Face masks are strongly recommended as a tool in the fight against COVID-19 and in adults there i... more Face masks are strongly recommended as a tool in the fight against COVID-19 and in adults there is very strong evidence that wearing a face mask is protective to the individual and also aids in decreasing the spread of the virus. There is less evidence for the protective effect of wearing face masks in children and the age at which children are recommended to wear masks differs widely between organisations and countries. This review summarises the current evidence of the benefits and disadvantages of children wearing a face mask, the physiological evidence of face covering in young children and the differences in recommendations between organisations and where there might be consensus.
OBJECTIVE to consolidate existing research in the field of sibling attended birth (SAB) into a bo... more OBJECTIVE to consolidate existing research in the field of sibling attended birth (SAB) into a body of knowledge to inform decision-making processes and guide midwifery practice throughout the sibling attended birth experience. DESIGN An integrative literature review. DATA SOURCES CINAHL Complete, Cochrane Library, PubMed, Index New Zealand, Australia/New Zealand Reference Centre, grey literature databases REVIEW METHODS: An extensive search of five electronic databases as well as 17 grey literature databases was conducted. Abstracts of 2340 papers and full texts of 39 papers were scrutinised for inclusion criteria leading to 22 studies being included in this review. The Crowe Critical Appraisal Tool was used to facilitate a systematic quality appraisal process. FINDINGS This review included 22 studies (13 qualitative, 4 quantitative and 5 mixed methods). Studies were analysed using a narrative synthesis approach. Publications mainly focussed on families' motivations for choosing SAB, the preparation for the event, and the impact of SAB on children's behaviour and the infant/sibling relationship. CONCLUSIONS This review identified that children experienced birth as a positive, exciting and important life event and parents viewed their SAB experiences as overwhelmingly positive and reported a heightened sense of family unity. Included studies did not address the long term effects of sibling attended birth, however, in the short-term, children did not show signs of trauma or severe distress, though differing levels of transient fear and anxiety were described. IMPLICATIONS FOR PRACTICE Families could benefit from receiving evidence based information to enable an informed decision regarding their children's involvement during pregnancy, birth and the immediate postpartum. Information shared by the midwife could focus on how families can achieve an optimal SAB experience for all family members.
BACKGROUND Becoming a competent midwife is a complex process. The aim of midwifery education is t... more BACKGROUND Becoming a competent midwife is a complex process. The aim of midwifery education is to support the development of competence in midwifery skills, knowledge and to prepare graduates to meet the responsibilities inherent in the midwifery role. AIM To explore the experiences of our alumni midwives, ask how well they perceived their midwifery programme had prepared them for beginning midwifery practice and to identify any curriculum changes, or postgraduate study topics, that would support the transition to midwifery practice. METHODS An online survey was conducted with alumni of a Bachelor of Midwifery programme (New Zealand) who graduated between 2011 and 2014. The quantitative data were analysed using descriptive statistics, and a general inductive approach was used to develop themes from the qualitative data in the comment boxes. FINDINGS Forty-two alumni viewed becoming a midwife as a blend/combination of: (1) gaining the knowledge and practical skills required for the profession; (2) management skills in areas of running a business, working with other people, navigating local procedures and processes effectively, and balancing work with personal life; (3) gaining confidence in one's competence, and (4) having support along the way. DISCUSSION Competence in current evidence-based midwifery knowledge and practice is important in educating midwifery students. However, to transition to practice, a supportive environment is needed to assist midwives to develop self-management, business skills, and the confidence to negotiate and collaborate with colleagues and other health professionals. CONCLUSIONS Not only did midwifery knowledge and practice skills matter for alumni, but also the acquisition of management skills, strategies for building confidence, and ongoing support. Content that facilitates these requirements should be included in midwifery programmes to support the transition from student to practitioner.
The aim of this study was to identify the potential risks and benefits of sleeping infants in a P... more The aim of this study was to identify the potential risks and benefits of sleeping infants in a Pēpi-Pod distributed to families with high risk of sudden unexpected death in infancy compared to a bassinet. Forty-five mostly indigenous Māori mothers who were referred by local health providers to receive a Pēpi-Pod were surveyed at recruitment, 1 and 3 months. A sleep study at 1 month included infrared video, oximetry and temperature measures. When compared with 89 historical bassinet controls, an intention-to-treat analysis of questionnaires showed no increase in direct bed sharing but demonstrated significantly less sharing of the maternal bedroom at both interviews, with the majority of those not sleeping in the maternal bedroom, actually sleeping in the living room. The 1 month 'as-used' analysis showed poorer maternal sleep quality. The 'as-used' analysis of video data (24 Pēpi-Pod and 113 bassinet infants) also showed no increase in direct bed sharing, head cover...
OBJECTIVES.We aimed,to provide a quantitative analysis of the sleep arrangements and behaviors of... more OBJECTIVES.We aimed,to provide a quantitative analysis of the sleep arrangements and behaviors of bed-sharing families to further understand,the risks and benefits as well as the effects of infant age and room,temperature,on bed-sharing behaviors. METHODS.Forty infants who,regularly bed shared with,1 parent,5 hours per night
OBJECTIVES.To observe,the behavior,of infants sleeping in the natural physical environment of hom... more OBJECTIVES.To observe,the behavior,of infants sleeping in the natural physical environment of home, comparing the 2 different sleep practices of bed sharing and cot sleeping quantifying to factors that have been identified as potential risks or benefits. METHODS.Forty routine bed-sharing infants, aged 5‐27 weeks were matched for age
We aimed to provide a quantitative analysis of the sleep arrangements and behaviors of bed-sharin... more We aimed to provide a quantitative analysis of the sleep arrangements and behaviors of bed-sharing families to further understand the risks and benefits as well as the effects of infant age and room temperature on bed-sharing behaviors. Forty infants who regularly bed shared with > or = 1 parent > or = 5 hours per night were recruited. Overnight video of the family and physiological monitoring of the infant was conducted in infants' homes. Infant sleep position, potential for exposure to expired air, head covering and uncovering, breastfeeding, movements, family sleep arrangements, responses to the infant, and interactions were logged. All infants slept with their mother. Fathers were included in 18 studies and siblings in 4. Infants usually slept beside the mother, separated from the father/siblings (if present), facing the mother, with head at mothers' breast level, touching, or with mother cradling. Median overnight breastfeeding duration was 40.5 minutes. Mothers c...
Abstract
Background: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in depri... more Abstract Background: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion worldwide has concentrated on avoidance of bedsharing, the indigenous Māori community in New Zealand has reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date there has been no assessment of the safety of this traditional sleeping device. Methods/Design: This two arm randomised controlled trial is being conducted with 200 mother-baby dyads recruited from Māori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and 6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation, and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight. Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness, maternal wellbeing, attachment to baby, and maternal sleep patterns. Discussion: Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the range of SUDI prevention research being undertaken worldwide. Trials registration: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered 16th November 2010 Keywords: Sudden Unexpected Death in Infancy, Sudden Infant Death Syndrome, Infant, Sleep, Prevention, Culture, Protocol, Indigenous, Bedsharing, Co-sleeping
Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationa... more Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationally. Research comparing physiological (expectant) and active management of the third stage of labor favors active management, although studies to date have focused on childbirth within hospital settings, and the skill levels of birth attendants in facilitating physiological third stage of labor have been questioned. The aim of this study was to investigate the effect of place of birth on the risk of postpartum hemorrhage and the effect of mode of management of the third stage of labor on severe postpartum hemorrhage. Data for 16,210 low-risk women giving birth in 2006 and 2007 were extracted from the New Zealand College of Midwives research database. Modes of third stage management and volume of blood lost were compared with results adjusted for age, parity, ethnicity, smoking, length of labor, mode of birth, episiotomy, perineal trauma, and newborn birthweight greater than 4,000 g. In total, 1.32 percent of this low-risk cohort experienced an estimated blood loss greater than 1,000 mL. Place of birth was not found to be associated with risk of blood loss greater than 1,000 mL. More women experienced blood loss greater than 1,000 mL in the active management of labor group for all planned birth places. In this low-risk cohort, those women receiving active management of third stage of labor had a twofold risk (RR: 2.12, 95% CI: 1.39-3.22) of losing more than 1,000 mL blood compared with those expelling their placenta physiologically. Planned place of birth does not influence the risk of blood loss greater than 1,000 mL. In this low-risk group active management of labor was associated with a twofold increase in blood loss greater than 1,000 mL compared with physiological management. (BIRTH 39:2 June 2012).
Face masks are strongly recommended as a tool in the fight against COVID-19 and in adults there i... more Face masks are strongly recommended as a tool in the fight against COVID-19 and in adults there is very strong evidence that wearing a face mask is protective to the individual and also aids in decreasing the spread of the virus. There is less evidence for the protective effect of wearing face masks in children and the age at which children are recommended to wear masks differs widely between organisations and countries. This review summarises the current evidence of the benefits and disadvantages of children wearing a face mask, the physiological evidence of face covering in young children and the differences in recommendations between organisations and where there might be consensus.
OBJECTIVE to consolidate existing research in the field of sibling attended birth (SAB) into a bo... more OBJECTIVE to consolidate existing research in the field of sibling attended birth (SAB) into a body of knowledge to inform decision-making processes and guide midwifery practice throughout the sibling attended birth experience. DESIGN An integrative literature review. DATA SOURCES CINAHL Complete, Cochrane Library, PubMed, Index New Zealand, Australia/New Zealand Reference Centre, grey literature databases REVIEW METHODS: An extensive search of five electronic databases as well as 17 grey literature databases was conducted. Abstracts of 2340 papers and full texts of 39 papers were scrutinised for inclusion criteria leading to 22 studies being included in this review. The Crowe Critical Appraisal Tool was used to facilitate a systematic quality appraisal process. FINDINGS This review included 22 studies (13 qualitative, 4 quantitative and 5 mixed methods). Studies were analysed using a narrative synthesis approach. Publications mainly focussed on families' motivations for choosing SAB, the preparation for the event, and the impact of SAB on children's behaviour and the infant/sibling relationship. CONCLUSIONS This review identified that children experienced birth as a positive, exciting and important life event and parents viewed their SAB experiences as overwhelmingly positive and reported a heightened sense of family unity. Included studies did not address the long term effects of sibling attended birth, however, in the short-term, children did not show signs of trauma or severe distress, though differing levels of transient fear and anxiety were described. IMPLICATIONS FOR PRACTICE Families could benefit from receiving evidence based information to enable an informed decision regarding their children's involvement during pregnancy, birth and the immediate postpartum. Information shared by the midwife could focus on how families can achieve an optimal SAB experience for all family members.
BACKGROUND Becoming a competent midwife is a complex process. The aim of midwifery education is t... more BACKGROUND Becoming a competent midwife is a complex process. The aim of midwifery education is to support the development of competence in midwifery skills, knowledge and to prepare graduates to meet the responsibilities inherent in the midwifery role. AIM To explore the experiences of our alumni midwives, ask how well they perceived their midwifery programme had prepared them for beginning midwifery practice and to identify any curriculum changes, or postgraduate study topics, that would support the transition to midwifery practice. METHODS An online survey was conducted with alumni of a Bachelor of Midwifery programme (New Zealand) who graduated between 2011 and 2014. The quantitative data were analysed using descriptive statistics, and a general inductive approach was used to develop themes from the qualitative data in the comment boxes. FINDINGS Forty-two alumni viewed becoming a midwife as a blend/combination of: (1) gaining the knowledge and practical skills required for the profession; (2) management skills in areas of running a business, working with other people, navigating local procedures and processes effectively, and balancing work with personal life; (3) gaining confidence in one's competence, and (4) having support along the way. DISCUSSION Competence in current evidence-based midwifery knowledge and practice is important in educating midwifery students. However, to transition to practice, a supportive environment is needed to assist midwives to develop self-management, business skills, and the confidence to negotiate and collaborate with colleagues and other health professionals. CONCLUSIONS Not only did midwifery knowledge and practice skills matter for alumni, but also the acquisition of management skills, strategies for building confidence, and ongoing support. Content that facilitates these requirements should be included in midwifery programmes to support the transition from student to practitioner.
The aim of this study was to identify the potential risks and benefits of sleeping infants in a P... more The aim of this study was to identify the potential risks and benefits of sleeping infants in a Pēpi-Pod distributed to families with high risk of sudden unexpected death in infancy compared to a bassinet. Forty-five mostly indigenous Māori mothers who were referred by local health providers to receive a Pēpi-Pod were surveyed at recruitment, 1 and 3 months. A sleep study at 1 month included infrared video, oximetry and temperature measures. When compared with 89 historical bassinet controls, an intention-to-treat analysis of questionnaires showed no increase in direct bed sharing but demonstrated significantly less sharing of the maternal bedroom at both interviews, with the majority of those not sleeping in the maternal bedroom, actually sleeping in the living room. The 1 month 'as-used' analysis showed poorer maternal sleep quality. The 'as-used' analysis of video data (24 Pēpi-Pod and 113 bassinet infants) also showed no increase in direct bed sharing, head cover...
OBJECTIVES.We aimed,to provide a quantitative analysis of the sleep arrangements and behaviors of... more OBJECTIVES.We aimed,to provide a quantitative analysis of the sleep arrangements and behaviors of bed-sharing families to further understand,the risks and benefits as well as the effects of infant age and room,temperature,on bed-sharing behaviors. METHODS.Forty infants who,regularly bed shared with,1 parent,5 hours per night
OBJECTIVES.To observe,the behavior,of infants sleeping in the natural physical environment of hom... more OBJECTIVES.To observe,the behavior,of infants sleeping in the natural physical environment of home, comparing the 2 different sleep practices of bed sharing and cot sleeping quantifying to factors that have been identified as potential risks or benefits. METHODS.Forty routine bed-sharing infants, aged 5‐27 weeks were matched for age
We aimed to provide a quantitative analysis of the sleep arrangements and behaviors of bed-sharin... more We aimed to provide a quantitative analysis of the sleep arrangements and behaviors of bed-sharing families to further understand the risks and benefits as well as the effects of infant age and room temperature on bed-sharing behaviors. Forty infants who regularly bed shared with > or = 1 parent > or = 5 hours per night were recruited. Overnight video of the family and physiological monitoring of the infant was conducted in infants' homes. Infant sleep position, potential for exposure to expired air, head covering and uncovering, breastfeeding, movements, family sleep arrangements, responses to the infant, and interactions were logged. All infants slept with their mother. Fathers were included in 18 studies and siblings in 4. Infants usually slept beside the mother, separated from the father/siblings (if present), facing the mother, with head at mothers' breast level, touching, or with mother cradling. Median overnight breastfeeding duration was 40.5 minutes. Mothers c...
Abstract
Background: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in depri... more Abstract Background: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion worldwide has concentrated on avoidance of bedsharing, the indigenous Māori community in New Zealand has reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date there has been no assessment of the safety of this traditional sleeping device. Methods/Design: This two arm randomised controlled trial is being conducted with 200 mother-baby dyads recruited from Māori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and 6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation, and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight. Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness, maternal wellbeing, attachment to baby, and maternal sleep patterns. Discussion: Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the range of SUDI prevention research being undertaken worldwide. Trials registration: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered 16th November 2010 Keywords: Sudden Unexpected Death in Infancy, Sudden Infant Death Syndrome, Infant, Sleep, Prevention, Culture, Protocol, Indigenous, Bedsharing, Co-sleeping
Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationa... more Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationally. Research comparing physiological (expectant) and active management of the third stage of labor favors active management, although studies to date have focused on childbirth within hospital settings, and the skill levels of birth attendants in facilitating physiological third stage of labor have been questioned. The aim of this study was to investigate the effect of place of birth on the risk of postpartum hemorrhage and the effect of mode of management of the third stage of labor on severe postpartum hemorrhage. Data for 16,210 low-risk women giving birth in 2006 and 2007 were extracted from the New Zealand College of Midwives research database. Modes of third stage management and volume of blood lost were compared with results adjusted for age, parity, ethnicity, smoking, length of labor, mode of birth, episiotomy, perineal trauma, and newborn birthweight greater than 4,000 g. In total, 1.32 percent of this low-risk cohort experienced an estimated blood loss greater than 1,000 mL. Place of birth was not found to be associated with risk of blood loss greater than 1,000 mL. More women experienced blood loss greater than 1,000 mL in the active management of labor group for all planned birth places. In this low-risk cohort, those women receiving active management of third stage of labor had a twofold risk (RR: 2.12, 95% CI: 1.39-3.22) of losing more than 1,000 mL blood compared with those expelling their placenta physiologically. Planned place of birth does not influence the risk of blood loss greater than 1,000 mL. In this low-risk group active management of labor was associated with a twofold increase in blood loss greater than 1,000 mL compared with physiological management. (BIRTH 39:2 June 2012).
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Background: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous
communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion
worldwide has concentrated on avoidance of bedsharing, the indigenous Māori community in New Zealand has
reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date
there has been no assessment of the safety of this traditional sleeping device.
Methods/Design: This two arm randomised controlled trial is being conducted with 200 mother-baby dyads
recruited from Māori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised
to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and
6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation,
and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time
head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned
sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of
time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight.
Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness,
maternal wellbeing, attachment to baby, and maternal sleep patterns.
Discussion: Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This
trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the
range of SUDI prevention research being undertaken worldwide.
Trials registration: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered
16th November 2010
Keywords: Sudden Unexpected Death in Infancy, Sudden Infant Death Syndrome, Infant, Sleep, Prevention,
Culture, Protocol, Indigenous, Bedsharing, Co-sleeping
Background: Sudden Unexpected Death in Infancy (SUDI) has persistent high rates in deprived indigenous
communities and much of this mortality is attributable to unsafe sleep environments. Whilst health promotion
worldwide has concentrated on avoidance of bedsharing, the indigenous Māori community in New Zealand has
reproduced a traditional flax bassinet (wahakura) designed to be used in ways that include bedsharing. To date
there has been no assessment of the safety of this traditional sleeping device.
Methods/Design: This two arm randomised controlled trial is being conducted with 200 mother-baby dyads
recruited from Māori communities in areas of high deprivation in the Hawkes Bay, New Zealand. They are randomised
to wahakura or bassinet use and investigation includes questionnaires at baseline (pregnancy), when baby is 1, 3, and
6 months, and an overnight video sleep study at 1 month with monitoring of baby temperature and oxygen saturation,
and measurement of baby urinary cotinine and maternal salivary oxytocin. Outcome measures are amount of time
head covered, amount of time in thermal comfort zone, number of hypoxic events, amount of time in the assigned
sleep device, amount of time breastfeeding, number of parental (non-feed related) touching infant events, amount of
time in the prone sleep position, the number of behavioural arousals and the amount of time infant is awake overnight.
Survey data will compare breastfeeding patterns at 1, 3, and 6 months as well as data on maternal mind-mindedness,
maternal wellbeing, attachment to baby, and maternal sleep patterns.
Discussion: Indigenous communities require creative SUDI interventions that fit within their prevailing world view. This
trial, and its assessment of the safety of a wahakura relative to a standard bassinet, is an important contribution to the
range of SUDI prevention research being undertaken worldwide.
Trials registration: Australian New Zealand Clinical Trials Registry: ACTRN12610000993099 Registered
16th November 2010
Keywords: Sudden Unexpected Death in Infancy, Sudden Infant Death Syndrome, Infant, Sleep, Prevention,
Culture, Protocol, Indigenous, Bedsharing, Co-sleeping