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.

Research over the years has suggested intermittent fasting has the potential to improve our health and reduce the likelihood of developing cancer.

So what should we make of a new study in mice suggesting fasting increases the risk of cancer?

What is intermittent fasting?

Intermittent fasting means switching between times of eating and not eating. Unlike traditional diets that focus on what to eat, this approach focuses on when to eat.

There are lots of commonly used intermittent fasting schedules. The 16/8 plan means you only eat within an eight-hour window, then fast for the remaining 16 hours. Another popular option is the 5:2 diet, where you eat normally for five days then restrict calories for two days.

In Australia, poor diet contributes to 7% of all cases of disease, including coronary heart disease, stroke, type 2 diabetes, and cancers of the bowel and lung. Globally, poor diet is linked to 22% of deaths in adults over the age of 25.

Intermittent fasting has gained a lot of attention in recent years for its potential health benefits. Fasting influences metabolism, which is how your body processes food and energy. It can affect how the body absorbs nutrients from food and burns energy from sugar and fat.

What did the new study find?

The new study, published in Nature, found when mice ate again after fasting, their gut stem cells, which help repair the intestine, became more active. The stem cells were better at regenerating compared with those of mice who were either totally fasting or eating normally.

This suggests the body might be better at healing itself when eating after fasting.

However, this could also have a downside. If there are genetic mutations present, the burst of stem cell-driven regeneration after eating again might make it easier for cancer to develop.

Polyamines – small molecules important for cell growth – drive this regeneration after refeeding. These polyamines can be produced by the body, influenced by diet, or come from gut bacteria.

The findings suggest that while fasting and refeeding can improve stem cell function and regeneration, there might be a tradeoff with an increased risk of cancer, especially if fasting and refeeding cycles are repeated over time.

While this has been shown in mice, the link between intermittent fasting and cancer risk in humans is more complicated and not yet fully understood.

What has other research found?

Studies in animals have found intermittent fasting can help with weight loss, improve blood pressure and blood sugar levels, and subsequently reduce the risks of diabetes and heart disease.

Research in humans suggests intermittent fasting can reduce body weight, improve metabolic health, reduce inflammation, and enhance cellular repair processes, which remove damaged cells that could potentially turn cancerous.

However, other studies warn that the benefits of intermittent fasting are the same as what can be achieved through calorie restriction, and that there isn’t enough evidence to confirm it reduces cancer risk in humans.

What about in people with cancer?

In studies of people who have cancer, fasting has been reported to protect against the side effects of chemotherapy and improve the effectiveness of cancer treatments, while decreasing damage to healthy cells.

Prolonged fasting in some patients who have cancer has been shown to be safe and may potentially be able to decrease tumour growth.

On the other hand, some experts advise caution. Studies in mice show intermittent fasting could weaken the immune system and make the body less able to fight infection, potentially leading to worse health outcomes in people who are unwell. However, there is currently no evidence that fasting increases the risk of bacterial infections in humans.

So is it OK to try intermittent fasting?

The current view on intermittent fasting is that it can be beneficial, but experts agree more research is needed. Short-term benefits such as weight loss and better overall health are well supported. But we don’t fully understand the long-term effects, especially when it comes to cancer risk and other immune-related issues.

Since there are many different methods of intermittent fasting and people react to them differently, it’s hard to give advice that works for everyone. And because most people who participated in the studies were overweight, or had diabetes or other health problems, we don’t know how the results apply to the broader population.

For healthy people, intermittent fasting is generally considered safe. But it’s not suitable for everyone, particularly those with certain medical conditions, pregnant or breastfeeding women, and people with a history of eating disorders. So consult your health-care provider before starting any fasting program.

Amali Cooray, PhD Candidate in Genetic Engineering and Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)

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