just because it highlights that the situation for mothers and babies is most desperate among the urban poor in the world’s poorest countries. It also reveals that, in cities around the world, the poorest urban children are at least twice as likely to die by the age of five as the richest urban children.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/80655/original/image-20150506-22684-119xyf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/80655/original/image-20150506-22684-119xyf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=315&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80655/original/image-20150506-22684-119xyf8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=315&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80655/original/image-20150506-22684-119xyf8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=315&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80655/original/image-20150506-22684-119xyf8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=396&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80655/original/image-20150506-22684-119xyf8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=396&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80655/original/image-20150506-22684-119xyf8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=396&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The disparity between motherhood in rich and poor countries.</span>
<span class="attribution"><a class="source" href="http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.8585863/k.9F31/State_of_the_Worlds_Mothers.htm#download-the-report">Save The Children</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The UK is ranked 24th in the report’s list of the best and worst places in the world for mothers and babies, an improvement of just two places from last year. The country hasn’t appeared in the top ten since 2012.</p>
<p>The report suggests that women in the UK are around twice as likely to die as a result of childbirth than their counterparts in Denmark or Finland. In fact, data in the report suggests that the situation for women in the UK appears closer to that of women in Slovenia, Qatar <a href="http://www.researchgate.net/publication/261030341_Shortcomings_of_maternity_care_in_serbia">and Serbia</a>.</p>
<p>This report should be a wake-up call to politicians, policy makers and healthcare providers across the UK. But we already know why mothers in the UK die. The UK has had a <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/reports">well-established audit and enquiry</a> into maternal deaths that has reported every three years since 1985, so we have good information on the reasons and circumstances in which UK mothers die in relation to childbirth.</p>
<h2>Changing population</h2>
<p>The UK has seen a shift in the demographics of women who are becoming pregnant, with more women who have increased care needs giving birth than in previous generations. There are now <a href="http://www.theguardian.com/society/2014/jan/05/older-mothers-strain-midwives">many more older mothers</a>, more obese women and more women whose own country of birth was <a href="http://onlinelibrary.wiley.com/enhanced/doi/10.1111/1471-0528.13279/">outside the UK</a>. These women are all at increased risk during pregnancy.</p>
<p>In addition, there are many more women with multiple health conditions who in previous generations would have been less likely to become pregnant.
The <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/reports">most recent report</a> into maternal deaths in the UK found that almost three quarters of the women who died had coexisting medical complications. However, as highlighted in the report, the majority of health issues disproportionately impact on poorer women and women living in the most disadvantaged communities.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/L_jWAqalgxg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Save The Children are highlighting the different experiences of rich and poor urban mothers.</span></figcaption>
</figure>
<p>So in a high-income country that is proud of its National Health Service and universal provision of maternity care, how can we ensure our mothers and babies fare as well as our European neighbours? Of course, we need to prioritise closing the gap between the richest and poorest in society. Improving education, nutrition and <a href="http://www.cph.org.uk/wp-content/uploads/2013/12/Maternal-Health-Evidence-Briefing_final.pdf">mental well-being</a> of young women before they even become pregnant would go some way to improving the health of mothers and babies in the UK.</p>
<p>However, the quality of and access to maternity care must also be addressed. Within the UK, there has been longstanding and ongoing debate about <a href="http://www.telegraph.co.uk/news/uknews/1500712/Increased-risk-of-baby-deaths-at-midwife-run-birth-centres.html">who should provide maternity care</a>, how often and <a href="http://www.bbc.co.uk/news/health-30206540">in what location</a>. If the health of mothers and babies is to be improved there is no room for professional rivalries or political grandstanding. Mothers and babies need skilled, evidence-based decision making from all care providers, with decisions based on the care needs of individual mothers and babies.</p>
<p>The recently published <a href="http://www.thelancet.com/series/midwifery">Lancet Series on Midwifery</a> indicates that the provision of skilled midwifery care is key to the safety of mothers and babies. This is equally true for the UK as for low income countries, and access to antenatal care must remain a priority. The <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/reports">recent confidential enquiries</a> into maternal deaths in the UK found that more than two thirds of women who died did not receive the nationally recommended level of antenatal care.</p>
<h2>Better relationships</h2>
<p>There is <a href="http://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-versus-other-models-of-care-for-childbearing-women">strong research evidence</a> for continuity of care in improving childbirth outcomes. Where a relationship exists between mothers and midwives before the birth, both are more able to recognise where health and or social problems occur.</p>
<p>One-to-one care by a midwife in labour has been a key target for maternity care for over 20 years. While <a href="http://www.itv.com/news/2015-04-11/labour-pledge-one-to-one-maternity-care-for-every-woman-during-labour-and-birth/">politicians make promises</a> about a midwife for every woman in labour, the public are entitled to ask why this is not already established in tablets of stone.</p>
<p>Since <a href="https://www.npeu.ox.ac.uk/mbrrace-uk/reports">60% of women</a> who die in relation to childbirth do so following birth, high quality postnatal services must be provided to all women in the UK. The <a href="http://www.cqc.org.uk/content/maternity-services-survey-2013">majority of UK women</a> now leave hospital within one to two days following birth. At the same time community maternity services have been <a href="https://www.rcm.org.uk/sites/default/files/Pressure%20Points%20-%20Postnatal%20Care%20Planning%20-%20Web%20Copy.pdf">substantially reduced</a>.</p>
<p>It is ironic that while more mothers with complex health problems are safely giving birth, routine postnatal midwifery support is being reduced. The death of one mother anywhere in the world is a tragedy, even more so when the majority of deaths may be avoided. The report from Save the Children shows that we have no room for complacency.</p><img src="https://counter.theconversation.com/content/41319/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Cheyne receives funding from Scottish Government Chief Scientist Office and Chief Nurse's Office and is affiliated with The Royal College of Midwives. This article represents the author's views, not those of any organisation.</span></em></p>Save The Children’s latest State of the World’s Mothers report highlights the impact of rising inequality on maternal deaths.Helen Cheyne, Royal College of Midwives professor of midwifery research, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/172542013-08-21T20:26:39Z2013-08-21T20:26:39ZWe need to protect new mothers from trauma and suicide<figure><img src="https://images.theconversation.com/files/29654/original/fn7vj6h8-1377061348.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Maternity services often become fragmented after women have given birth.</span> <span class="attribution"><span class="source">David/Flickr</span></span></figcaption></figure><p><a href="http://www.hindawi.com/journals/bmri/2013/623743/">Research we have just published</a> shows the deaths of 48 of the 129 women in New South Wales who died during pregnancy or within a year of giving birth were due to suicide and trauma. It suggests mothers may need support from integrated health and community services for the first year of their child’s life. </p>
<p><a href="http://www.telegraph.co.uk/news/uknews/1364475/Suicide-is-main-cause-of-maternal-deaths.html">Suicide</a> is one of the leading or the main cause of mothers dying within a year of giving birth in countries such as <a href="http://www.nzdoctor.co.nz/news/2012/june-2012/13/suicide-leading-cause-of-maternal-death.aspx">New Zealand</a>, the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02847.x/pdf">United Kingdom</a>, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/22015873">United States</a> and <a href="https://www.mja.com.au/journal/2007/186/7/maternal-mortality-and-psychiatric-morbidity-perinatal-period-challenges-and?0=ip_login_no_cache%3Dae7af16553ef3b83be0aadf56499af6f">Australia</a>. </p>
<p>Women may commit suicide because of mental health disorders, which were either pre-existing or developed during pregnancy or after they gave birth. Traumatic births or lack of support before and after the birth (or both) can also be contributing factors.</p>
<h2>What we found</h2>
<p>We examined maternal deaths in New South Wales from suicide and trauma in the year following birth, from 2000 to 2006. We found 37 women died during pregnancy and within 42 days of giving birth, and 92 died between 42 days and a year after their child was born.</p>
<p>Of the 129 women who had died, 48 deaths were due to suicide or trauma – the biggest single category of maternal death. Other major causes of death included hemorrhages, blood clots and high blood pressure, among other things.</p>
<p>Trauma includes accidental injury, transport accidents and homicide, and suicide is death as a result of intentional self-harm. </p>
<p>Of the 48, four deaths occurred during pregnancy and in the first 42 days following birth. And 44 occurred between 42 days and 12 months after birth. </p>
<p>So death from suicide and trauma rises significantly between nine and 12 months after birth; it is nearly four times the rate compared to the first three months following birth.</p>
<p>A large proportion of women who died from suicide (73%) had a history of mental illness or substance abuse, or both. Most of the women who died because of accidental injury also had a history of mental illness or substance abuse (or both). </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/29656/original/3p2m9nt2-1377061814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/29656/original/3p2m9nt2-1377061814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/29656/original/3p2m9nt2-1377061814.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/29656/original/3p2m9nt2-1377061814.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/29656/original/3p2m9nt2-1377061814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/29656/original/3p2m9nt2-1377061814.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/29656/original/3p2m9nt2-1377061814.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Support services are becoming less available just as babies are becoming more demanding and sleeping less.</span>
<span class="attribution"><span class="source">rabble/Flickr</span></span>
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</figure>
<p>There’s a chance some of these latter deaths may actually have been suicide although it’s difficult to be sure. But death from a firearm discharge, for instance, may be accidental or intentional.</p>
<h2>Some reasons why</h2>
<p>The women who died had higher rates of intervention in birth, higher rates of early-term births, pregnancy complications and neonatal intensive care admissions. They also tended to have babies who were born with a low birth weight and were ten times more likely than other women to have their baby die. </p>
<p>Clearly, these women were at particular risk of ill health - mental and physical. And they may have needed extra attention from health services, for a longer period of time.</p>
<p>Current maternity services pay significant attention to women who are pregnant and giving birth. And we are providing better care in the immediate postpartum period than we ever did before.</p>
<p>We now screen women in the public health sector (this not done routinely in the private sector) for issues such as mental illness, drug and alcohol use, and domestic violence, during pregnancy and, again, in the postpartum period. </p>
<p>It’s after the birth that services often become fragmented and there’s a gap between maternity care and postpartum support in the community. </p>
<p>Most Australian states and territories offer women a home visit after they give birth, with access to community-based clinics. But this can be patchy, locally-determined and women may not know about it or choose to access it. </p>
<p>Our research suggests health services may be fading away at a time when mothers are most vulnerable and at greater risk of death than in previous months. These support services are becoming less available just as babies are becoming more demanding and sleeping less.</p>
<p>This is also about the time when women may be going back to work or feeling the financial strain of not working. Relationships may be strained because of all these factors as well. And mental health or substance abuse issues exacerbate women’s vulnerability. </p>
<p>There’s a general attitude in society that new mothers need a lot of support but should really be getting on with it by nine months. We clearly need to take a closer look at the type and timing of support services we are providing new mothers.</p><img src="https://counter.theconversation.com/content/17254/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from the NHMRC and ARC</span></em></p><p class="fine-print"><em><span>Charlene Thornton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research we have just published shows the deaths of 48 of the 129 women in New South Wales who died during pregnancy or within a year of giving birth were due to suicide and trauma. It suggests mothers…Hannah Dahlen, Professor of Midwifery, Western Sydney UniversityCharlene Thornton, Post-doctoral Fellow in the School of Medicine, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.