Health Times September edition

September 2016

Midwifery Feature + Complementary therapies empower parents through childbirth + Canberra trials publicly-funded home births + Step forward in midwifery gender equity dispute + Dietitians key to tackling obesity in pregnancy

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Health Centre Managers PN 1201/1301/1601

Remuneration package $156,494 – $176,947 Sunrise Health Service Aboriginal Corporation (SHSAC) takes a broad view of primary health care, and has a philosophy of community participation, and a strong focus on care coordination.

The Health Centre Manger will have a strong coordination and facilitation role that incorporates a bio-psychosocial approach which includes: • Work in collaboration with local Board Directors, Community Health Committee (CHC) members, senior community mentors and Aboriginal Health Practitioners (AHP), to identify health priorities and community driven solutions • Build the capacity of AHP’s and other Indigenous staff to provide the highest possible standard of culturally appropriate health care • Act as the coordination point for local and town based health program service delivery • Work in close collaboration with other organisations and departments, both internal and external to Sunrise to achieve optimal health service delivery outcomes • Manage all aspects of the day to day operation of the Health Centre including forward planning, program portfolio management, planning and coordination of all staff, pharmacy management, asset management and impress stock control • Working with other stakeholders as and where required to provide high level accident, emergency and comprehensive primary health care The organisation is ISO 9001 accredited and our remote health centres are AGPAL accredited, so an understanding of the CQI process is important.

Applications are sought from health professionals with experience in delivering primary health care services in remote Indigenous communities, to carry out professional practices in line with Sunrise clinical procedures and treatment protocols detailed in the CARPA Standard Treatment Manuals, and work in partnership with other health professionals to ensure a multi-disciplinary approach to health care.

Benefits: • 3/4 TOILS (Travel out of Isolated lands) per year • 6 weeks Leave per year • Up to 10 days study leave • Salary packaging options up to $15,899 per packaging year • Relocation and repatriation • Subsidised Housing, power and telephone Applicants must address the Selection Criteria (As contained in the Position Profile) MUST have a current Manual Drivers Licence, Criminal History Check & Working with Children Clearance, or the ability to obtain.

Applications close COB 14th September, 2016 The Position Profile is available on careers section of our website www.sunrise.org.au For further information contact Human Resources on PH: 08 8971 9500.

Send Applications “In Confidence” to HR Manager, Sunrise Health Service, PO Box 1696, Katherine NT 0851 or Fax: 08 8971 2511 or to: hr@sunrise.org.au Indigenous people are strongly encouraged to apply. Sunrise Health Service is an equal opportunity employer. We maintain a strong No Smoking Policy. Providing primary health care services to remote communities East of Katherine Bulman, Jilkminggan, Manyallaluk, Mataranka, Minyerri, Ngukurr, Weemol, Wugularr, Urapunga

ABN: 26 778 213 582 ICN: 4170

SUNRISE

HEALTH SERVICE Page 02| www.HealthTimes.com.au

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HealthTimes - August 2016 | Page 07

Dietitians key to tackling obesity in pregnancy

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regional Victorian health service is using dietetic intervention to combat obesity in pregnancy and excessive gestational weight gain.

With maternal obesity linked to an increased risk of birth complications, from gestational diabetes to macrosomia, caesarean section and diabetes in later life, West Gippsland Healthcare Group introduced the Positive Pregnancy Program (PPP) in 2010, as a cost-effective approach to optimising gestational weight gain.

A review of the program, featuring data analysis from 174 participants, reveals a major decline in participants’ gestational weight gain (3.6kg on average) compared to previous pregnancies (14kg on average).

Women who attended three or more appointments with a dietitian gained significantly less weight than those who attended just the initial dietetic assessment.

Rates of caesarean delivery among participants were less than those of obese Australian women in other studies (30.5 per cent compared to 48.7 per cent). The group’s rate was also equal to the general Australian population (at 30.9 per cent).

Obesity in pregnancy and excessive gestational weight gain not only poses health risks for mothers and their babies, it’s also an issue for hospitals, particularly for rural health services with weight restrictions.

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Accredited Practising Dietitian (APD) Nicole Robertson, a senior dietitian at Warragul’s West Gippsland Healthcare who presented research on the initiative at the Dietitians Association of Australia’s (DAA) National Conference this year, says pregnant women accessing the regional health service who exceed a Body Mass Index (BMI) of more than 50 are required to be transferred to a metropolitan hospital for their labour and birth.

Ms Robertson says the health service’s PPP initiative refers women with a prepregnancy BMI of 35kg/m2 and over for individual assessment and counselling with a dietitian, followed with ongoing reviews every four to six weeks.

The dietary education provided is based on the Australian Guide to Healthy Eating. It focuses on promoting nutritional adequacy in pregnancy and gestational weight gain in line with the current guidelines.

Gestational weight gain targets follow Institute of Medicine (IOM) guidelines, which recommend a target of five to nine kilograms for obese women with a BMI of 30kg/m2.

Women with a BMI of 40kg/m2 are encouraged to maintain their weight or lose up to 4kg, in line with individual obstetric recommendations and previous guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

For the full article visit HealthTimes.com.au

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Midwifery Jobs With Monash Health Monash Women’s maternity service is the largest maternity provider in Victoria providing care to over 9,500 women each year across three hospitals: Monash Medical Centre, Dandenong and Casey.

Monash Women’s Maternity Services are currently seeking highly motivated professional midwives to join our teams in any of our three facilities. All teams have a shared leadership (midwife and obstetrician) to provide a comprehensive collaborative approach to pregnancy, birth and postnatal care. This integrated service structure provides one of Australia’s safest levels of maternity care. You would be working in an environment where ongoing learning and research are fundamental.

If you are a midwife who wants to work within their full scope of practice together with women then this is the opportunity you’ve been looking for!

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HealthTimes - August 2016 | Page 13

Step forward in midwifery gender equity dispute

By Karen Keast New Zealand’s largest equal pay challenge will now head to mediation.

The New Zealand College of Midwives (NZCOM) has accepted an eleventh hour Ministry of Health offer to have its case heard in mediation instead of court.

The College filed a statement of claim in the High Court in 2015 against the government’s Ministry of Health, alleging its pay levels breach gender rules under the New Zealand Bill of Rights Act.

In its landmark claim, the College alleged the inadequate remuneration of about 1000 self-employed, community-based Lead Maternity Carer (LMC) midwives was based on gender discrimination.

The College launched the legal battle to ensure midwifery remains an attractive career choice which is financially sustainable, with remuneration reflecting the value of midwifery-provided services.

Despite the move to mediation, the case, which was due to be heard in the Wellington High Court this month, was adjourned instead of being withdrawn, allowing the College to proceed to court if the parties fail to reach an agreement within three months.

NZCOM chief executive Karen Guilliland said it’s the first time the College has received “an unencumbered offer” to discuss and negotiate with executive government decision-makers.

“This new offer is a real breakthrough.

We were prepared to go to court because it seemed we had no alternative,” she said.

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“We had made numerous attempts to have serious discussions with the Ministry of Health over conditions and pay equity but had got nowhere.”

Ms Guilliland said pay parity will remain at the centre of the negotiations.

Discussions with the Ministry would not have occurred without the College taking its claims action to the High Court, she said.

“We are not a union, we are not litigators, we are midwives caring for women and their babies and we want to be able to continuing doing just that within a safe and sustainable maternity service.”

New Zealand women have a choice of where they give birth. The LMC midwife works with women and provides care in the woman’s choice of birth place.

In 2015, there were 61,036 births up from the 57,242 births registered in 2014.

The number of women registering for LMC has increased to 50,878, while the number of women registered with a general practitioner has fallen from 6,902 in 1999 to just 261 last year.

The College, which represents more than 3100 members, claims midwives are being discriminated against on the basis of gender, as their pay and conditions have failed to keep pace with that of traditionally male-dominated professions with similar levels of education and responsibility.

In 2015, the average taxable income of an LMC midwife, after business expenses, stood at $58,239.

For more articles visit HealthTimes.com.au

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Ngaanyatjarra Health Service (NHS) is an Aboriginal Community Controlled Health Service providing primary and preventative health care to 11 communities in the Central Desert region of WA. We are seeking expressions of interest from medical professionals:

• Remote Area Nurses • Remote Outreach Midwives • Remote Child Health Nurses • Personal Care Assistants We have: • Highly attractive remuneration including salary packaging • Six weeks annual leave plus 4 weeks availability leave, plus 8 days travel per annum for permanent Staff • Financial support towards your Continuing Professional Development after 12 months • Comfortable, furnished, air conditioned accommodation • 4WD vehicle provided for travel within the Ngaanyatjarra Lands for work purposes • Flights to and from Ngaanyatjarra Lands provided Requirements: • Registration with AHPRA • Primary health care experience • Able to have or gain National Police Clearance and Working with Children documentation • Recent remote nursing experience will be highly regarded TO APPLY Email: recruitment@nghealth.org.au

HealthTimes - August 2016 | Page 15

Canberra trials publicly-funded home births Canberra women will soon have the option of a publicly-funded home birth.

The ACT Health Publicly Funded Homebirth Service will provide one to two home births a month, or up to 24 a year, for low-risk pregnant women who live within a 30 minute radius of the Centenary Hospital for Women and Children.

Applications for the three-year trial, delivered through the Canberra Midwifery Program, will open in October with the first home births expected in February.

Professor of Midwifery Deborah Davis, who holds a joint appointment with the University of Canberra and ACT Health, said Canberra women will now have another choice.

“Women need to be able to have the sort of birth experiences that are right for them and, for some women, home is the place that they want to have their babies, so it gives them an option which I think is really important,” she said.

The Australian Institute of Health and Welfare’s Australia’s Mothers and Babies 2010 report reveals just 0.5 per cent of all births took place in Australian homes in 2010.

Professor Davis said while privately practising midwives can provide home birth services, the costs can deter parents from choosing to birth at home.

“The affordability puts it out of some women’s reach, so there might be a lot more women who are keen on having a home birth now,” she said.

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“There will certainly be a group of women who are keen to take it up - I think it will be popular.”

A network of publicly-funded home birth models operate across Australia, in New South Wales, the Northern Territory, South Australia, Victoria, Tasmania and Western Australia.

Under the ACT home birth model, two midwives will be present at each birth and work closely with a team of midwives, obstetricians and neonatologists.

Professor Davis said the Canberra home birth model will serve as an extension of the hospital’s existing continuity of midwifery care and birth centre program.

“Midwives who are currently working in the birth centre and providing caseloading care will add a woman or two per month to their caseload,” she said.

“It’s not so different for the midwives or the service - they’ll add this woman to their caseload and rather than birthing in the birth centre, they’ll be supporting her to have her baby at home.”

Professor Davis said evidence shows home births are a safe option for low-risk pregnant women with a registered midwife.

“I think in the past we’ve had attitudes about these women or midwives being a bit extreme or on the fringes but it’s a really safe option and a great option for low-risk women,” she said.

For the full article visit HealthTimes.com.au

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HealthTimes - August 2016 | Page 17

Complementary therapies empower parents through childbirth

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fter experiencing complications in her first two births, with both labours involving epidurals, Dr Kate Levett (PhD) wanted to de-medicalise her third birth.

Enrolled in a public midwifery continuity of care program in New South Wales, Dr Levett participated in several private birth preparation courses and went on to experience a water birth, without any pain relief. “It was fantastic and it was all a very good outcome,� she says.

A health educator and acupuncturist, the positive birthing experience inspired Dr Levett to embark on a PhD study to examine whether antenatal education classes that focused on complementary therapies for pain relief could drive down rates of epidural use and caesarean sections.

With the assistance of her two Western Sydney University supervisors, including renowned midwifery advocate Professor Hannah Dahlen and complementary medicine researcher Professor Caroline Smith of the National Institute of Complementary Medicine (NICM), the team conducted a randomised controlled trial of 176 women having their first baby, with low-risk pregnancies, across two public hospitals in Sydney.

The researchers designed the Complementary Therapies for Labour and Birth course, based on the She Births and acupressure for la-

Page 18| www.HealthTimes.com.au

bour and birth courses, while adding evidencebased complementary medicine techniques - acupressure, visualisation, yoga, massage and breathing techniques.

In the course, participants learnt about the six main acupressure points during labour progression, rehearsed four guided visualisations, four breathing techniques and two massage techniques.

They also learnt about five yoga postures and movements designed to encourage relaxation, the physiological position for labour, the opening of the pelvis and downward descent of the baby.

Importantly, the study also focused on partners playing a pivotal and active role throughout the labour - working with pain and reducing stress while supporting the birthing woman.

Under the study, women and their partners attended the two-day weekend antenatal program plus received standard care, or received standard care alone.

The study’s overwhelmingly positive results, published in BMJ Open, came as a surprise for the researchers, who hoped to see a 20 per cent reduction in epidural rates.

Instead, they found women in the study had dramatically lower epidural rates (23.9 per cent for the study group compared to 68.7 per cent for the control group), and fewer caesarean sections (18.2 per cent versus 32.5 per cent).

Women in the study group were significantly less likely to require their labour to be accelerated using artificial means (28 per cent versus almost 58 per cent), and less likely to have perineal trauma (almost 85 per cent compared to 96 per cent).

The study group also experienced a shorter second stage of labour, and the group’s babies were less likely to be resuscitated at birth (13.6 per cent compared to almost 29 per cent).

Researchers say the study highlights the effectiveness of a novel approach to antenatal education featuring evidence-based complementary medicine techniques. The team hopes to establish a larger national or international trial to confirm the results.

Dr Levett, now a Research Fellow at the University of Notre Dame Australia and an Adjunct Fellow at NICM, says the course focused on empowering women and their birth partners, using education to equip the partners with a toolkit of options throughout the birthing process.

“We taught them about what the physiology of labour is and what’s normal labour - what does labour look life in real life, not the TV labours, and not what they’ve heard described from people who’ve had bad outcomes,” she says.

“We talked about how relaxation decreases fear and decreases pain, and we showed the partners - this is what you do, this is how you help and we role-played things.”

Couples participating in the study group used an average of three different complementary medicine techniques over the course of the birthing process. The main techniques were acupressure, breathing and relaxation.

Dr Levett says birth partners later reported that they knew what to do, right throughout the labour.

“That was super important - they said that made the difference, they didn’t feel like a fly on the wall, they didn’t feel like they were out of control,” she says.

Professor Dahlen says the study shows the importance of women and their partners taking charge of their labour and birth.

“You can’t just go in and hand-over and I actually think this is the heart of it,” she says.

“I think with all the well-meaning intention in the world, we are often looking at interventions that we can do in order to save women, if you like, or reduce interventions for women, and we therefore are the heroes in this drama.

“But what this course did was make women and their partners the heroes in the drama and by doing that we actually got better results than when we look at trying to rescue the day.”

With a move away from natural childbirth to hospital births in recent decades, the researchers say antenatal education classes now focus on the provision of parenting information and information on medical interventions for birth, such as caesarean sections and options for pain relief.

The study results demonstrate that Australia needs to rethink how it delivers its antenatal education, Professor Dahlen says.

“I seriously wonder whether parent education should happen outside of hospital systems and influence because in this process we came across courses undertaken in hospitals in Sydney that just shocked me,” she says.

“I could not believe that we were dressing up husbands in theatre gear so that they’d be comfortable when they went to theatre, and having anaesthetists invited to speak at antenatal classes.

“We’ve allowed our own fears and our own limitations to invade childbirth education and therefore, by default, we have limited and we have not empowered parents to actually be active participants in their own birth.”

For the full article visit HealthTimes.com.au HealthTimes - August 2016 | Page 19

Sports physiotherapy inside the Australian Olympic Team

M

ark Alexander remembers sitting on his dad’s knee at the age of seven, watching the events of the Moscow Olympic Games unfold on TV. A track and field runner, Mark’s dream was to one day compete in the Olympic arena himself. But while he reached a state level at both high jump and table tennis, he didn’t have the athletic ability to compete on the international stage.

Instead, Mark chose to help other elite athletes achieve their Olympic podium dreams.

The Melbourne physiotherapist has since supported Australia’s triathlon team to achieve silver at the Athens Games in 2004 and take home its first ever triathlon Olympic gold medal, plus a bronze, at the Beijing Games in 2008.

“It was about being a part of something bigger than yourself,” he says.

“The best part for me was actually being a part of a high performing team that was well oiled, that was performing at its peak and winning gold, silver, bronzes - which are obviously a pretty awesome outcome measure.

“It’s also about the thanks. I loved it when the athletes, along the journey, just said ‘thanks’.”

Mark began his physiotherapy career at the Royal Brisbane Hospital before heading to the UK where he worked for the London Broncos for two years.

He returned to Australia to work at the Australian Institute of Sport in Canberra, where he

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experienced his first taste of the Olympics, servicing athletes training for the Sydney Games in 2000.

He then moved to Melbourne’s Olympic Park Sports Medicine Centre and later spent a year working for renowned Irish dance troupe, Riverdance, on its Australian and European tours.

Mark, who completed a Master of Sports Physiotherapy in 2005, went on to spend six years working with the Australian triathlon team, helping the team clinch a silver and a bronze at the 2002 Commonwealth Games in Manchester and two gold and a bronze at the 2006 Commonwealth Games in Melbourne.

As part of the role, he supported the team at the World Championships in Mexico in 2002, New Zealand in 2003, Spain in 2004, Switzerland in 2006, Germany in 2007, and Canada in 2008.

It was during that time, Mark realised there was no product athletes could take with them on their travels to continue their self-treatment. He invented a solution - BakBalls - a portable and inexpensive self-treatment device for back and neck pain and stiffness.

“In 2002, we were just using squash balls and golf balls, and rolling pins with a tea towel wrapped around them,” Mark says.

“Physiotherapists are all about empowerment and allowing your patients and your athletes to manage themselves, so I thought - I need something that my triathletes can travel the world with when I’m not there.”

The device has been used by the Australian Cricket Team and the Australian Olympic Team, a number of AFL, NRL and Super Rugby teams, as well as thousands of people across Australia.

Mark has since developed several other simple, portable products as part of his BakPhysio business. The latest devices, Neckrest and Backrest, will be released in the next few months.

At the Beijing Olympics, the behind-thescenes support team for the five Australian triathletes included Mark, as the sole physiotherapist, a massage therapist, sports psychologist, dietitian, sports physician and a bike mechanic.

While his role was focused on the clinical servicing, injury prevention and treatment of triathletes, Mark was often required to carry out a range of other tasks.

“It’s about being a key team member, it’s not about yourself as an individual, it’s about supporting the team,” he says.

“I was driving trucks, lifting bike bags, doing a lot of things that had nothing to do with physiotherapy but that’s what you have to do as a critical team member.”

Speaking in the lead up to the Rio Olympic Games, Mark says the triathlon team spend a week acclimatising to the country and becoming familiar with the triathlon course. The team swim in the morning and run/ride in the afternoon, before heading into a recovery session.

To get their bodies prepared to peak for their event, the athletes then wind back their training. That’s when some athletes often experience tightness and stiffness.

“Generally most athletes will get stiffer, so they’ll have a bit more massage, do more stretching and more sleeping,” Mark says.

“We make sure they’re in top shape. One athlete leading up to an Olympics had hip problems, so we did a lot of hip work, another athlete had foot problems, so we had to do a lot of tape for blisters on the feet.”

Mark says one of the biggest mistakes athletes can make in the lead up to an Olympic

Games is making untested changes to their diet, equipment or training.

One triathlete came off his bike at the Athens Olympics after notching up the fastest running time of the day.

“Had he not fallen off his bike, not just once but twice, he would have been up the front of the pack and his fastest run time would mean that he’d probably have won a gold medal,” Mark says.

“But he changed his bike tyres the day before the race and just did a roll around and didn’t really test them out. Coming down a bike hill, around tight corners, he fell over twice.

“People get nervous and they just make poor decisions sometimes and that’s the role of the staff is to hopefully minimise those errors.”

On the day of Olympic competition, Mark says he’s loosened up a triathlete’s neck and shoulders or taped feet but mostly the work involves helping with equipment and getting athletes to the starting line.

It’s a pressure cooker environment, where the support team are also crucial to keeping the athletes relaxed.

“We manage that stress and pressure, and you really have to know your athletes to know whether their pressure has just been dialling up over the last hour or so,” Mark says.

“If you have to address that, you just really crack some jokes and get them laughing or smiling to relax them a little bit.

“Every athlete has different coping mechanisms. Some athletes will put their headphones on and listen to music or some tapes and just retreat into themselves and you just leave them alone.

“Other athletes will go hyper and they’ll just be bouncing around and cracking gags themselves because that’s how they deal with stress and pressure.”

For the full article visit HealthTimes.com.au HealthTimes - August 2016 | Page 21

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Supercare pharmacies to improve patient access: PSA Victoria’s new 24-hour Supercare pharmacies will boost crucial patient access to pharmacy services and improve health outcomes, according to the Victorian branch of the Pharmaceutical Society of Australia (PSA).

PSA Victorian branch president Ben Marchant applauded the State Government’s $28.7 million funding injection to trial 15 metropolitan and five rural around-the-clock community pharmacies.

“The 24/7 community pharmacy model increases patient access to vital services while also reducing pressure on doctors and hospital services,” he said.

“The 24/7 pharmacies also recognise the changing needs of many people who cannot readily access a pharmacy during regular opening hours.

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“PSA has experience in implementing afterhours pharmacy services and looks forward to sharing this experience with the Victorian government.”

The first five Supercare pharmacies have now opened at Ascot Vale, Yarraville, Craigieburn and Wantirna South in Melbourne and in regional Victoria at Ballarat.

Under the government initiative, 20 pharmacies across the state will open their doors 24-hours, every day, by 2018.

The initiative is designed to provide families, shift workers and others with non-emergency care after hours.

for the full article visit HealthTimes.com.au

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How physiotherapists can ace tennis elbow It’s often referred to as tennis elbow but despite its name, the most common chronic musculoskeletal condition to impact the elbow mainly affects people working in manual jobs who perform repetitive hand tasks, such as meat processing and factory workers.

Tennis elbow, also known as lateral epicondylalgia, is not only a prevalent condition, it can also be an incredibly painful, debilitating and complex injury to treat.

Dr Leanne Bisset (PhD), a musculoskeletal physiotherapist and senior lecturer at Griffith University’s Menzies Health Institute Queensland, says tennis elbow has also been the focus of hundreds of research trials and published papers, making it difficult for time-poor practitioners to keep up to date with the latest and best evidence-based practice.

Dr Bisset, a clinician and researcher in chronic upper limb musculoskeletal conditions, recently joined Physiotherapy Professor Bill Vicenzino, of the University of Queensland and the NHMRC Centre for Research Excellence in Translation of Research into Improved Outcomes in Musculoskeletal Pain and Health, to review the research and provide a summary for physiotherapists on tennis elbow.

Their paper, titled ‘Physiotherapy management of lateral epicondylalgia’, published in the Journal of Physiotherapy last year, has become a muchread snapshot examining not only the burden of tennis elbow but also its diagnosis, assessment and treatment.

Most importantly, it covers the management of tennis elbow through a range of physiotherapy interventions, such as exercise, manual therapy and manipulation, orthotics and taping, acupuncture and dry needling, laser, ultrasound and phonophoresis, shock wave therapy and multimodal programs.

Page 28| www.HealthTimes.com.au

“What’s unique about this paper is that it brings together the whole picture of this condition and it also gives clinicians an evidence-informed clinical reasoning process or guide. We discuss the clinical reasoning behind the evidence, to try and help clinicians interpret and apply the evidence to the individual patient in their clinical practice,” Dr Bisset says.

The review shows about 40 per cent of people will experience tennis elbow at some stage in their life, with it mostly affecting men and women aged between 35 and 54.

The condition can also have a devastating impact on people’s ability to maintain their work, home and social life, Dr Bisset says.

“A lot of the time my patients will report that they can’t even pick up a cup of coffee because their elbow pain is so severe – it can have a significant negative impact, especially when it’s really severe.”

Tennis elbow is relatively easy to diagnose using clinical assessment, with the condition typically presenting as pain on the outside (lateral humeral epicondyle) of the elbow. Patients often report that it hurts to grip or contract those muscles attached to the outside elbow area.

Dr Bisset says there is a broad spectrum of severity with tennis elbow, with some patients presenting with mild, localised symptoms while others experience more widespread or severe pain.

“Because of the differences in the way that patients present with tennis elbow, we can’t approach all those patients using the same treatment,” she says.

“There is also a group of about 20 per cent of people with tennis elbow who don’t seem to recover, regardless of the treatment they receive. They seem to be a more severe group who are at risk of more long-term pain and disability.”

For the full article visit HealthTimes.com.au

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