Health Times February 2018

H

February 2018

Midwifery Feature + Volunteer midwifery: what does it involve? + The effects of premature birth on language development + 3 out of 5 women wanting water births achieve their aim + New research aims to find allied health solutions to neuropathic pain

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New research aims to find allied health solutions to neuropathic pain

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s survival rates for serious medical conditions such as cancer and stroke increases, along with the diagnosis and management of other lifelong ailments such as diabetes, many patients face a life of enduring neuropathic pain.

Currently, this type of persistent pain is most commonly treated through surgical or pharmaceutical intervention, which have the potential to cause additional undesirable side effects.

Reducing persistent neuropathic pain through methods other than medication or surgery will be the focus of new research conducted Professor Michel Coppieters, the newly appointed Menzies Foundation Professor of Allied Health Research at Griffith University.

The research will concentrate on understanding the specific mechanisms of neuropathic pain, how it evolves, improving the way it is diagnosed and the potential for non-surgical and non-pharmacological management.

“Neuropathic pain is common, but very difficult to manage,” says Professor Coppieters.

“And it is pain that serve no purpose.

“In contrast to some other types of pain, is it 100% dysfunctional.”

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Neuropathic refers to pain is that which originates from the nervous system itself.

“It can be from the peripheral nervous system or central nervous system,” says Professor Coppieters.

“For neuropathic pain from the central nervous system, think conditions like spinal cord injury or stroke, though these are not my domain.”

Neuropathic pain from the peripheral nervous system may be the result of a number of common scenarios, such as: • Compression or entrapment neuropathies, such as carpal tunnel syndrome or radiculopathy • Diabetes (diabetic neuropathies) • N e u r o t i c medication, such as chemotherapy.

“For example, following breast cancer treatment, 20 - 60 percent of of women develop neuropathic pain in their arm, and some may experience significant functional limitations,” says Professor Coppieters.

“Considering the increased survival rates and longer life expectancy, prevention and successful management of these side effects is important as they can have a significant impact on people’s lives,” he says.

“There may also be a neuropathic pain component in low back pain, neck pain, knee and hip osteoarthritis, etc.”

But Professor Coppieters says it’s important to note that the distinction between the peripheral and central nervous systems is largely artificial.

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“Following peripheral nerve injuries, changes occur in the central nervous system which typically increase the pain intensity.

“The umbrella term for this is central sensitisation.”

To date, there have been no similar research projects undertaken at the university, which Professor Coppieters says will concentrate on better understanding the conditions that affect the musculoskeletal system, in order to develop better clinical diagnoses and management strategies.

“Pain is largely influenced by the immune system,” he says.

“Neurons in our brain and spinal cord are outnumbered by other cells, such as glia cells, which are immunocompetent.

“The research aims to understand the mechanisms of neuropathic pain better, in order to prevent and better manage pain.”

To more effectively manage neuropathic pain long term, Dr Coppieters says it is important to be

able to identify in advance which patients are likely to respond positively to a particular interventions, and which patients will not.

“We also like to understand how that treatment works,” says Professor Coppieters.

“The research will focus on specific populations and the impact of exercise and pain education on those populations.

“For example, which patients with back pain or neck pain respond well to physiotherapy and exercise, why do they get better and which pathological mechanism has changed?”

Along with measuring the impact of physiotherapy and exercise, Professor Coppieters says pain education of patients and their relatives will be a primary component of his research.

“It’s a neuroscience based pain education: empowering patients with knowledge about pain.

“What is it, what does it mean, what affects it?

“We are merging fields of neurobiology and psychology.”

HealthTimes - February 2018 | Page 09

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anxiety and can provide a tipping point for hile awareness of the mental health mental illness to occur.” struggles faced by many new mums Contact jenni@feldebiz.com.au or phone 9737 9945 to enquire or to says be added to our mailing list.

Ms Barclay there are a number of is increasing, new research shows that 03 one Look at www.feldenkraisinstitute.com.au/events/list to see what's on near you. processes in place to help midwives identify quarter of pregnant women will experience mental health issues in both pregnant some form of mental health challenge. women and new mothers, however multiple The UK study from King’s College limitations and barriers contribute London revealed that of the one in to increased pressure on four women, 11 per cent had maternity staff, reducing depression, 15 per cent their ability to effectively had anxiety, 2 per cent support the women had eating disorders who need it. and 2 per cent D u r i n g had obsessivep r e g n a n c y , c o m p u l s i v e universal screening disorders. generally the Many women Kick-start Edinburgh Postnatal experienced a an exciting new chapter of We ar Depression Score your Mental Health career in Canberra! combination two or e interv iew g for (EPDS), to more issues.

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“Australian studies have found similar Benefits working for ACT Health: “If a woman requires mental health figures whenof both anxiety and depression • Generous package available* • Flexible work arrangements follow-up due to a raised EPDS, appropriate are taken intorelocation account across the whole • Study leave assistance • Nurse salaries among the highest in referral is made by the midwife,” says Ms span of pregnancy, and when co• Paid parental leave Australia Barclay. morbidities such as intimate partner • Free parking • Ongoing -professional development *conditions apply opportunities “Conversations will be held relating to violence - are factored in,” says Ms Barclay. supports at home, the woman’s thoughts “Time constraints, sleep deprivation, Contact Shane King at Geneva Healthcare and fears about the pregnancy and birth lack of community or family support, to arrange your interview. etc.” isolation, adjustment to leaving the 1800 123 900 Email:roles shanek@genevahealth.com The EDPS is generally repeated at 20 workforce, transitioning and weeks gestation. relationships - all heighten awareness and

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HealthTimes - February 2018 | Page 13

Nursing until the end - how voluntary assisted dying will impact Victorian nurses

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or more than two decades, the Australian Nursing and Midwifery Federation (Victoria) has been pushing for the legalisation of Voluntary Assisted Dying, or euthanasia, as it’s commonly known.

Last year, Victoria became the first state in Australia to do so. From 2019, terminally ill patients will have the right to request a lethal drug to end their lives. If the patient meets all set criteria, they will receive the drug within 10 days of their request, administering it themselves if physically possible.

It’s a decision supported, not only by the ANMF, but by nurses themselves, many of whom have witnessed first hand the devastation experienced by some patients during their final weeks and months.

“The smallest number of people to benefit are those who utilise the legislation to its fullest, and their families, who will no longer face accusations, investigations, and potential prosecution for helping a suffering loved one, or even being present when they died,” says nurse Tara Nipe, who has spent the vast majority of her career caring people following serious incidents such as stroke, as well as neurogenerative diseases including motor neurone and Parkinson’s disease, endstage kidney failure, and autoimmune diseases like lupus.

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“We know from international data that, for many, the knowledge this option is available helps far more patients than take it up.

“The voluntary assisted dying legislation means hundreds of Victorians now have the reassurance and peace of mind that comes from knowing they have an alternative if palliative care measures aren’t enough.”

Ms Nipe says that most of the patients she has cared for during their final moments, have had peaceful, comfortable deaths, however there are exceptions to the rule.

“I’ve also been directly asked, and once begged, to assist dying patients to die.

“This request most often came from people with neurodegenerative conditions like motor neurone disease, whose symptoms are usually harder to manage than pain, though no less distressing, debilitating, and dire.”

“My hope is that a number of people will achieve better palliative care as a result of these consultations, and not need to continue through the entire process.”

One of the protections of the legislation is that voluntariness is a requirement for everyone involved, including health practitioners.

“Only specifically qualified physicians will be able to administer the medication for the small percentage of those who are unable to take it

themselves, so the extent of nurse participation is assisting with drug preparation, witnessing a request, witnessing drug administration, facilitating contact, on request, with doctors who will coordinate and consult on the process, and providing information and/or resources about voluntary assisted dying.

“As patients spend more time, on average, with nurses than their medical team, it’s already common for them to confide in and ask questions of us that they are uncomfortable raising with doctors, so I expect this will happen on occasion.”

“The extent of involvement is entirely up to the nurse.”

While there will no doubt be some nurses who object to voluntary assisted dying, and will have the right to refuse to provide information about voluntary assisted dying or be involved in the process.

But Ms Tate urges those nurses who do have objections to keep a couple of things in mind.

“First, the number of people who access voluntary assisted dying will be a very small percentage of those they care for - just 0.39% of all deaths in Oregon were due to assisted dying, and that legislation is less stringent than Victoria’s.

“Second, the compassion and care we have for our patients is independent of the life decisions they make; while some of us may disagree with a patient’s decision to explore voluntary assisted dying options, or to utilise it, our therapeutic relationships won’t change - they are, and will continue to be, patientcentred.”

ANMF Victoria Branch Acting Secretary Paul Gilbert says many nurses were aware of experiences, prior to the legislation passing parliament, where terminally ill patients took their own lives in harrowing circumstances.

“Despite the illegality, patients were sometimes able to secure life ending medication, and we saw the difference in a patient’s outlook when they had a choice to end their life, and once given that power, did not use it,” says Mr Gilbert.

“It is a power shift in the patient’s favour.

“All involved, not only nurses, should be mindful of the importance of caring and assessment of all factors that contribute to a person requesting voluntary assisted dying. The request should not change or negate the nature of caring.”

Under the nurses’ code of conduct, nurses who choose not to be involved, will be obliged to respectfully inform the person and their employer of their conscientious objection and ensure the person has access to alternative care.

The code also stipulates that in providing end-of-life care, nurses must understand the limits of healthcare in prolonging life, recognise when efforts to prolong life may not be in a person’s best interest and accept a person’s right to refuse treatment.

“I know many nurses share my relief that the patients we’ve seen suffer, despite expert palliative interventions, will now have an alternative, should they choose it,” says Ms Tate.

“This is an adjunct, not an alternative, to the quality palliative care Victorian’s currently receive.”

HealthTimes - February 2018 | Page 15

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Volunteer midwifery – what does it involve?

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orking in developing contexts had been a career goal for midwife Jacqui Jones, so when a position came up with Médecins Sans Frontières/Doctors Without Borders (MSF), she was quick to sign up.

“Part of my inspiration for choosing nursing then a midwifery career was so that I would be an asset in countries that needed it.

This was the right fit for me after learning about MSF’s values and objectives. The organisation treats anyone in need of medical care, regardless of their societal standing, political views or ethnicity.”

With MSF, Jones also found herself drawn to the opportunity to fulfil mentoring and teaching roles and empower local staff.

Over the past three years, Jones has worked in Afghanistan, Nigeria, and most recently in Bangladesh where almost 700,000 Rohingya have sought refuge since August 2017.

Jones was part of a team responsible for setting up a “Women’s Health Room” in a newly built clinic in the Tasnimarkhola settlement south of Cox’s Bazaar. Established to provide antenatal and postnatal care, family planning, sexual violence and safe abortion care, the clinic’s generic offering made it easier for women to visit.

The team offered psychological first aid, medication and vaccinations to women who had been sexually assaulted or abused. But, as Jones explains, “It emerged that what women

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needed most help with was contraception.

We saw women of all ages but many were 18-year-olds, usually because they had already had a baby within the two years beforehand, and didn’t want another baby just now. A lot of them were just coming in to get their next dose, to continue whatever they’d been taking before.”

Jones understands that being a midwife with an international medical humanitarian organisation isn’t always easy. “The biggest challenge is not having many diagnostic tests. When I was in Nigeria, we were sending people to get ultrasounds, that were not always accurate.

I had scans reporting ‘no cardiac activity’, and then a healthy baby was born hours later.

“Of course, the situations are tough.

The worst cases are when you know the patient would have survived if they were brought into an emergency department back home. It can make you feel very helpless.”

At the same time, Jones adds that her local team’s drive and persistence, despite their own personal struggles, is the motivation that keeps her going. “It’s a humbling environment.”

“Accepting that working in these contexts is different medicine to back home is part and parcel of the role. For the most part, you are dealing with the same medical conditions, just in a severe state. Pre-eclampsia, premature labour and severe bleeding can affect any

pregnant woman. However, there are different ways of screening and treating depending on which country you are in.”

For others looking to work overseas, Jones says the best way forward is to set realistic expectations from the get go. “I’m not sure you can ever be prepared for it professionally. You will inevitably find yourself treating patients and conditions that you have only ever experienced in medical books. Personally, you need to be in a good head space, and accept that the work is tough and often with long hours.

“However, it is very rewarding and your colleagues keep you grounded, offering support and a special bond you will never replicate in any other working environment.”

Médecins Sans Frontières Australia is looking for midwives to help deliver medical assistance to the people who need it most. You must be able to commit to a minimum of six months and be a resident of Australia or New Zealand. Find out more on the MSF Australia website: http://www.msf.org. au/join-our-team/work-overseas/who-weneed/medical/midwives Meanwhile, volunteers with nursing skills are needed on Australian soil too. The Asylum Seeker Resource Centre (ASRC) is currently looking for clinicians to assist with processing medical records of those held in detention such as Manus Island, Nauru and the Australian regional immigration processing centres.

The ASRC works with the Detention Rights Advocacy Program (DRAP) who obtains the complete medical records of asylum seekers

who require medical treatment but face inappropriate treatment due to their situation.

People often require transfer to Australia or in recent times, Taiwan, for specialist treatment and diagnostics, but the bureaucratic and legal approvals they face are endless – which is where the Detention Rights Advocacy Program steps in.

“The Australian government very regularly does not approve these transfers or delays them significantly, which results in people being left in life threatening situations (for example those with acute cardiac conditions), at risk of suicide, or living with chronic pain or humiliating medical conditions that cannot be treated in Nauru and Papua New Guinea.

This can happen at onshore facilities too, and we also sometimes see people with serious health conditions deported to their country of origin,” says Natasha Blucher from DRAP. Through their lobbying, DRAP are able to obtain full medical records of those in need, where volunteer clinicians work with the group to provide a report and recommendation for treatment. These reports generally address what treatment the person has been receiving; whether that treatment is appropriate; what treatment is required and what might be the consequences if this treatment is not provided.

The time commitment is flexible - the review plus report takes approximately 5-8 hours.

Clinicians can simply nominate when they are available to complete a review, and they will receive those cases that are the most urgent or appropriate to the person’s qualifications.

HealthTimes - February 2018 | Page 19

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Time restraints and lack of training place added pressure on midwives and patients

By Nicole Madigan What our patients say about birthing at MDHS

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“In November 2017 I was lucky enough to have given birth to my first anxiety and can provide a tipping point for hile awareness of the mental health child at MDHS. From the beginning of my pregnancy the midwives were struggles faced by many mums extremely supportive, they really made usnew feel they were on thismental journey illness to occur.” with my husband andresearch I every step ofshows the way, that and they were. The Ms Barclay says there are a number of is increasing, new one attentiveness and caring nature of the midwives at MDHS helped me get processes in place to help midwives identify quarter ofa challenging pregnantbirth women will experience through which resulted in an emergency caesarean. some form of challenge.

Throughout my mental pregnancyhealth I was often asked why I was havingmental my child health issues in both pregnant atThe MDHSUK and why wouldn't I go to aKing’s larger hospital in Bendigowomen or and new mothers, however multiple study from College Ballarat. Well it is simple really, you get 5 star service that I know you limitations and barriers contribute London revealed that of the one in wouldn't get anywhere else.”

Mason, MDHS Board Vice-president to increased pressure on four women, 11 per centKelly had

maternity staff, reducing depression, 15 per cent Rural Midwifery - A Rewarding Career! their ability to effectively had anxiety, 2 per cent support the women had eating disorders of working who need it. andBenefits 2 per cent at Maryborough District Health Service

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Ability to perform elective and emergency LUSCS. Depression Score combination two or What we are looking for and benefits of working at MDHS (EPDS), is offered to more issues.

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Benefits include: salary packaging, permanent contract, supportive environment with a great a range of other psychosocial Julianne Barclay says she development isn’t team, access to professional opportunities andand excellent facilities including the staff gymnasium. issues, for example, housing, are raised by surprised by the findings. the midwife.

“Australian studies have found similar For further Cathy Egan,“If Nurse Unit Manager, on 03mental 5461 0322. a woman requires health figures when information, both anxietyplease and contact depression To learn more about what’s on offer within our community visit: www.visitmaryborough.com.au. follow-up due to a raised EPDS, appropriate are taken into account across the whole referral is made by the midwife,” says Ms span of pregnancy, and when cowww.mdhs.vic.gov.au Barclay. morbidities - such as intimate partner “Conversations will be held relating to violence - are factored in,” says Ms Barclay. supports at home, the woman’s thoughts “Time constraints, sleep deprivation, and fears about the pregnancy and birth lack of community or family support, etc.” isolation, adjustment to leaving the The EDPS is generally repeated at 20 workforce, transitioning roles and weeks gestation. relationships - all heighten awareness and

Page 20| HealthTimes.com.au

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HealthTimes - February 2018 | Page 21

The effects of premature birth on language development

R

esearch published in eNeuro indicates premature babies are likely to experience developmental delays in the auditory cortex, which was associated with speech and language impairments at two years of age.

Drawing on previous research from ultrasounds of babies in-utero, it has already been determined that foetuses can hear and respond to external stimuli as early as 25 weeks.

“Ultrasound studies reveal, for example, that, beginning at least as early as 25 weeks into gestation, fetuses will blink or move in response to externally p r o d u c e d sounds,” said r e s e a r c h l e a d e r Professor Brian Monson from University of Illinois.

“Other research shows that newborns prefer to listen to sounds - such as music or speech - that they were exposed to in the womb over unfamiliar sounds. And electroencephalogram studies of the brains of preterm infants show electrical activity in the auditory cortex in response to sound.”

The primary auditory cortex is the first cortical region to receive auditory signals from the ears via the brain, and the nonprimary auditory cortex does the processing of the sounds. The research found that the primary auditory cortex develops faster than

Page 22| HealthTimes.com.au

the non-primary auditory cortex; with the majority of the latter’s development occurring between 26-40 weeks.

“We have a pretty limited understanding of how the auditory brain develops in preterm infants. We know from previous research on full-term newborns that not only are fetuses hearing, but they’re also listening and learning.”

By looking at the primary auditory cortex in neuroimaging procedures within the infants’ first four days of life, researchers tracked the development of the brain tissue through the comparison of diffusion of water in the brain tissues – where patterns in the grey and white matter change in recognisable patterns, indicating connection development of neurons and axons.

While it was thought some of the babies included in the trial that were placed in open-bay NICU units may have greater primary auditory cortex diffusion versus their counterparts in single-patient rooms – due to the social interaction – no significant observations were measured.

The additional association between the delayed development of the nonprimary auditory cortex in infancy and language delays (but not cognitive functioning) in the children at age 2, suggested that disruptions to this part of the brain as a result of premature birth may contribute to the speech and language problems Professor Monson said.

“It’s exciting to me that we may be able to use this technique to help predict later language ability in infants who are born preterm,” Professor Monson said. “I hope one day we also will be able to intervene for those infants who may be at greatest risk of language deficits, perhaps even before they begin to use words.”

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HealthTimes - February 2018 | Page 23

Antibiotics during pregnancy linked to increased hospitalisation of children with infection

A

new study by the Murdoch Children’s Research Institute (MCRI) has revealed children born to mothers who were prescribed antibiotics during pregnancy may have up to a 20 per cent higher risk of being hospitalised with infection.

The study, a collaboration between MCRI and Aarhus University of Denmark, found children between the ages of newborn up to 14 years of age, of women prescribed antibiotics closer to birth or prescribed more than one antibiotics course during pregnancy, had an even greater risk of infection.

The study, published in the International Journal of Epidemiology looked at data from more than three quarters of a million pregnancies from 1997 to 2009 in Denmark.

About 1 in 5 mothers were prescribed antibiotics in pregnancy.

In Australia, 12% (approximately one in 8) pregnant women were prescribed antibiotics in pregnancy in a large Australian studyof pregnant women are prescribed antibiotics during pregnancy. There are few studies comparing antibiotic rates in pregnancy internationally, but antibiotic use in early childhood in Australia is one of the highest in the world.

Lead author Dr Jessica Miller said infections during pregnancy are common and need to be treated appropriately.

Page 24 | HealthTimes.com.au

“We do however need to use antibiotics sensibly in all age groups, including pregnant women because they do decrease “good” bacteria in the gut microbiome. A healthy microbiome is important early in life for the developing immune system and possibly for preventing serious infection.”

Babies born vaginally had a higher risk of infection risk than those born by caesarean section when mothers were prescribed antibiotics in pregnancy. Researchers believe this is related to the influence of the gut microbiome. This is because a vaginally born baby gets their microbiome from the mother’s gut and birth canal. Whereas babies born by caesarean section acquire a microbiome from the mother’s skin and the hospital environment.

The greatest risk for hospitalised infection was gastrointestinal infection in children born vaginally to mothers who were prescribed antibiotics in pregnancy. The child’s gut microbiome is particularly important in gastrointestinal infections.

Researchers also found that children born to mothers who were given antibiotics before conception had an increased risk. This suggests that other shared factors, such as genetic make-up and the home environment, may also contribute to infection risk in both mother and child.

For the full article visit HealthTimes.com.au

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3 in 5 women wanting water births achieve their aim

A

Western Australian study published in the Australian and New Zealand Journal of Obstetrics and Gynaecology in January has reported that of the 502 women surveyed who were intending to have a water birth, 303 (59 per cent) were able to labour in water, and 179 (41 per cent) were able to birth in water.

The researchers at Curtin University and King Edward Memorial Hospital (KEMH) comment the data suggests midwives are selecting the appropriate women with low-risk pregnancies to labour and birth in water.

“This research found that women who were identified and approved to undertake labour in water were less likely than those who were not to be transferred to KEMH’s main birth suite, suggesting the labour had fewer or no complications, and they were more likely to have a normal or spontaneous vaginal birth,” lead author Dr Lucy Lewis said.

“The main reason women who used water for their labour did not end up having a water birth was the fact they experienced an obstetric complication. This suggests the midwives at KEMH are following water birth guidelines by responding appropriately in the event a complication arises during labour.”

The small study indicated an association between water birthing and a shorter first and second stage of labour, as well as women being three times more likely to have an intact perineum. Such results were also higher

Page 26 | HealthTimes.com.au

among women who had previously given birth (multiparous).

It is interesting to note that the caesarean birth rate at KEMH is 37% for women of all risk; compared to 34% in all of WA; whereas for the group of water-birthers it was only 6% - it must be noted however that only women with low-risk pregnancies were offered the water birth option.

As the midwifery continuity of care model becomes more popular with patients in its quality of maternity care and provision of midwifery services that are responsive to women’s needs and wants, so too has the demand for water immersion as a birth choice – and the medical community is taking notice, as examined in The Lancet’s Midwifery Series.

Dr Lewis is encouraging maternity units who offer water immersion for labour and/ or birth to publish their data, to help women make the best-informed decision for their labour. Dr Lewis’s previous research has looked into the reasons why women plan water births, with many women believing such a procedure would help them avoid an epidural.

Additionally, through the suggestion of establishing a national body to collect and publish this data, the researcher team hopes this will lead to further collaboration between the birth team of obstetricians, neo-natologists and midwives through the development of standards of optimal care and outcomes for all involved.

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HealthTimes.com.au HealthTimes - February 2018 | Page 27

Time restraints and lack of training place added pressure on midwives and patients

By Nicole Madigan

W

hile awareness of the mental health struggles faced by many new mums is increasing, new research shows that one quarter of pregnant women will experience some form of mental health challenge.

The UK study from King’s College London revealed that of the one in four women, 11 per cent had depression, 15 per cent had anxiety, 2 per cent had eating disorders and 2 per cent had obsessivec o m p u l s i v e disorders.

Many women experienced a combination two or more issues.

A u s t r a l i a n Nursing and Midwifery Federation (Vic Branch) Maternity Services Officer Julianne Barclay says she isn’t surprised by the findings.

“Australian studies have found similar figures when both anxiety and depression are taken into account across the whole span of pregnancy, and when comorbidities - such as intimate partner violence - are factored in,” says Ms Barclay.

“Time constraints, sleep deprivation, lack of community or family support, isolation, adjustment to leaving the workforce, transitioning roles and relationships - all heighten awareness and

Page 28| HealthTimes.com.au

anxiety and can provide a tipping point for mental illness to occur.”

Ms Barclay says there are a number of processes in place to help midwives identify mental health issues in both pregnant women and new mothers, however multiple limitations and barriers contribute to increased pressure on maternity staff, reducing their ability to effectively support the women who need it.

D u r i n g p r e g n a n c y , universal screening generally the Edinburgh Postnatal Depression Score (EPDS), is offered to all women on booking in.

At this visit issues such as intimate partner violence and a range of other psychosocial issues, for example, housing, are raised by the midwife.

“If a woman requires mental health follow-up due to a raised EPDS, appropriate referral is made by the midwife,” says Ms Barclay.

“Conversations will be held relating to supports at home, the woman’s thoughts and fears about the pregnancy and birth etc.”

The EDPS is generally repeated at 20 weeks gestation.

“Midwives will observe, assess and monitor a woman’s mood during all visits during the antenatal period and will offer advice and appropriate solutions when required. “ This includes helping a pregnant woman to access a support group or counselling as required or organising referral to a specialist mental health practitioner if this is warranted.

“Midwives continually assess, reassure and educate pregnant women during antenatal visits and this places them in a unique position to identify symptoms of mood disorder or mental illness.”

A similar process takes place post birth. “ M i d w i v e s continuously and unobtrusively assess mothers during labour and birth and in particular attachment and interaction with the baby after birth.

“During the postnatal stay in hospital this work continues along with providing opportunities for women to discuss their concerns.”

Unfortunately, lack of time can result in these important processes being rushed, or in some instances, not taking place at all.

“Midwives in antenatal clinics and postnatal wards do not have sufficient time to perform all of the above all of the time,” says Ms Barclay.

“If a woman discloses information that requires further follow-up all the rest of the clinic is running late.

“This is a great pressure on midwives.”

Furthermore, if a midwife appears rushed, a woman is less likely to disclose her concerns.

“In the postnatal space, midwives make 1 to 3 home visits.

“Again, the higher acuity of mothers and babies at discharge means that often midwives are running very late by the end of the day if they provide appropriate time for women to express their concerns or disclose issues that require follow-up.”

Due to the specialised and highly fraught nature of mental health issues, Ms Barclay says midwives should be more actively supported in upskilling in relation to assessment and treatment of less complex issues.

“M i d w i v e s should be s u p p o r t e d in gaining mental health qualifications and - informally - they should be involved in local policy and protocol development.”

Ms Barclay says midwives should also be actively guided and educated by mental health nurses.

“Mental health nurses should be employed alongside midwives to provide a point of immediate referral as well as to capacity build the midwifery workforce,” says Ms Barclay.

She also called for properly resourced antenatal care to allow full mainstreaming of mental health and psychosocial screening and assessment throughout pregnancy.

HealthTimes - February 2018 | Page 29

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HealthTimes - February 2018 | Page 31

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