Biomedical subjects

Stephanie J Brown

Publications and source records attributed to Stephanie J Brown.

5 recordsLinked to original sources

PubMed2006

Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy.

BACKGROUND: In the first year after childbirth, 94% of women experience one or more major health problems (urinary incontinence, faecal incontinence, perineal pain, back pain). Difficulties in intimate partner relationships and changes affecting sexual health are also common. The aim of this study is to investigate changes in women's health from early pregnancy until four years after the birth of a first child. METHODS/DESIGN: The Maternal Health Study is a longitudinal study designed to fill in some of the gaps in current research evidence regarding women's physical and psychological health and recovery after childbirth. A prospective pregnancy cohort of >1500 nulliparous women has been recruited in early pregnancy at six metropolitan public hospitals in Melbourne, Australia between April 2003 and December 2005. In the first phase of the study participants are being followed up at 30-32 weeks gestation in pregnancy, and at three, six, nine, 12 and 18 months postpartum using a combination of self-administered questionnaires and telephone interviews. Women consenting to extended follow-up (phase 2) will be followed up six and 12 months after any subsequent births and when their first child is four years old. Study instruments incorporate assessment of the frequency and severity of urinary and bowel symptoms, sexual health issues, perineal and abdominal pain, depression and intimate partner violence. Pregnancy and birth outcome data will be obtained by review of hospital case notes. DISCUSSION: Features of the study which distinguish it from prior research include: the capacity to identify incident cases of morbidity and clustering of health problems; a large enough sample to detect clinically important differences in maternal health outcomes associated with the method of birth; careful exposure measurement involving manual abstraction of data from medical records in order to explore mediating factors and possible causal pathways; and use of a variety of strategies to improve ascertainment of health outcomes.

Journal Article↗

PubMed2006

Use of periconceptional folic acid supplements in Victoria and New South Wales, Australia.

OBJECTIVES: To determine the proportion of women who took folate supplementation prior to conception and in the first three months of pregnancy and/or increased folate dietary intake; to determine how folate supplementation varied with socio-demographic factors; and to describe the ways women had seen or heard about folate prior to pregnancy. METHODS: Two population-based surveys were used: the Victorian Survey of Recent Mothers 2000 and the 2001 NSW Child Health Survey. RESULTS: Thirty-six per cent of women in Victoria reported taking periconceptional folate supplements compared with 46% in NSW. In Victoria, 8%, and in NSW, 28% of women had increased dietary folate intake. In both surveys younger women, women with less education, less income, of non-English speaking background and women who were not married were less likely to take folate supplements in the recommended period. In Victoria, multiparous women were significantly less likely to take supplements. In NSW, women with an unplanned pregnancy and those living in rural areas were significantly less likely to take periconceptional folate supplements. Fifty-three per cent of women cited a general practitioner or obstetrician as a source of folate information and 45% cited family or friends; both of these sources were significantly associated with periconceptional folate supplementation. CONCLUSIONS: Less than 50% of women took periconceptional folate supplements. Among socially disadvantaged groups, the proportion was significantly lower. IMPLICATIONS: Since women are unlikely to achieve adequate folate intake periconceptionally without deliberate action, there remains the need for a multifaceted approach to providing women with information about folate. Future surveys are needed to monitor usage and knowledge.

Adolescent↗

PubMed2006

Future directions for Victoria's public maternity services: is this "what women want"?

BACKGROUND: Several state governments are once again reviewing policies for the provision of maternity care. This paper presents findings from a state-wide Victorian survey of recent mothers conducted in 2000 regarding women's experiences of antenatal care. We also offer some reflections on the way in which results from this and earlier Victorian surveys have been used, somewhat selectively, to support the State Government's new framework for maternity services, while other issues highlighted in the survey results have been overlooked. DESIGN: Population-based postal survey mailed to Victorian women who gave birth in a 2-week period in September 1999, 5-6 months after childbirth. RESULTS: 42% of women attending a public hospital clinic described their antenatal care as "very good" compared with 73% of women attending a birth centre, 59% attending private practitioners for antenatal care but receiving public intrapartum care (combined care), 56% attending a midwives clinic, 53% receiving shared care and 84% of women receiving private maternity care. The social characteristics of women enrolling in different models of care do not explain these differences. Immigrant women were much less likely to be happy with their care in pregnancy than Australian-born women, with no improvement in ratings of care over more than a decade.

Adolescent↗

PubMed2005

Women's views and experiences of postnatal hospital care in the Victorian Survey of Recent Mothers 2000.

OBJECTIVE: To investigate the views and experiences of postnatal hospital care of a representative sample of Victorian women who gave birth in Victoria, Australia, in 1999. DESIGN: Postal survey sent to women 5-6 months after giving birth. SETTING: Victoria, Australia. PARTICIPANTS: 1616 women who gave birth in Victoria in a 2-week period in September 1999. FINDINGS: 50.8% of women described their postnatal care in hospital as 'very good'. After adjusting for parity, method of birth, length of stay, model of care and socio-demographic characteristics, specific aspects of care with the greatest negative impact on the overall rating of postnatal care were as follows: midwives perceived as rushed and too busy (adjusted OR = 4.59 [95% CI 3.4-6.1]), doctors and midwives perceived as not 'always' sensitive and understanding (adjusted OR = 3.88 [2.8-5.5]), support and advice about going home not 'very helpful' (adjusted OR = 3.18 [2.3-4.5]), help and advice about baby feeding not 'extremely helpful' (adjusted OR = 3.27 [2.1-5.1]), not being given advice about baby feeding (adjusted OR = 2.84 [1.2-6.9]). Staying in hospital only 1-2 days (adjusted OR=2.00 [1.2-3.4]), and not knowing any of the midwives in the postnatal ward (adjusted OR = 1.80 [1.3-2.4]) were also associated with less positive ratings of postnatal hospital care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The 2000 Survey shows that women rate early postnatal care in hospital far less favourably than care in pregnancy, labour and birth. The findings indicate that interactions with caregivers are a major influence on women's overall rating of postnatal hospital care. Acting on these findings requires a greater focus on communication and listening skills, attention to staffing levels, and leadership promoting more women-centred care in postnatal wards.

Adolescent↗

PubMed1998

Communication and decision-making in labour: do birth plans make a difference?

OBJECTIVES: To assess usage of birth plans, and examine differences in social and obstetric characteristics, and intrapartum experiences of women who did and did not use a birth plan. DESIGN: Population-based survey distributed by hospitals and home birth practitioners, 6-7 months post-natally. SETTING AND PARTICIPANTS: Women who gave birth in Victoria, Australia over a 2-week period in September, 1993, excluding those who had a stillbirth or neonatal death. MAIN OUTCOME MEASURES: Use of a written birth plan; perceived helpfulness, advantages and disadvantages of birth plans; relationship between use of birth plans and overall rating of intrapartum care, and involvement in decision-making. RESULTS: Twenty per cent of women (270/1336) had prepared a written birth plan and discussed it with caregivers. Women who made use of a birth plan were more likely to be satisfied with pain relief (OR = 1.74[1.3-2.3]), but did not differ from women not completing a birth plan in terms of their overall rating of intrapartum care, or involvement in making decisions about their care. CONCLUSIONS: The lack of association between use of a written birth plan and variables assessing women's views of intrapartum care suggest there are insufficient grounds for continuing to advocate a policy of encouraging pregnant women to complete written birth plans, unless it is within the context of a well-designed randomized trial able to provide further evidence regarding their effectiveness.

Journal Article↗