Biomedical subjects

Stephanie Brown

Publications and source records attributed to Stephanie Brown.

18 recordsLinked to original sources

PubMed2006

The performance of the Edinburgh Postnatal Depression Scale in English speaking and non-English speaking populations in Australia.

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) has been widely used to assess maternal depression following childbirth in a range of English speaking countries, and increasingly also in translation in non-English speaking ones. It has performed satisfactorily in most validation studies, has proved easy to administer, is acceptable to women, and rates of depression in the range of 10-20% have been consistently found. METHODS: The performance of the EPDS was compared across different population samples in Australia: (i) Women born in Australia or in another English speaking country who completed the EPDS in English as part of the 1994 postal Survey of Recent Mothers (SRM) 6-7 months after birth (n = 1166); (ii) Women born in non-English speaking countries who also completed the EPDS in English in the same survey (n = 142); and (iii) Women born in Vietnam (n = 103), Turkey (n = 104) and the Philippines (n = 106) who completed the EPDS 6-9 months after birth in translation in the Mothers in a New Country Study (MINC) study (total n = 313). The pattern of item responses on the EPDS was assessed in various ways across the samples and internal reliability coefficients were calculated. Exploratory factor analyses were also conducted to assess the similarity in the factor solutions across the samples. RESULTS: The EPDS had good construct validity and item endorsement by women was similar across the samples. Internal reliability of the scale was also very satisfactory with Cronbach's alpha for each sample being > or = 8. Between 39 and 46% of the variance in each of the three main samples was accounted for by one principal factor 'depression' (6-7 items loading), with two supplementary factors 'loss of enjoyment' (2 items loading) and 'despair/self-harm' (2-3 items loading) accounting for a further 20-25% of the variance. Alternative one and two factor solutions also showed a great deal of consistency between the samples. CONCLUSIONS: The good item consistency of the EPDS and the relative stability of the factor patterns across the samples are indicative that the scale is understood and completed in similar ways by women in these different English speaking and non-English speaking population groups. With the proviso that careful translation processes and extensive piloting of translations are always needed, these findings lend further support to the use of the EPDS in cross-cultural research on depression following childbirth.

Adult↗

PubMed2006

Influence of salinity and organic matter on silver accumulation in Gulf toadfish (Opsanus beta).

To help extend the freshwater based biotic ligand model for silver (Ag) into brackish and saltwater conditions, 50g Gulf toadfish (Opsanus beta) were acclimated to 2.5%, 5%, 10%, 20%, 40%, 80%, or 100% salt water and exposed for 6d to 1.0microM AgNO(3), with or without 10mg C/L organic matter. Suwannee River natural organic matter collected by reverse osmosis was used. Silver accumulation in toadfish gills and plasma decreased as salinity increased, indicating low bioavailability of AgCl complexes. Complexation of Ag by organic matter, normally important in freshwater conditions, was less important as salinity increased. Although relatively little intestinal Ag uptake was observed, both liver and bile accumulated Ag from water imbibed past the isosmotic salinity point ( approximately 1/3 salt water). Toadfish also produced intestinal carbonate pellets, minerals which did not influence Ag accumulation. Our results further stress the importance of Ag speciation, physiological mechanisms, and intestinal Ag uptake when modelling Ag uptake and toxicity beyond freshwater conditions.

Animals↗

PubMed2006

PRISM (Program of Resources, Information and Support for Mothers): a community-randomised trial to reduce depression and improve women's physical health six months after birth [ISRCTN03464021].

BACKGROUND: In the year after birth one in six women has a depressive illness, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support, more negative life events, and poorer physical health and see factors contributing to depression as lack of support, isolation, exhaustion and physical health problems. Fewer than one in three seek help in primary care despite frequent health care contacts. METHODS: Primary care and community-based strategies embedded in existing services were implemented in a cluster-randomised trial involving 16 rural and metropolitan communities, pair-matched, within the State of Victoria, Australia. Intervention areas were also provided with a community development officer for two years. The primary aim was to reduce the relative risk of depression by 20% in mothers six months after birth and to improve their physical health. Primary outcomes were obtained by postal questionnaires. The analysis was by intention-to-treat, unmatched, adjusting for the correlated nature of the data. RESULTS: 6,248 of 10,144 women (61.6%) in the intervention arm and 5057/ 8,411 (60.1%) in the comparison arm responded at six months, and there was no imbalance in major covariates between the two arms. Women's mental health scores were not significantly different in the intervention arm and the comparison arm (MCS mean score 45.98 and 46.30, mean EPDS score 6.91 and 6.82, EPDS > or = 13 ('probable depression') 15.7% vs. 14.9%, Odds ratio(adj) 1.06 (95% CI 0.91-1.24). Women's physical health scores were not significantly different in intervention and comparison arms (PCS mean scores 52.86 and 52.88). CONCLUSION: The combined community and primary care interventions were not effective in reducing depression, or in improving the physical health of mothers six months after birth.

Adult↗

PubMed2006

Putting woman-centered care into practice: a new (ANEW) approach to psychosocial risk assessment during pregnancy.

BACKGROUND: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy. METHODS: ANEW used a before-and-after survey design to evaluate the effects of a 6-month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self-rated communication skills, and open-ended questions about participants' experience of the educational program. RESULTS: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program. CONCLUSIONS: The program increased the self-reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Adult↗

PubMed2005

Peer mentoring: a culturally sensitive approach to end-of-life planning for long-term dialysis patients.

BACKGROUND: This study is designed to explore the impact of peer mentoring on end-of-life decision making. METHODS: A controlled randomized intervention study with 203 patients from 21 dialysis centers across Michigan explored the impact of peer mentors, dialysis patients trained to help other patients, on end-of-life planning. RESULTS: Communicating information on advance directives (ADs) through peer mentoring significantly influenced the completion of ADs overall compared with distributing standard printed material or no specific designed intervention. However, the influence was most prominent among African Americans, not only increasing actual completion of ADs (P < 0.001) and comfort discussing ADs (P < 0.01), but also improving subjective well-being (P < 0.05) and anxiety (P < 0.05) during the study period. These effects of peer mentoring did not appear among white patients, although printed material on ADs decreased reported suicidal ideation (P < 0.05). CONCLUSION: These results suggest the importance of addressing specific cultural factors in the process of AD education. Common practice assumes that printed materials are effective in educating patients about health care and decision making. However, peer mentoring, a relationship-centered person-to-person approach, may be more effective in some cultural groups because it partakes of oral, rather than written, traditions. Acknowledging cultural differences and tailoring our approach could be powerful in enhancing trust and participation and decreasing potential disparities in health care outcomes.

Adult↗

PubMed2005

What is it about antenatal continuity of caregiver that matters to women?

BACKGROUND: Continuity of care and of caregiver are thought to be important influences on women's experience of maternity care. The aim of this study was to analyze the influence of two aspects of continuity of caregiver in the antenatal period on women's overall rating of antenatal care: the extent to which women saw the same caregiver throughout pregnancy, and the extent to which women thought that their caregiver knew and remembered them and their progress from one visit to the next. METHODS: An anonymous, population-based postal survey was conducted of 1,616 women who gave birth in a 14-day period in September 1999 in Victoria, Australia. Multivariate methods were used to analyze the data. RESULTS: Most women saw the same caregiver at each antenatal visit (77%), and thought that caregivers got to know them (65%). This finding varied widely among different models of maternity care. Before adjustment, women were much more likely to describe their antenatal care as very good if they always or mostly thought the caregiver got to know them (OR 5.86, 95% CI 4.3, 7.9), and if they always or mostly saw the same caregiver at each visit (OR 2.91, 95% CI 2.0, 4.3). Adjusting for sociodemographic factors, parity, risk status of the pregnancy, and several specific aspects of antenatal care revealed that seeing the same caregiver was no longer associated with rating of care (adjusted OR 0.65, 95% CI 0.3,1.2), but women who thought that caregivers got to know and remember them remained much more likely to rate their care highly (adjusted OR 3.18, 95% CI 2.0, 5.1). CONCLUSIONS: These findings suggest that changing the delivery of antenatal care to increase women's chances of seeing the same caregiver at each visit is not by itself likely to improve the overall experience of care, but time spent personalizing each encounter in antenatal care would be well received. The analysis also confirmed the importance that women place on quality interactions with their doctors and midwives.

Adolescent↗

PubMed2004

Influence of water chemistry and natural organic matter on active and passive uptake of inorganic mercury by gills of rainbow trout (Oncorhynchus mykiss).

To distinguish physiologically regulated uptake from passive uptake of inorganic Hg in fish, rainbow trout (Oncorhynchus mykiss) were exposed to inorganic Hg (0.5, 1, or 2 microM total Hg) in ion-poor water with various treatments. Addition of ions to the water (mM concentrations of Ca, K, Cl) did not consistently alter Hg accumulation by trout gills, although there was a trend to higher Hg accumulation at higher ion concentrations. The apical Ca channel blockers Verapamil and lanthanum also did not consistently affect Hg accumulation by trout gills. Pre-treatment of trout with the Na channel blocker Phenamil decreased Hg uptake by about half. These results suggest a combination of physiologically regulated and passive uptake of Hg by trout gills. Strong complexing agents of Hg (EDTA, NTA, ethylenediamine, cysteine) decreased Hg-binding by trout gills in a dose-dependent manner. From these data, a conditional equilibrium binding constant for Hg to the gills was estimated as logK(Hg-gill) = 18.0, representing very strong binding of Hg to the gills. This value is a first step in creating a biotic ligand model (BLM) for inorganic Hg and fish. Natural organic matter (2-10 mg C/L) also decreased Hg-binding by trout gills, although mM concentrations of Na, K, and Cl interfered with this effect. At low concentrations of these ions, natural organic matter samples isolated from various sources bound Hg to similar degrees, as judged by Hg accumulation by trout gills. A conditional binding constant to natural organic matter (NOM) was estimated as logK(Hg-NOM) = 18.0 with about 0.5 micromol binding sites per mg C, representing strong binding of Hg to NOM.

Amiloride↗

PubMed2004

Mounting a community-randomized trial: sample size, matching, selection, and randomization issues in PRISM.

This paper discusses some of the processes for establishing a large cluster-randomized trial of a community and primary care intervention in 16 local government areas in Victoria, Australia. The development of the trial in terms of design factors such as sample size estimates and the selection and randomization of communities to intervention or comparison is described. The intervention program to be implemented in Program of Resources, Information and Support for Mothers (PRISM) was conceived as a whole community approach to improving support for all mothers in the first 12 months after birth. A cluster-randomized trial was thus the design of choice from the outset. With a limited number of communities available, a matched-pair design with eight pairs was chosen. Sample size estimates, adjusting for the cluster randomization and the pair-matched design, showed that with eight pairs, on average, 800 women from each community would need to respond to provide sufficient power to determine a 3% reduction in the prevalence of maternal depression 6 months after birth-a reduction deemed to be a worthwhile impact of the intervention to be reliably detected at 80% power. The process of selecting suitable communities and matching them into pairs required careful collection of data on numbers of births, size of the local government areas (LGAs), and an assessment of the capacity of communities to implement the intervention. Ways of dealing with boundary issues associated with potential contamination are discussed. Methods for the selection of feasible configurations of sets of pairs and the ultimate allocation to intervention or comparison are provided in detail. Ultimately, all such studies are a balancing act between selecting the minimum number of communities to detect a meaningful outcome effect of an intervention and the maximum size budget and other resources allow.

Adult↗

PubMed2004

Early discharge: no evidence of adverse outcomes in three consecutive population-based Australian surveys of recent mothers, conducted in 1989, 1994 and 2000.

Length of postnatal hospital stay has declined dramatically since the 1970s, with ongoing controversy about potential harmful effects. Three population-based surveys of recent mothers conducted in the State of Victoria, Australia have been analysed to assess the impact of shorter length of stay on breast feeding and women's psychological well-being. Women giving birth in Victoria, Australia in 1 week in 1989, 2 weeks in 1993 and 2 weeks in 1999, excluding those who had a stillbirth or neonatal death, were mailed surveys 5-8 months postpartum. Adjusted response fractions were: 71.4% in 1989 (n = 790), 62.5% in 1994 (n = 1313), and 67% in 2000 (n = 1616). Participants were representative in terms of method of birth, parity and infant birthweight. Younger women, single women and women of non-English-speaking background (born outside Australia) were under-represented. The primary outcome measures were infant feeding at 6 weeks postpartum and maternal depression at 5-8 months postpartum (Edinburgh Postnatal Depression Scale > or = 13). There was no significant association between length of stay (1-2 days vs. > or = 5 days, 3-4 days vs. > or = 5 days) and primary outcome measures in univariable analyses of the 1989 Survey, or multivariable analyses of the 1994 and 2000 Surveys adjusting for relevant social and obstetric factors. For stays of 3-4 days, the adjusted odds ratio for formula feeding at 6 weeks was 1.35 [95% CI 0.9, 1.9] in 1994 and 1.22 [95% CI 0.9, 1.7] in 2000. The confidence intervals are compatible with a very small reduction or a large increase in formula feeding, neither reaching statistical significance. For depressive symptoms at 5-7 months postpartum (EPDS score > or = 13), the adjusted odds ratio for women staying 3-4 days was 0.96 [95% CI 0.7, 1.4] in 1994 and 0.90 [95% CI 0.6, 1.3] in 2000. These confidence intervals are compatible with a 30-40% reduction or a 30-40% increase in odds of depressive symptoms. Based on these findings shorter length of stay does not appear to have an adverse impact on breast feeding or women's emotional well-being. Testing early discharge policies in well-designed randomised trials remains a priority for developing stronger evidence to inform practice.

Adolescent↗

PubMed2004

PRISM: mounting a community-randomised trial. Establishing partnerships with local government.

This paper describes initial partnership development in PRISM (Program of Resources, Information and Support for Mothers), a community-randomised trial to improve maternal health in the first year after birth conducted in Victoria in the period 1998--2003. First, we discuss the principles underpinning community recruitment methods in PRISM that guided both our initial approaches to, and our continuing relationships with, communities. Second, we outline the strategies used to recruit communities and to establish the groundwork for ongoing partnerships over the projected six years of the study.

Community Health Services↗

PubMed2004

Maternity care with the women's business service at the Mildura Aboriginal Health Service.

OBJECTIVE: To assess and contrast views and experiences of women attending the Women's Business Service at the Mildura Aboriginal Health Service with those of rural women attending public maternity services who participated in a Victorian statewide survey conducted in 2000. METHODS: Face-to-face interviews were conducted with clients of the Women's Business Service (n=25) using a structured interview schedule based on the Victorian Survey of Recent Mothers 2000. Comparisons were made with rural women who had participated in the 2000 survey and had received public care for their pregnancy (n=333). RESULTS: Compared with rural participants in the 2000 survey, women who attended the Women's Business Service were significantly more likely to say care providers kept them informed (OR 20.63, 95% CI 3.27-853.75), midwives were never rushed during check-ups (OR 22.24, 95% CI 3.50-921.47), and to say they were happy with medical care (OR 5.79, 95% CI 1.68-30.67). Eighty per cent of interview participants described their antenatal care as 'very good'. Fewer women rated intrapartum care (64%) or postnatal hospital care (43%) as 'very good'. Compared with rural participants in the statewide survey, women attending the Women's Business Service were significantly more confident about looking after their baby in the first week at home (OR 9.08, 95% CI 2.95-37.01), and less likely to want additional help or advice (OR 0.21, 95% CI 0.04-0.73). CONCLUSIONS: Women using the Women's Business Service were significantly more positive about many aspects of their care than women attending other rural public maternity services. The study lends support to the view that Aboriginal community-controlled health services are well placed to provide appropriate and accessible care to Indigenous women.

Adult↗

PubMed2003

PRISM (Program of Resources, Information and Support for Mothers) Protocol for a community-randomised trial [ISRCTN03464021].

BACKGROUND: In the year after birth one in six women has a depressive illness, and 30% are still depressed, or depressed again, when their child is 2 years old, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support overall, more negative life events, and poorer physical health. Their perceptions of factors contributing to depression are lack of support, isolation, exhaustion and physical health problems. Fewer than one in three affected women seek help in primary care despite frequent contacts. METHODS/DESIGN: PRISM aims to reduce depression and physical health problems of recent mothers through primary care strategies to increase practitioners' response to these issues, and through community-based strategies to develop broader family and community supports for recent mothers. Eligible local governments will be recruited and randomised to intervention or comparison arms, after stratification (urban/rural, size, birth numbers, extent of community activity), avoiding contiguous boundaries. Maternal depression and physical health will be measured six months after birth, in a one year cohort of mothers, in intervention and comparison communities. The sample size to detect a 20% relative reduction in depression, adjusting for cluster sampling, and estimating a population response fraction of 67% is 5740 x 2. Analysis of the physical and mental health outcomes, by intention to treat, will adjust for the correlated structure of the data.

Adult↗

PubMed2003

The expression of methyl CpG binding factor MeCP2 correlates with cellular differentiation in the developing rat brain and in cultured cells.

Mutations in the MeCP2 gene cause Rett syndrome, a neurologic condition affecting primarily young girls. To gain insight into the normal function of MeCP2, we examined its temporal and spatial expression patterns, and immunoreactive prevalence, during late embryonic and perinatal brain development. MeCP2 mRNA was detected in most regions of the developing rat brain by the late embryonic stage. Regions displaying the strongest mRNA expression include the hippocampus, cortex, and cerebellum, and moderate expression was observed in most other brain regions. At the protein level, MeCP2 was strongly expressed in adult forebrain neurons, but was not detected in astrocytes. The nonubiquitous expression of MeCP2 was also observed in the embryonic cortex, as about one-third of acutely dissociated embryonic day 14 neuroepithelial cells failed to stain with MeCP2. To test whether MeCP2 expression correlates with neuronal differentiation, colocalization of MeCP2 expression with either the precursor cell marker nestin or the young neuronal marker beta-III tubulin was examined in the same acutely dissociated cortical cells. Although strong MeCP2 expression was detected in approximately 75% of beta-III tubulin-positive cells, only about 25% of nestin-positive precursor cells were MeCP2 positive. Further support for a correlation of MeCP2 expression with cell differentiation was observed in culture, where Western blot analysis during the in vitro differentiation of PC12, NG108-15, and SH-SY5Y cells revealed that MeCP2 levels increased as the cells acquired a more differentiated phenotype. This increase was associated with differentiation, as MeCP2 expression levels did not vary within different phases of the cell cycle. Taken together, these data support a role for MeCP2 in the establishment and/or maintenance of neuronal maturity.

Animals↗

PubMed2003

Satisfaction with team midwifery care for low- and high-risk women: a randomized controlled trial.

BACKGROUND: In 1996 a new model of maternity care characterized by continuity of midwifery care from early pregnancy through the postpartum period was implemented for women attending Monash Medical Centre, a tertiary level obstetric service, in Melbourne, Australia. This study's purpose was to assess the impact of this model on women's views and experiences of care during the antenatal, intrapartum, and postpartum periods compared with views of women receiving standard maternity care. METHODS: One thousand low- and high-risk women who booked at the antenatal clinic and met the eligibility criteria were randomly allocated to continuity of midwifery care from a group of seven midwives in collaboration with medical staff, or to standard care from a variety of midwives and medical staff. Women's views of care were measured by means of a postal questionnaire at four months after the birth. RESULTS: Team midwifery care was associated with increased satisfaction with antenatal, intrapartum, and some aspects of postpartum care. The differences were most obvious for antenatal care. CONCLUSIONS: Continuity of midwifery care is realistically achievable in a tertiary obstetric referral service and is associated with increased satisfaction.

Adult↗

PubMed2003

Evaluating innovations in maternity care: methodological approaches to a baseline postal survey.

BACKGROUND: A network of four public maternity hospitals in Melbourne, Australia, has implemented a range of initiatives aimed at improving maternity care. Comprehensive evaluation aims to determine whether or not the maternity service enhancement strategies have led to improvements in women's views and experiences of care. This paper discusses the baseline survey study design and methodological issues associated with the recruitment and reminder processes. METHOD: All women who gave birth over a 14-week period in 1999 at one of the four maternity units, except those who had a stillbirth or neonatal death, were invited to participate in the baseline postal survey. Questionnaires were sent to women at 3 months postpartum. A system of written and telephone reminders was instituted. RESULTS: The overall response fraction to the baseline survey was 65.2 percent (1256/1922). The sample was representative in terms of maternal age, method of birth, and infant birthweight. Women born overseas of non-English speaking background, single women, and women having their second or subsequent baby were underrepresented. CONCLUSIONS: The pleasing response fraction in part may be attributed to the method of recruitment and the reminder processes. Rigorous and careful approaches to methodology enhance study integrity and provide context to the interpretation of study findings.

Continuity of Patient Care↗

PubMed2003

Having a baby in Victoria 1989-2000: women's views of public and private models of care.

OBJECTIVE: To assess and contrast women's views of antenatal, intrapartum and postnatal care based on data collected in three state-wide surveys of recent mothers conducted in 1989, 1994 and 2000. METHODS: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth. RESULTS: 58.6% of women participating in the 1989 survey rated their antenatal care as 'very good' compared with 62.4% in 1994 and 66.5% in 2000 (chi 2 for trend = 15.01, p < 0.001). In all three surveys, women enrolled in public models of care were significantly more likely to rate their antenatal care as less than 'very good' than women enrolled in private models of care. More than two-thirds of the women in each survey rated their intrapartum care as 'very good' (1989-67%, 1994-71%, 2000-72%). Over the time period there was an improvement in the proportion of women rating their care as 'very good' among women in private care (chi 2 for trend = 33.1, p < 0.001), but no improvement was seen in public care. Only 52% (1994) and 51% (2000) of women rated their postnatal care as 'very good'. CONCLUSIONS: The conduct of three population-based surveys of recent mothers in Victoria over the past 10 years has provided valuable information for charting the impact of organisational changes on women's views and experiences of maternity care.

Birthing Centers↗

PubMed2002

Immigrant women's views about care during labor and birth: an Australian study of Vietnamese, Turkish, and Filipino women.

BACKGROUND: Few studies of immigrant women's views of maternity care in their new homelands have been conducted. In Victoria, Australia, approximately 1 woman in 7 giving birth was born overseas in a non-English speaking country. This paper examines the views of three groups of immigrant women about the care they received in hospital for the birth of their babies and compares the findings with a population-based statewide survey. METHODS: Mothers in a New Country was a study of 318 Vietnamese, Turkish, and Filipino women interviewed about their maternity care experiences by bicultural interviewers 6 months after giving birth in Melbourne, Australia. The interview schedule was adapted from the 1994 Victorian Survey of Recent Mothers, a population-based postal survey of 1336 women. RESULTS: Of the 3 groups, 27 percent of Vietnamese, 48 percent of Turkish, and 39 percent of Filipino women reported their care during labor and birth as "very good," figures significantly lower than for the statewide survey, in which 61 percent of women experiencing similar models of care described their care as "very good." This significant differential in views about care was also present for many individual aspects of care. In the current study of mothers in a new country, comments about aspects of care with which women were particularly happy and unhappy highlighted their appreciation of care that was safe, kind, supportive, and respectful, and conversely, illustrated how distressed women were when care failed to meet these basic standards. CONCLUSIONS: What immigrant women wanted from their maternity care proved to be extremely similar to what Australian-born women--and women the world over--want. Unfortunately, immigrant women were much less likely to experience care that gave them what they wanted.

Adult↗

PubMed2002

Having a baby in Victoria 1989-2000: continuity and change in the decade following the Victorian Ministerial Review of Birthing Services.

OBJECTIVE: To investigate changing patterns in the provision of maternity care in Victoria based on data collected in three statewide surveys conducted in 1989, 1994 and 2000. METHODS: Postal surveys were mailed to all women who gave birth in Victoria in one week in 1989, and in two weeks in 1993 and 1999, excluding those who had a stillbirth or neonatal death. Questionnaires were sent to women by hospitals and home birth practitioners 5-8 months after the birth. RESULTS: 71.4% of women (n = 790) returned completed surveys in 1989, 62.5% (n = 1,336) in 1994, and 67% (n = 1,616) in 2000. The proportion of women receiving public care increased from 41.1% in 1989 to 63.6% in 1999. Simultaneously, the proportion of women attending public hospital antenatal clinics decreased from 16.6% in 1989 to 8.7% in 1999. Shared care (15.8%) and combined care (29.2%), where women attend a GP or specialist obstetrician for all antenatal care and receive standard public intrapartum care in a public hospital, are now the most common models of public maternity care in Victoria. The proportion of women enrolled in public maternity care who had a known midwife caring for them in labour did not change significantly between 1993 and 1999 (34.9% vs. 30.3%, OR = 0.81 [0.7-1.0]). Sixty per cent of women had a midwife home visit after leaving hospital in 1999 compared with 23.8% in 1993. CONCLUSIONS: The conduct of three population-based surveys at regular intervals over the past 10 years highlights major changes in the organisation of maternity care in Victoria. Comparable information cannot be derived from routine data collections. The Victorian Surveys of Recent Mothers provide an important and unique mechanism for monitoring the impact of shifts in policy and practice over the past decade.

Adult↗