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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Half of Australians in aged care have depression. Psychological therapy could help
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While many people maintain positive emotional wellbeing as they age, around half of older Australians living in residential aged care have significant levels of depression. Symptoms such as low mood, lack of interest or pleasure in life and difficulty sleeping are common.
Rates of depression in aged care appear to be increasing, and without adequate treatment, symptoms can be enduring and significantly impair older adults’ quality of life.
But only a minority of aged care residents with depression receive services specific to the condition. Less than 3% of Australian aged care residents access Medicare-subsidised mental health services, such as consultations with a psychologist or psychiatrist, each year.
Cochrane AustraliaInstead, residents are typically prescribed a medication by their GP to manage their mental health, which they often take for several months or years. A recent study found six in ten Australian aged care residents take antidepressants.
While antidepressant medications may help many people, we lack robust evidence on whether they work for aged care residents with depression. Researchers have described “serious limitations of the current standard of care” in reference to the widespread use of antidepressants to treat frail older people with depression.
Given this, we wanted to find out whether psychological therapies can help manage depression in this group. These treatments address factors contributing to people’s distress and provide them with skills to manage their symptoms and improve their day-to-day lives. But to date researchers, care providers and policy makers haven’t had clear information about their effectiveness for treating depression among older people in residential aged care.
The good news is the evidence we published today suggests psychological therapies may be an effective approach for people living in aged care.
We reviewed the evidence
Our research team searched for randomised controlled trials published over the past 40 years that were designed to test the effectiveness of psychological therapies for depression among aged care residents 65 and over. We identified 19 trials from seven countries, including Australia, involving a total of 873 aged care residents with significant symptoms of depression.
The studies tested several different kinds of psychological therapies, which we classified as cognitive behavioural therapy (CBT), behaviour therapy or reminiscence therapy.
CBT involves teaching practical skills to help people re-frame negative thoughts and beliefs, while behaviour therapy aims to modify behaviour patterns by encouraging people with depression to engage in pleasurable and rewarding activities. Reminiscence therapy supports older people to reflect on positive or shared memories, and helps them find meaning in their life history.
The therapies were delivered by a range of professionals, including psychologists, social workers, occupational therapists and trainee therapists.
Cochrane AustraliaIn these studies, psychological therapies were compared to a control group where the older people did not receive psychological therapy. In most studies, this was “usual care” – the care typically provided to aged care residents, which may include access to antidepressants, scheduled activities and help with day-to-day tasks.
In some studies psychological therapy was compared to a situation where the older people received extra social contact, such as visits from a volunteer or joining in a discussion group.
What we found
Our results showed psychological therapies may be effective in reducing symptoms of depression for older people in residential aged care, compared with usual care, with effects lasting up to six months. While we didn’t see the same effect beyond six months, only two of the studies in our review followed people for this length of time, so the data was limited.
Our findings suggest these therapies may also improve quality of life and psychological wellbeing.
Psychological therapies mostly included between two and ten sessions, so the interventions were relatively brief. This is positive in terms of the potential feasibility of delivering psychological therapies at scale. The three different therapy types all appeared to be effective, compared to usual care.
However, we found psychological therapy may not be more effective than extra social contact in reducing symptoms of depression. Older people commonly feel bored, lonely and socially isolated in aged care. The activities on offer are often inadequate to meet their needs for stimulation and interest. So identifying ways to increase meaningful engagement day-to-day could improve the mental health and wellbeing of older people in aged care.
Some limitations
Many of the studies we found were of relatively poor quality, because of small sample sizes and potential risk of bias, for example. So we need more high-quality research to increase our confidence in the findings.
Many of the studies we reviewed were also old, and important gaps remain. For example, we are yet to understand the effectiveness of psychological therapies for people from diverse cultural or linguistic backgrounds.
Separately, we need better research to evaluate the effectiveness of antidepressants among aged care residents.
What needs to happen now?
Depression should not be considered a “normal” experience at this (or any other) stage of life, and those experiencing symptoms should have equal access to a range of effective treatments. The royal commission into aged care highlighted that Australians living in aged care don’t receive enough mental health support and called for this issue to be addressed.
While there have been some efforts to provide psychological services in residential aged care, the unmet need remains very high, and much more must be done.
The focus now needs to shift to how to implement psychological therapies in aged care, by increasing the competencies of the aged care workforce, training the next generation of psychologists to work in this setting, and funding these programs in a cost-effective way.
Tanya Davison, Adjunct professor, Health & Ageing Research Group, Swinburne University of Technology and Sunil Bhar, Professor of Clinical Psychology, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Blackberries vs Blueberries – Which is Healthier?
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Our Verdict
When comparing blackberries to blueberries, we picked the blackberries.
Why?
They’re both great! But the humble blackberry stands out (and is an example of “foods that are darker are often more nutrient-dense”).
In terms of macronutrients, they’re quite similar, being both berry fruits that are mostly water, but blackberries do have 2x the fiber (and for what it’s worth, 2x the protein, though this is a small number obviously), while blueberries have 2x the carbohydrates. An easy win for blackberries.
When it comes to vitamins, blackberries have notably more of vitamin A, B3, B5, B9, C, and E, as well as choline, while blueberries have a little more of vitamins B1, B2, and B6. A fair win for blackberries.
In the category of minerals, blackberries have a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. Blueberries are not higher in any minerals. Another easy win for blackberries.
Blueberries are famous for their antioxidants, but blackberries actually equal them. The polyphenolic content varies from one fruit to another, but they are both loaded with an abundance (thousands) of antioxidants, especially anthocyanins. Blackberries and blueberries tie in this category.
Adding up the sections makes for an easy, easy win for blackberries—but diversity is always best, so enjoy both!
Want to learn more?
You might like to read:
- Cherries vs Blueberries – Which is Healthier?
- Strawberries vs Cherries – Which is Healthier?
- Strawberries vs Raspberries – Which is Healthier?
- Goji Berries vs Blueberries – Which is Healthier?
Take care!
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Cooking for Longevity – by Nisha Melvani
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Before it gets to the recipes, this book kicks off with a lot of science (much more than is usual for even healthy-eating recipe books), demystifying more nutrients than most people think of on a daily basis, what they do and where to get them, and even how to enhance nutrient absorption.
As well as an up-front ingredients list, we additionally get not just meal planning advice in the usual sense of the word, but also advice on timing various aspects of nutrition in order to enjoy the best metabolic benefits.
The recipes themselves are varied and good. It’s rare to find a recipe book that doesn’t include some redundant recipes, and this one’s no exception, but it’s better to have too much information than too little, so it’s perhaps no bad thing that all potentially necessary bases are covered.
In terms of how well it delivers on the title’s promised “cooking for longevity” and the subtitle’s promised “boosting healthspan”, the science is good; very consistent with what we write here at 10almonds, and well-referenced too.
Bottom line: if you’d like recipes to help you live longer and more healthily, then this book has exactly that.
Click here to check out Cooking For Longevity, and cook for longevity!
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Type 2 Diabetic Foot Problems
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It’s Q&A Day!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Q: I’d like to know more about type 2 diabetic foot problems
You probably know that the “foot problems” thing has less to do with the feet and more to do with blood and nerves. So, why the feet?
The reason feet often get something like the worst of it, is because they are extremities, and in the case of blood sugars being too high for too long too often, they’re getting more damage as blood has to fight its way back up your body. Diabetic neuropathy happens when nerves are malnourished because the blood that should be keeping them healthy, is instead syrupy and sluggish.
We’ll definitely do a main feature sometime soon on keeping blood sugars healthy, for both types of diabetes plus pre-diabetes and just general advice for all.
In the meantime, here’s some very good advice on keeping your feet healthy in the context of diabetes. This one’s focussed on Type 1 Diabetes, but the advice goes for both:
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The Five Key Traits Of Healthy Aging
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The Five Keys Of Aging Healthily
Image courtesy of Peter Prato. This is Dr. Daniel Levitin. He’s a neuroscientist, and his research focuses on aging, the brain, health, productivity, and creativity. Also music, and he himself is an accomplished musician also, but we’re not going to be focusing on that today.
We’re going to be looking at the traits that, according to science, promote healthy longevity in old age. In other words, the things that increase our healthspan, from the perspective of a cognitive scientist.
What does he say we should do?
Dr. Levitin offers us what he calls the “COACH” traits:
- Curiosity
- Openness
- Associations
- Conscientiousness
- Healthy practices
By “associations”, he means relationships. However, that would have made the acronym “CORCH”, and decisions had to be made.
Curiosity
Leonardo da Vinci had a list of seven traits he considered most important.
We’ll not go into those today (he is not our featured expert of the day!), but we will say that he agreed with Dr. Levitin on what goes at the top of the list: curiosity.
- Without curiosity, we will tend not to learn things, and learning things is key to keeping good cognitive function in old age
- Without curiosity, we will tend not to form hypotheses about how/why things are the way they are, so we will not exercise imagination, creativity, problem-solving, and other key functions of our brain
- Without curiosity, we will tend not to seek out new experiences, and consequently, our stimuli will be limited—and thus, so will our brains
Openness
Being curious about taking up ballroom dancing will do little for you, if you are not also open to actually trying it. But, openness is not just a tag-on to curiosity; it deserves its spot in its own right too.
Sometimes, ideas and opportunities come to us unbidden, and we have to be able to be open to those too. This doesn’t mean being naïve, but it does mean having at least a position of open-minded skepticism.
Basically, Dr. Levitin is asking us to be the opposite of the pejorative stereotype of “an old person stuck in their ways”.
Associations
People are complex, and so they bring complexities to our lives. Hopefully, positively stimulating ones. Without them to challenge us (again, hopefully in a positive way), we can get very stuck in a narrow field of experience.
And of course, having at least a few good friends has numerous benefits to health. There’s been a lot of research on this; 5 appears to be optimal.
- More than that, and the depth tends to tail off, and/or stresses ensue from juggling too many relationships
- Fewer than that, and we might be only a calendar clash away from loneliness
Friends provide social stimulation and mutual support; they’re good for our mental health and even our physiological immunity (counterintuitively, by means of shared germs).
And, a strong secure romantic relationship is something that has been found time and again to extend healthy life.
Note: by popular statistics, this benefit is conferred upon men partnered with women, men partnered with men, women partnered with women, but not women partnered with men.
There may be a causative factor that’s beyond the scope of this article which is about cognitive science, not feminism, but there could also be a mathematical explanation for this apparent odd-one-out:
Since women tend to live longer than men (who are also often older than their female partners), women who live the longest are often not in a relationship—precisely because they are widows. So these long-lived widows will tend to skew the stats, through no fault of their husbands.
On the flipside of this, for a woman to predecease her (statistically older and shorter-lived) husband will often require that she die quite early (perhaps due to accident or illness unrelated to age), which will again skew the stats to “women married to men die younger”, without anything nefarious going on.
Conscientiousness
People who score highly in the character trait “conscientiousness” will tend to live longer. The impact is so great, that a child’s scores will tend to dictate who dies in their 60s or their 80s, for example.
What does conscientiousness mean? It’s a broad character trait that’s scored in psychometric tests, so it can be things that have a direct impact on health, such as brushing one’s teeth, or things that are merely correlated, such as checking one’s work for typos (this writer does her best!).
In short, if you are the sort of person who attends to the paperwork for your taxes on time, you are probably also the sort of person who remembers to get your flu vaccination and cancer screening.
Healthy practices
This means “the usual things”, such as:
- Healthy diet (Mediterranean Diet consistently scores up top)
- Good exercise (especially the tendency to keep moving in general)
- Good sleep (7–9 hours, no compromises)
- Not drinking (or at least only very moderate consumption, but the only safe amount is zero)
- Not smoking (just don’t; there is no wiggle room on this one)
Want to learn more?
You can check out his book, which we reviewed all so recently, and you can also enjoy this video, in which he talks about matters concerning healthy aging from a neuroscientist’s perspective, ranging from heart health and neurodegeneration, to the myth of failing memory, to music and lifespan and more:
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In the Realm of Hungry Ghosts – by Dr. Gabor Maté
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We’ve reviewed books by Dr. Maté before, and this one’s about addiction. We’ve reviewed books about addiction before too, so what makes this one different?
Wow, is this one so different. Most books about addiction are about “beating” it. Stop drinking, quit sugar, etc. And, that’s all well and good. It is definitely good to do those things. But this one’s about understanding it, deeply. Because, as Dr. Maté makes very clear, “there, but for the grace of epigenetics and environmental factors, go we”.
Indeed, most of us will have addictions; they’re (happily) just not too problematic for most of us, being either substances that are not too harmful (e.g. coffee), or behavioral addictions that aren’t terribly impacting our lives (e.g. Dr. Maté’s compulsion to keep buying more classical music, which he then tries to hide from his wife).
The book does also cover a lot of much more serious addictions, the kind that have ruined lives, and the kind that definitely didn’t need to, if people had been given the right kind of help—instead of, all too often, they got the opposite.
Perhaps the greatest value of this book is that; understanding what creates addiction in the first place, what maintains it, and what help people actually need.
Bottom line: if you’d like more insight into the human aspect of addiction without getting remotely wishy-washy, this book is probably the best one out there.
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