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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Somatic Exercises For Nervous System Regulation – by Rose Kilian
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We’ve written before about the vagus nerve, its importance, and how to make use of it, but it’s easy to let it slip from one’s mind when it comes to exercises. This book fixes that!
The promised 35 exercises are quite a range, and are organized into sections:
- Revitalizing through breath
- Stress and tension release
- Spinal and postural health
- Mindfulness and grounding
- Movements for flexibility
- Graceful balance and focus
While it’s not necessary to do all 35 exercises, it’s recommended to do at least some from each section, to “cover one’s bases”, and enjoy the best of all worlds.
The exercises are drawn from many sources, but tai chi and yoga are certainly the most well-represented. Others, meanwhile, are straight from physiotherapy or are things one might expect to be advised at a neurology consultation.
Bottom line: if you’d like to take better care of your vagus nerve, the better for it to take care of you, this book can certainly help with that.
Click here to check out Somatic Exercises For Nervous System Regulation, and take care of yourself!
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When Your Brain’s “Get-Up-And-Go” Has Got Up And Gone…
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Sometimes, there are days when the body feels heavy, the brain feels sluggish, and even the smallest tasks feel Herculean.
When these days stack up, this is usually a sign of depression, and needs attention. Unfortunately, when one is in such a state, taking action about it is almost impossible.
Almost, but not quite, as we wrote about previously:
The Mental Health First-Aid You’ll Hopefully Never Need ← this is about as close to true mental health bootstrapping as actually works
Today though, we’re going to assume it’s just an off-day or such. So, what to do about it?
Try turning it off and on again
Sometimes, a reboot is all that’s needed, and if napping is an option, it’s worth considering. However, if you don’t do it right, you can end up groggy and worse off than before, so do check out:
How To Be An Expert Nap-Artist (No More “Sleep Hangovers”!)
If your exhaustion is nevertheless accompanied by stresses that are keeping you from resting, then there’s another “turn it off and on again” process for that:
Fuel in the tank
Our brain is an energy-intensive organ, and cannot run on empty for long. Thus, lacking energy can sometimes simply be a matter of needing to supply some energy. Simple, no? Except, a lot of energy-giving foods can cause a paradoxical slump in energy, so here’s how to avoid that:
Eating For Energy (In Ways That Actually Work)
There are occasions when exhausted, when preparing food seems like too much work. If you’re not in a position to have someone else do it for you, how can you get “most for least” in terms of nutrition for effort?
Many of the above-linked items can help (a bowl of nuts and/or dried fruit is probably not going to break the energy-bank, for instance), but beyond that, there are other considerations too:
How To Eat To Beat Chronic Fatigue (While Chronically Fatigued) ← as the title tells, this is about chronic fatigue, but the advice therein definitely goes for acute fatigue also.
The lights aren’t on
Sometimes it may be that your body is actually fine, but your brain is working in a clunky fashion at best. Assuming there is no more drastic underlying cause for this, a lack of motivation is often as simple as a lack of appropriate dopamine response. When that’s the case…
Lacking Motivation? Science Has The Answer
If, instead, the issue is more serotonin-based than dopamine based, then green places with blue skies are ideal. Depending on geography and season, those things may be in short supply, but the brain is easily tricked with artificial plants and artificial sunlight. Is it as good as a walk in the park on a pleasant summer morning? Probably not, but it’s many times better than nothing, so get those juices flowing:
Neurotransmitter Cheatsheet ← four for the price of one, here!
Schedule time for rest, or your body/brain will schedule it for you
There’s a saying in the field of engineering that “if you don’t schedule time for maintenance, your equipment will schedule it for you”, and the same is true of our body/brain. If you’re struggling to get good quantity, here’s how to at least get good quality:
How To Rest More Efficiently (Yes, Really)
And, importantly,
7 Kinds Of Rest When Sleep Is Not Enough
Take care!
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A new emergency procedure for cardiac arrests aims to save more lives – here’s how it works
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
As of January this year, Aotearoa New Zealand became just the second country (after Canada) to adopt a groundbreaking new procedure for patients experiencing cardiac arrest.
Known as “double sequential external defibrillation” (DSED), it will change initial emergency response strategies and potentially improve survival rates for some patients.
Surviving cardiac arrest hinges crucially on effective resuscitation. When the heart is working normally, electrical pulses travel through its muscular walls creating regular, co-ordinated contractions.
But if normal electrical rhythms are disrupted, heartbeats can become unco-ordinated and ineffective, or cease entirely, leading to cardiac arrest.
Defibrillation is a cornerstone resuscitation method. It gives the heart a powerful electric shock to terminate the abnormal electrical activity. This allows the heart to re-establish its regular rhythm.
Its success hinges on the underlying dysfunctional heart rhythm and the proper positioning of the defibrillation pads that deliver the shock. The new procedure will provide a second option when standard positioning is not effective.
Using two defibrillators
During standard defibrillation, one pad is placed on the right side of the chest just below the collarbone. A second pad is placed below the left armpit. Shocks are given every two minutes.
Early defibrillation can dramatically improve the likelihood of surviving a cardiac arrest. However, around 20% of patients whose cardiac arrest is caused by “ventricular fibrillation” or “pulseless ventricular tachycardia” do not respond to the standard defibrillation approach. Both conditions are characterised by abnormal activity in the heart ventricles.
DSED is a novel method that provides rapid sequential shocks to the heart using two defibrillators. The pads are attached in two different locations: one on the front and side of the chest, the other on the front and back.
A single operator activates the defibrillators in sequence, with one hand moving from the first to the second. According to a recent randomised trial in Canada, this approach could more than double the chances of survival for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard shocks.
The second shock is thought to improve the chances of eliminating persistent abnormal electrical activity. It delivers more total energy to the heart, travelling along a different pathway closer to the heart’s left ventricle.
Evidence of success
New Zealand ambulance data from 2020 to 2023 identified about 1,390 people who could potentially benefit from novel defibrillation methods. This group has a current survival rate of only 14%.
Recognising the potential for DSED to dramatically improve survival for these patients, the National Ambulance Sector Clinical Working Group updated the clinical procedures and guidelines for emergency medical services personnel.
The guidelines now specify that if ventricular fibrillation or pulseless ventricular tachycardia persist after two shocks with standard defibrillation, the DSED method should be administered. Two defibrillators need to be available, and staff must be trained in the new approach.
Though the existing evidence for DSED is compelling, until recently it was based on theory and a small number of potentially biased observational studies. The Canadian trial was the first to directly compare DSED to standard treatment.
From a total of 261 patients, 30.4% treated with this strategy survived, compared to 13.3% when standard resuscitation protocols were followed.
The design of the trial minimised the risk of other factors confounding results. It provides confidence that survival improvements were due to the defibrillation approach and not regional differences in resources and training.
The study also corroborates and builds on existing theoretical and clinical scientific evidence. As the trial was stopped early due to the COVID-19 pandemic, however, the researchers could recruit fewer than half of the numbers planned for the study.
Despite these and other limitations, the international group of experts that advises on best practice for resuscitation updated its recommendations in 2023 in response to the trial results. It suggested (with caution) that emergency medical services consider DSED for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard treatment.
Training and implementation
Although the evidence is still emerging, implementation of DSED by emergency services in New Zealand has implications beyond the care of patients nationally. It is also a key step in advancing knowledge about optimal resuscitation strategies globally.
There are always concerns when translating an intervention from a controlled research environment to the relative disorder of the real world. But the balance of evidence was carefully considered before making the decision to change procedures for a group of patients who have a low likelihood of survival with current treatment.
Before using DSED, emergency medical personnel undergo mandatory education, simulation and training. Implementation is closely monitored to determine its impact.
Hospitals and emergency departments have been informed of the protocol changes and been given opportunities to ask questions and give feedback. As part of the implementation, the St John ambulance service will perform case reviews in addition to wider monitoring to ensure patient safety is prioritised.
Ultimately, those involved are optimistic this change to cardiac arrest management in New Zealand will have a positive impact on survival for affected patients.
Vinuli Withanarachchie, PhD candidate, College of Health, Massey University; Bridget Dicker, Associate Professor of Paramedicine, Auckland University of Technology, and Sarah Maessen, Research Associate, Auckland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Widen the Window – by Dr. Elizabeth Stanley
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Firstly, about the title… That “window” that the author bids us “widen” is not a flowery metaphor, but rather, is referring to the window of exhibited resilience to stress/trauma; the “window” in question looks like an “inverted U” bell-curve on the graph.
In other words: Dr. Stanley’s main premise here is that we respond best to moderate stress (i.e: in that window, the area under the curve!), but if there is too little or too much, we don’t do so well. The key, she argues, is widening that middle part (expanding the area under the curve) in which we perform optimally. That way, we can still function in a motivated fashion without extrinsic threats, and we also don’t collapse under the weight of overwhelm, either.
The main strength of this book, however, lies in its practical exercises to accomplish that—and more.
“And more”, because the subtitle also promised recovery from trauma, and the author delivers in that regard too. In this case, it’s about widening that same window, but this time to allow one’s parasympathetic nervous system to recognize that the traumatic event is behind us, and no longer a threat; we are safe now.
Bottom line: if you would like to respond better to stress, and/or recover from trauma, this book is a very good tool.
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Reverse Inflammation Naturally – by Dr. Michelle Honda
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This book is in some ways not as marketable as some; it doesn’t have lots of colorful healthy food on the cover; it doesn’t even have a “woman laughing alone with salad” (you know the stock photo trope), let alone someone looking glamorous in a labcoat with a stethoscope draped over their shoulder despite listening to hearts not being a regular part of their job as an immunologist or such.
What it does have, instead, is a lot of very useful information, and much more than you’ll usually find in a book for laypeople.
For example, you probably know that for fighting inflammation, a green salad is better than a cheeseburger, say, and a black coffee is better than a glass of wine.
But do you know about the roles, for good or ill, of prostaglandins and linoleic fats vs dietary fats? How about delta-6-desaturase? Neu5Gc and arachidonic acid?
Dr. Honda demystifies all of these and more, as well as talking about the impacts of very many foods and related habits on various different inflammation-based disease. And of course, almost all disease involves some kind of inflammation (making fighting inflammation one of the best things you can do for your overall disease-avoidance strategy!), but she singles out some of the most relevant, as per the list on the front cover.
She also talks a lot of “pharmacy in your kitchen”, in other words, what herbs, spices, and plant extracts we can enjoy for (evidence-based!) benefits on top of our default healthy diet free (or at least mostly free, for surely none of us are perfect) from inflammatory agents.
Not content with merely giving a huge amount of information, she also gives recipes and a meal plan, but honestly, it’s the informational chapters that are the real value of the book.
Bottom line: if you’d like to reduce your body’s inflammation levels (and/or perhaps those of a loved one for whom you cook), then this book will be an invaluable resource.
Click here to check out Reverse Inflammation Naturally, and reverse inflammation naturally!
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Gut-Healthy Tacos
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Full of prebiotics and probiotics, healthy fats, colorful salad boasting vitamins and minerals aplenty, and of course satisfying protein too, these tacos are also boasting generous flavors to keep you coming back for more…
You will need
- 24 sardines—canned is fine (if vegetarian/vegan, substitute tempeh and season generously; marinade if you have time)
- 12 small wholewheat tortillas
- 1 14oz/400g can black beans, drained
- 1 ripe avocado, stoned and cut into small chunks
- 1 red onion, thinly sliced
- 1 little gem lettuce, shredded
- 12 cherry tomatoes, halved
- 1 bulb garlic, crushed
- 1 lemon, sliced
- 4 tbsp plain unsweetened yogurt (your choice what kind, but something with a live culture is best)
- 3oz pickled jalapeños, roughly chopped
- 1oz cilantro (or substitute parsley if you have the cilantro-tastes-like-soap gene), finely chopped
- 1 tbsp extra virgin olive oil
- 2 tsp black pepper
- 1 tsp smoked paprika
- Juice of 1 lime
- Optional: Tabasco sauce, or similar hot sauce
Method
(we suggest you read everything at least once before doing anything)
1) Preheat your oven to a low temperature; 200℉ or just under 100℃ is fine
2) Place the lemon slices on top of the sardines on top of foil on a baking tray; you want the foil to be twice as much as you’d expect to need, because now you’re going to fold it over and make a sort of sealed envelope. You could use a dish with a lid yes, but this way is better because there’s going to be less air inside. Upturn the edges of the envelope slightly so that juices won’t run out, and make sure the foil is imperfectly sealed so a little steam can escape but not much at a time. This will ensure it doesn’t dry out, while also ensuring your house doesn’t smell of fish. Put all this into the oven on a middle shelf.
3) Mix the lime juice with the onion in a bowl, and add the avocado and tomatoes, mixing gently. Add half the cilantro, and set aside.
4) Put the black beans in a sieve and pour boiling water over them to refresh and slightly warm them. Tip them into a bowl and add the olive oil, black pepper, and paprika. Mix thoroughly with a fork, and no need to be gentle this time; in fact, deliberately break the beans a little in this case.
5) Mix the yogurt, jalapeños, garlic, and remaining cilantro in a small bowl.
6) Get the warmed sardines from the oven; discard the lemon slices.
7) Assemble! We recommend the order: tortilla, lettuce, fish (2 per taco), black bean mixture, salad mixture, garlic jalapeño yogurt mixture. You can also add a splash of the hot sauce per your preference, or if catering for more people, let people add their own.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- We Are Such Stuff As Fish Are Made Of
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Making Friends With Your Gut (You Can Thank Us Later)
- Our Top 5 Spices: How Much Is Enough For Benefits?
- Enjoy Pungent Polyphenols For Your Heart & Brain
Take care!
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