Hazel Keedle, Western Sydney University and Hannah Dahlen, Western Sydney University

In theory, pregnant women in Australia can choose the type of health provider they see during pregnancy, labour and after they give birth. But this is often dependent on where you live and how much you can afford in out-of-pocket costs.

While standard public hospital care is the most common in Australia, accounting for 40.9% of births, the other main options are:

• GP shared care, where the woman sees her GP for some appointments (15% of births)
• midwifery continuity of care in the public system, often called midwifery group practice or caseload care, where the woman sees the same midwife of team of midwives (14%)
• private obstetrician care (10.6%)
• private midwifery care (1.9%).

Given the choice, which model would women prefer?

Our new research, published BMC Pregnancy and Childbirth, found women favoured seeing the same health provider throughout pregnancy, in labour and after they have their baby – whether that’s via midwifery group practice, a private midwife or a private obstetrician.

Assessing strengths and limitations

We surveyed 8,804 Australian women for the Birth Experience Study (BESt) and 2,909 provided additional comments about their model of maternity care. The respondents were representative of state and territory population breakdowns, however fewer respondents were First Nations or from culturally or linguistically diverse backgrounds.

We analysed these comments in six categories – standard maternity care, high-risk maternity care, GP shared care, midwifery group practice, private obstetric care and private midwifery care – based on the perceived strengths and limitations for each model of care.

Overall, we found models of care that were fragmented and didn’t provide continuity through the pregnancy, birth and postnatal period (standard care, high risk care and GP shared care) were more likely to be described negatively, with more comments about limitations than strengths.

What women thought of standard maternity care in hospitals

Women who experienced standard maternity care, where they saw many different health care providers, were disappointed about having to retell their story at every appointment and said they would have preferred continuity of midwifery care.

Positive comments about this model of care were often about a midwife or doctor who went above and beyond and gave extra care within the constraints of a fragmented system.

The model of care with the highest number of comments about limitations was high-risk maternity care. For women with pregnancy complications who have their baby in the public system, this means seeing different doctors on different days.

Some respondents received conflicting advice from different doctors, and said the focus was on their complications instead of their pregnancy journey. One woman in high-risk care noted:

The experience was very impersonal, their focus was my cervix, not preparing me for birth.

Why women favoured continuity of care

Overall, there were more positive comments about models of care that provided continuity of care: private midwifery care, private obstetric care and midwifery group practice in public hospitals.

Women recognised the benefits of continuity and how this included informed decision-making and supported their choices.

The model of care with the highest number of positive comments was care from a privately practising midwife. Women felt they received the “gold standard of maternity care” when they had this model. One woman described her care as:

Extremely personable! Home visits were like having tea with a friend but very professional. Her knowledge and empathy made me feel safe and protected. She respected all of my decisions. She reminded me often that I didn’t need her help when it came to birthing my child, but she was there if I wanted it (or did need it).

However, this is a private model of care and women need to pay for it. So there are barriers in accessing this model of care due to the cost and the small numbers working in Australia, particularly in regional, rural and remote areas, among other barriers.

Women who had private obstetricians were also positive about their care, especially among women with medical or pregnancy complications – this type of care had the second-highest number of positive comments.

This was followed by women who had continuity of care from midwives in the public system, which was described as respectful and supportive.

However, one of the limitations about continuity models of care is when the woman doesn’t feel connected to her midwife or doctor. Some women who experienced this wished they had the opportunity to choose a different midwife or doctor.

What about shared care with a GP?

While shared care between the GP and hospital model of care is widely promoted in the public maternity care system as providing continuity, it had a similar number of negative comments to those who had fragmented standard hospital care.

Considering there is strong evidence about the benefits of midwifery continuity of care, and this model of care appears to be most acceptable to women, it’s time to expand access so all Australian women can access continuity of care, regardless of their location or ability to pay.

Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University and Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Throughout recorded history, our hair and nails played an important role in signifying who we are and our social status. You could say, they separate the caveman from businessman.

It was no surprise then that many of us found a new level of appreciation for our hairdressers and nail artists during the COVID lockdowns. Even Taylor Swift reported she cut her own hair during lockdown.

So, what would happen if all this hair and nail grooming got too much for us and we decided to give it all up. Would our hair and nails just keep on growing?

The answer is yes. The hair on our head grows, on average, 1 centimeter per month, while our fingernails grow an average of just over 3 millimetres.

When left unchecked, our hair and nails can grow to impressive lengths. Aliia Nasyrova, known as the Ukrainian Rapunzel, holds the world record for the longest locks on a living woman, which measure an impressive 257.33 cm.

When it comes to record-breaking fingernails, Diana Armstrong from the United States holds that record at 1,306.58 cm.

Most of us, however, get regular haircuts and trim our nails – some with greater frequency than others. So why do some people’s hair and nails grow more quickly?

Remind me, what are they made out of?

Hair and nails are made mostly from keratin. Both grow from matrix cells below the skin and grow through different patterns of cell division.

Nails grow steadily from the matrix cells, which sit under the skin at the base of the nail. These cells divide, pushing the older cells forward. As they grow, the new cells slide along the nail bed – the flat area under the fingernail which looks pink because of its rich blood supply.

A hair also starts growing from the matrix cells, eventually forming the visible part of the hair – the shaft. The hair shaft grows from a root that sits under the skin and is wrapped in a sac known as the hair follicle.

This sac has a nerve supply (which is why it hurts to pull out a hair), oil-producing glands that lubricate the hair and a tiny muscle that makes your hair stand up when it’s cold.

At the follicle’s base is the hair bulb, which contains the all-important hair papilla that supplies blood to the follicle.

Matrix cells near the papilla divide to produce new hair cells, which then harden and form the hair shaft. As the new hair cells are made, the hair is pushed up above the skin and the hair grows.

But the papilla also plays an integral part in regulating hair growth cycles, as it sends signals to the stem cells to move to the base of the follicle and form a hair matrix. Matrix cells then get signals to divide and start a new growth phase.

Unlike nails, our hair grows in cycles

Scientists have identified four phases of hair growth, the:

1. anagen or growth phase, which lasts between two and eight years
2. catagen or transition phase, when growth slows down, lasting around two weeks
3. telogen or resting phase, when there is no growth at all. This usually lasts two to three months
4. exogen or shedding phase, when the hair falls out and is replaced by the new hair growing from the same follicle. This starts the process all over again.

Each follicle goes through this cycle 10–30 times in its lifespan.

If all of our hair follicles grew at the same rate and entered the same phases simultaneously, there would be times when we would all be bald. That doesn’t usually happen: at any given time, only one in ten hairs is in the resting phase.

While we lose about 100–150 hairs daily, the average person has 100,000 hairs on their head, so we barely notice this natural shedding.

So what affects the speed of growth?

Genetics is the most significant factor. While hair growth rates vary between individuals, they tend to be consistent among family members.

Nails are also influenced by genetics, as siblings, especially identical twins, tend to have similar nail growth rates.

But there are also other influences.

Age makes a difference to hair and nail growth, even in healthy people. Younger people generally have faster growth rates because of the slowing metabolism and cell division that comes with ageing.

Hormonal changes can have an impact. Pregnancy often accelerates hair and nail growth rates, while menopause and high levels of the stress hormone cortisol can slow growth rates.

Nutrition also changes hair and nail strength and growth rate. While hair and nails are made mostly of keratin, they also contain water, fats and various minerals. As hair and nails keep growing, these minerals need to be replaced.

That’s why a balanced diet that includes sufficient nutrients to support your hair and nails is essential for maintaining their health.

Nutrient deficiencies may contribute to hair loss and nail breakage by disrupting their growth cycle or weakening their structure. Iron and zinc deficiencies, for example, have both been linked to hair loss and brittle nails.

This may explain why thick hair and strong, well-groomed nails have long been associated with perception of good health and high status.

However, not all perceptions are true.

No, hair and nails don’t grow after death

A persistent myth that may relate to the legends of vampires is that hair and nails continue to grow after we die.

In reality, they only appear to do so. As the body dehydrates after death, the skin shrinks, making hair and nails seem longer.

Morticians are well aware of this phenomenon and some inject tissue filler into the deceased’s fingertips to minimise this effect.

So, it seems that living or dead, there is no escape from the never-ending task of caring for our hair and nails.

Michelle Moscova, Adjunct Associate Professor, Anatomy, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.