Women want to see the same health provider during pregnancy, birth and beyond
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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.
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How To Avoid Carer Burnout (Without Dropping Care)
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How To Avoid Carer Burnout
Sometimes in life we find ourselves in a caregiving role.
Maybe we chose it. For example, by becoming a professional carer, or even just by being a parent.
Oftentimes we didn’t. Sometimes because our own parents now need care from us, or because a partner becomes disabled.
Philosophical note: an argument could be made for that latter also having been a pre-emptive choice; we probably at some point said words to the effect of “in sickness and in health”, hopefully with free will, and hopefully meant it. And of course, sometimes we enter into a relationship with someone who is already disabled.
But, we are not a philosophy publication, and will henceforth keep to the practicalities.
First: are you the right person?
Sometimes, a caregiving role might fall upon you unasked-for, and it’s worth considering whether you are really up for it. Are you in a position to be that caregiver? Do you want to be that caregiver?
It may be that you do, and would actively fight off anyone or anything that tried to stop you. If so, great, now you only need to make sure that you are actually in a position to provide the care in question.
It may be that you do want to, but your circumstances don’t allow you to do as good a job of it as you’d like, or it means you have to drop other responsibilities, or you need extra help. We’ll cover these things later.
It may be that you don’t want to, but you feel obliged, or “have to”. If that’s the case, it will be better for everyone if you acknowledge that, and find someone else to do it. Nobody wants to feel a burden, and nobody wants someone providing care to be resentful of that. The result of such is two people being miserable; that’s not good for anyone. Better to give the job to someone who actually wants to (a professional, if necessary).
So, be honest (first with yourself, then with whoever may be necessary) about your own preferences and situation, and take steps to ensure you’re only in a caregiving role that you have the means and the will to provide.
Second: are you out of your depth?
Some people have had a life that’s prepared them for being a carer. Maybe they worked in the caring profession, maybe they have always been the family caregiver for one reason or another.
Yet, even if that describes you… Sometimes someone’s care needs may be beyond your abilities. After all, not all care needs are equal, and someone’s condition can (and more often than not, will) deteriorate.
So, learn. Learn about the person’s condition(s), medications, medical equipment, etc. If you can, take courses and such. The more you invest in your own development in this regard, the more easily you will handle the care, and the less it will take out of you.
And, don’t be afraid to ask for help. Maybe the person knows their condition better than you, and certainly there’s a good chance they know their care needs best. And certainly, there are always professionals that can be contacted to ask for advice.
Sometimes, a team effort may be required, and there’s no shame in that either. Whether it means enlisting help from family/friends or professionals, sometimes “many hands make light work”.
Check out: Caregiver Action Network: Organizations Near Me
A very good resource-hub for help, advice, & community
Third: put your own oxygen mask on first
Like the advice to put on one’s own oxygen mask first before helping others (in the event of a cabin depressurization in an airplane), the rationale is the same here. You can’t help others if you are running on empty yourself.
As a carer, sometimes you may have to put someone else’s needs above yours, both in general and in the moment. But, you do have needs too, and cannot neglect them (for long).
One sleepless night looking after someone else is… a small sacrifice for a loved one, perhaps. But several in a row starts to become unsustainable.
Sometimes it will be necessary to do the best you can, and accept that you cannot do everything all the time.
There’s a saying amongst engineers that applies here too: “if you don’t schedule time for maintenance, your equipment will schedule it for you”.
In other words: if you don’t give your body rest, your body will break down and oblige you to rest. Please be aware this goes for mental effort too; your brain is just another organ.
So, plan ahead, schedule breaks, find someone to take over, set up your cared-for-person with the resources to care for themself as well as possible (do this anyway, of course—independence is generally good so far as it’s possible), and make the time/effort to get you what you need for you. Sleep, distraction, a change of scenery, whatever it may be.
Lastly: what if it’s you?
If you’re reading this and you’re the person who has the higher care needs, then firstly:all strength to you. You have the hardest job here; let’s not forget that.
About that independence: well-intentioned people may forget that, so don’t be afraid to remind them when “I would prefer to do that myself”. Maintaining independence is generally good for the health, even if sometimes it is more work for all concerned than someone else doing it for you. The goal, after all, is your wellbeing, so this shouldn’t be cast aside lightly.
On the flipside: you don’t have to be strong all the time; nobody should.
Being disabled can also be quite isolating (this is probably not a revelation to you), so if you can find community with other people with the same or similar condition(s), even if it’s just online, that can go a very, very long way to making things easier. Both practically, in terms of sharing tips, and psychologically, in terms of just not feeling alone.
See also: How To Beat Loneliness & Isolation
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Practical Optimism – by Dr. Sue Varma
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We’ve written before about how to get your brain onto a more positive track (without toxic positivity), but there’s a lot more to be said than we can fit into an article, so here’s a whole book packed full with usable advice.
The subtitle claims “the art, science, and practice of…”, but mostly it’s the science of. If there’s art to be found here, then this reviewer missed it, and as for the practice of, well, that’s down to the reader, of course.
However, it is easy to use the contents of this book to translate science into practice without difficulty.
If you’re a fan of acronyms, initialisms, and other mnemonics (such as the rhyming “Name, Claim, Tame, and Reframe”), then you’ll love this book as they come thick and fast throughout, and they contribute to the overall ease of application of the ideas within.
The writing style is conversational but with enough clinical content that one never forgets who is speaking—not in the egotistical way that some authors do, but rather, just, she has a lot of professional experience to share and it shows.
Bottom line: if you’d like to be more optimistic without delving into the delusional, this book can really help a lot with that (in measurable ways, no less!).
Click here to check out Practical Optimism, and brighten up your life!
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Regular Nail Polish vs Gel Nail Polish – Which is Healthier?
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Our Verdict
When comparing regular nail polish to gel nail polish, we picked the regular.
Why?
This one’s less about what’s in the bottle, and more about what gets done to your hands:
- Regular nail polish application involves carefully brushing it on.
- Regular nail polish removal involves wiping with acetone.
…whereas:
- Gel nail polish application involves deliberately damaging (roughing up) the nail to allow the color coat to adhere, then when the top coat is applied, holding the nails (and thus, the attached fingers) under a UV light to set it. That UV lamp exposure is very bad for the skin.
- Gel nail polish removal involves soaking in acetone, which is definitely worse than wiping with acetone. Failure to adequately soak it will result in further damage to the nail while trying to get the base coat off the nail that you already deliberately damaged when first applying it.
All in all, regular nail polish isn’t amazing for nail health (healthiest is for nails to be free and naked), but for those of us who like a little bit of color there, regular is a lot better than gel.
Gel nail polish damages the nail itself by necessity, and presents a cumulative skin cancer risk and accelerated aging of the skin, by way of the UV lamp use.
For your interest, here are the specific products that we compared, but the above goes for any of this kind:
Regular nail polish | Gel nail polish
If you’d like to read more about nail health, you might enjoy reading:
The Counterintuitive Dos and Don’ts of Nail Health
Take care!
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11 Things That Can Change Your Eye Color
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Eye color is generally considered so static that iris scans are considered a reasonable security method. However, it can indeed change—mostly for reasons you won’t want, though:
Ringing the changes
Putting aside any wishes of being a manga protagonist with violet eyes, here are the self-changing options:
- Aging in babies: babies are often born with lighter eyes, which can darken as melanocytes develop during the first few months of life. This is similar to how a small child’s blonde hair can often be much darker by the time puberty hits!
- Aging in adults: eyes may continue to darken until adulthood, while aging into the elderly years can cause them to lighten due to conditions like arcus senilis
- Horner’s syndrome: a nerve disorder that can cause the eyes to become lighter due to loss of pigment
- Fuchs heterochromic iridocyclitis: an inflammation of the iris that leads to lighter eyes over time
- Pigment dispersion syndrome: the iris rubs against eye fibers, leading to pigment loss and lighter eyes
- Kayser-Fleischer rings: excess copper deposits on the cornea, often due to Wilson’s disease, causing larger-than-usual brown or grayish rings around the iris
- Iris melanoma: a rare cancer that can darken the iris, often presenting as brown spots
- Cancer treatments: chemotherapy for retinoblastoma in children can result in lighter eye color and heterochromia
- Medications: prostaglandin-based glaucoma treatments can darken the iris, with up to 23% of patients seeing this effect
- Vitiligo: an autoimmune disorder that destroys melanocytes, mostly noticed in the skin, but also causing patchy loss of pigment in the iris
- Emotional and pupil size changes: emotions and trauma can affect pupil size, making eyes appear darker or lighter temporarily by altering how much of the iris is visible
For more about all these, and some notes about more voluntary changes (if you have certain kinds of eye surgery), enjoy:
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Want to learn more?
You might also like to read:
Understanding And Slowing The Progression Of Cataracts
Take care!
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Exercise and Fat Loss (5 Things You Need To Know)
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It’s easy to think “I’ll eat whatever; I can always burn it off later”, and if it’s an odd occasion, then that’s fine; indeed, a fit and healthy body can usually weather small infrequent dietary indiscretions easily. But…
You can’t outrun a bad diet
Exercise can create a calorie deficit, but over time, the body balances this out by adjusting one’s metabolism, leading to a plateau in fat loss—and as you might know, you can’t out-exercise a bad diet. On the contrary, dietary adjustments are crucial for fat loss and body recomposition.
About that calorie deficit in the first place, by the way: extreme calorie deficits through exercise alone can lead to muscle loss, reduced energy, and thus sabotage long-term fat loss because having muscle mass increases one’s base metabolic rate (while having fat does not).
Another thing to bear in mind about exercise is that longer workouts without adequate rests in between can cause burnout, injury, or weight gain due to the body doing its best to conserve energy.
So, a good diet is a necessary condition for both muscle maintenance and fat loss.
Five Key Diet Tips:
- Include foods you love: don’t feel obliged cut out favorite foods that are a little unhealthy; incorporate them in moderation for sustainability.
- Keep adjustments small: avoid making drastic dietary changes all at once; make gradual tweaks to prevent feeling deprived.
- Prioritize protein: focus on including a protein source in every meal to increase satiety and aid in muscle building.
- Avoid low-calorie diets: drastically cutting calories can lead to muscle loss, metabolic adaptation, and overeating.
- Embrace diet evolution: changes may not feel sustainable at first, but adjustments over time help achieve long-term balance. You can always “adjust course” as you go.
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
Are You A Calorie-Burning Machine?
Take care!
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Quinoa vs Couscous – Which is Healthier?
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Our Verdict
When comparing quinoa to couscous, we picked the quinoa.
Why?
Firstly, quinoa is the least processed by far. Couscous, even if wholewheat, has by necessity been processed to make what is more or less the same general “stuff” as pasta. Now, the degree to which something has or has not been processed is a common indicator of healthiness, but not necessarily declarative. There are some processed foods that are healthy (e.g. many fermented products) and there are some unprocessed plant or animal products that can kill you (e.g. red meat’s health risks, or the wrong mushrooms). But in this case—quinoa vs couscous—it’s all borne out pretty much as expected.
For the purposes of the following comparisons, we’ll be looking at uncooked/dry weights.
In terms of macros, quinoa has a little more protein, slightly lower carbs, and several times the fiber. The amino acids making up quinoa’s protein are also much more varied.
In the category of vitamins, quinoa has more of vitamins A, B1, B2, B6, and B9, while couscous boasts a little more of vitamins B3 and B5. Given the respective margins of difference, as well as the total vitamins contained, this category is an easy win for quinoa.
When it comes to minerals, this one’s not even more clear. Quinoa has a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Couscous, meanwhile has more of just one mineral: sodium. So, maybe not one you want more of.
All in all, today’s is an easy pick: quinoa!
Want to learn more?
You might like to read:
- Carbohydrate Mythbusting: Should You Go Light Or Heavy On Carbs?
- What’s The Real Deal With The Paleo Diet?
- Gluten Mythbusting: What’s The Truth? ← we didn’t mention it above, but couscous is by default gluten-free, and couscous, being made of wheat, is by default not gluten-free, which may be another reason for some to choose quinoa
Take care!
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