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.

“I have to be hard on myself,” Sarah told me in a recent telehealth psychology session. “I would never reach my potential if I was kind and let myself off the hook.”

I could empathise with this fear of self-compassion from clients such as Sarah (not her real name). From a young age, we are taught to be kind to others, but self-kindness is never mentioned.

Instead, we are taught success hinges on self-sacrifice. And we need a healthy inner critic to bully us forward into becoming increasingly better versions of ourselves.

But research shows there doesn’t have to be a trade-off between self-compassion and success.

Self-compassion can help you reach your potential, while supporting you to face the inevitable stumbles and setbacks along the way.

What is self-compassion?

Self-compassion has three key ingredients.

1. Self-kindness

This involves treating yourself with the same kindness you would extend towards a good friend – via your thoughts, feelings and actions – especially during life’s difficult moments.

For instance, if you find yourself fixating on a minor mistake you made at work, self-kindness might involve taking a ten-minute walk to shift focus, and reminding yourself it is OK to make mistakes sometimes, before moving on with your day.

2. Mindfulness

In this context, mindfulness involves being aware of your own experience of stress or suffering, rather than repressing or avoiding your feelings, or over-identifying with them.

Basically, you must see your stress with a clear (mindful) perspective before you can respond with kindness. If we avoid or are consumed by our suffering, we lose perspective.

3. Common humanity

Common humanity involves recognising our own experience of suffering as something that unites us as being human.

For instance, a sleep-deprived parent waking up (for the fourth time) to feed their newborn might choose to think about all the other parents around the world doing exactly the same thing – as opposed to feeling isolated and alone.

It’s not about day spas, or booking a manicure

When Sarah voiced her fear that self-compassion would prevent her success, I explained self-compassion is distinct from self-indulgence.

“So is self-compassion just about booking in more mani/pedis?” Sarah asked.

Not really, I explained. A one-off trip to a day spa is unlikely to transform your mental health.

Instead, self-compassion is a flexible psychological resilience factor that shapes our thoughts, feelings and actions.

It’s associated with a suite of benefits to our wellbeing, relationships and health.

What does the science say?

Over the past 20 years, we’ve learned self-compassionate people enjoy a wide range of benefits. They tend to be happier and have fewer psychological symptoms of distress.

Those high on self-compassion persevere following a failure. They say they are more motivated to overcome a personal weakness than those low on self-compassion, who are more likely to give up.

So rather than feeling trapped by your inadequacies, self-compassion encourages a growth mindset, helping you reach your potential.

However, self-compassion is not a panacea. It will not change your life circumstances or somehow make life “easy”. It is based on the premise that life is hard, and provides practical tools to cope.

It’s a factor in healthy ageing

I research menopause and healthy ageing and am especially interested in the value of self-compassion through menopause and in the second half of life.

Because self-compassion becomes important during life’s challenges, it can help people navigate physical symptoms (for instance, menopausal hot flushes), life transitions such as divorce, and promote healthy ageing.

I’ve also teamed up with researchers at Autism Spectrum Australia to explore self-compassion in autistic adults.

We found autistic adults report significantly lower levels of self-compassion than neurotypical adults. So we developed an online self-compassion training program for this at-risk population.

Three tips for self-compassion

You can learn self-compassion with these three exercises.

1. What would you say to a friend?

Think back to the last time you made a mistake. What did you say to yourself?

If you notice you’re treating yourself more like an enemy than a friend, don’t beat yourself up about it. Instead, try to think about what you might tell a friend, and direct that same friendly language towards yourself.

2. Harness the power of touch

Soothing human touch activates the parasympathetic “relaxation” branch of our nervous system and counteracts the fight or flight response.

Specifically, self-soothing touch (for instance, by placing both hands on your heart, stroking your forearm or giving yourself a hug) reduces cortisol responses to psychosocial stress.

3. What do I need right now?

Sometimes, it can be hard to figure out exactly what self-compassion looks like in a given moment. The question “what do I need right now” helps clarify your true needs.

For example, when I was 37 weeks pregnant, I woke up bolt awake one morning at 3am.

Rather than beating myself up about it, or fretting about not getting enough sleep, I gently placed my hands on my heart and took a few deep breaths. By asking myself “what do I need right now?” it became clear that listening to a gentle podcast/meditation fitted the bill (even though I wanted to addictively scroll my phone).

Lydia Brown, Senior Lecturer in Psychology, The University of Melbourne

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