2009€¦ · epidural analgesia in labour in women with uncomplicated pregnancies having a first...

2009ANNuAL REpORT

2009ANNUAL REPORT

AIMS AND OBJECTIVESMCHR is a multidisciplinary research centre which aims to:

• undertakeandinterpretresearchonmothers’andchildren’shealth;• contributetopolicydevelopment;• provideadviceandresourcestoandcollaboratewithresearchersin

relatedfields;and•beinvolvedinpostgraduateandcontinuingeducation.

4 DIRECTOR’S REPORT 5 RESEARCH PROGRAM

5 HealtH ServiceS reSearcH5 Astudyoftheprovisionofthe

emergencycontraceptivepill(ECP)over-the-counter(OTC)inAustralia

5 Theemergencycontraceptivepillrescheduled:knowledge,attitudesandpracticeamongwomen–asub-studyofthestudyoftheprovisionoftheemergencycontraceptivepill(ECP)over-the-counter(OTC)inAustralia

6 Whyarewomenusingcomplementarymedicine to enhance fertility?

6 Theviews,experiencesandreferralpatterns of Victorian fertility specialists regardingfertilityenhancementbycomplementaryandalternativemedicine

6 Whatmotivatesgeneralpractitionersworkinginintegratedmedicalpracticesto use complementary medicine as treatment modalities?

6 Diabetes&AntenatalMilkExpressing(DAME):apilotprojecttoinformthedevelopmentofarandomised controlled trial

7 Apilotstudytounderpinalargetrialontheroleofacupunctureinreducingformalinductionoflabouranduseofepiduralanalgesiainlabourinwomenwithuncomplicatedpregnancieshavingafirstbirthat40plusweeks’gestation

7 Arewomenreallyscaredofgivingbirth?Women’sexplanationsforchoosingelectivecaesareansfortheirfirstbirth

7 COmparingStandardMaternitycarewithOnetoonemidwiferySupport(COSMOS):Arandomisedtrial

7 WAVE:Women’sandstaffviews: anevaluationofmaternitycareatBarwon Health

8 AreviewofpostnatalcareintheVictorianprivatehospitalsector(PinCPrivate)

8 Areviewofpostnatalcareocumentationin Victoria

8 Analternativeapproachtoearlypostnatal care: A pilot study

9 Alternativeapproachestoearlypostnatalcare:Exploringwomen’sviews

9 PinCANEW:Supportingwomenafterchildbirth

9 Areviewofhome-basedpostnatalcarein Victoria

9 Medicationsandbreastfeedingwomen:Knowledge,attitudesandpracticesofgeneralpractitioners

10 PeriNatal OUtcOMeS10 Perinataloutcomesfollowingtreatment

forcervicaldysplasia

10 Impactofsizeoftheexcisionfortreatmentforcervicaldysplasiaonsubsequentpregnancyoutcome

10 Birthoutcomesandmaternalandperinatalmorbidityassociatedwithinductionandaugmentationoflabourinuncomplicatedfirstbirths

10 PerinatalmorbidityamongAustralianwomenaged35yearsandolder

10 EarlyBirths–acase-controlstudyofverypretermbirth

10 MILC(mothers’andinfants’lactationcohort):Amulti-sitestudy

11 Theroleofmicro-organisms(S. aureus & C. albicans)inthepathogenesisofbreastpainandinfectioninlactatingwomen(CASTLEStudy)

11 Women’sattitudesandexperiencesofbreastfeeding–Doesmaternalweightmakeadifference?

11 Breastfeedingwomen’suseofbreastpumps:Adescriptivestudy

Contents

2 Mother & Child Health ResearchANNUALREPORT2009

Mother & Child Health ResearchANNUALREPORT20093

11 Systematic reviews11 Interventionstohelpwomentostop

smokinginpregnancy

11 Riskscoringsystemsforpredictingpretermbirthwiththeaimofreducingassociatedadverseoutcomes(Protocol)

12 collaborative Work12 TheWomenandBabiesWellbeing:Action

throughTrials(WOMBAT)Collaboration

12 crOSS-cUltUral iSSUeS12 SouthAsianWomen’sexperiencesof

livingwithGestationalDiabetesMellitus

12 Maternitycareandhealthafterbirth:theexperiencesofIranianandAfghanwomeninMelbourne,Australia

12 ImmigrantandAustralian-bornwomen’sexperiencesoflifewithanewbaby: a comparison

13 Improvingmaternitycareandobstetricoutcomesforimmigrantwomen

13 collaborative Work13 ReproductiveOutcomesAndMigration

(ROAM):aninternationalcollaboration

13 WOMeN’S HealtH aND rePrODUctiON

13 Theexperienceofpostnataldepressionin a rural Australian community

13 Improvingmaternalandchildhealthcareforvulnerablemothers(MOVE)

14 MOSAIC(MOtherS’AdvocatesIntheCommunity)aclusterrandomisedtrial

14 Systematic reviews14 Interventionstoreduceoreliminate

violenceandpromotethephysicalandpsychosocialwell-beingofwomenwhoexperienceintimatepartnerabuse: asuiteofsystematicreviews

14 Debriefingforthepreventionofpsychologicaltraumainwomenfollowingchildbirth

14 collaborative Work14 Weave:aclusterrandomizedtrialofa

multi-facetedpracticebasedsysteminterventionimplementedinVictoriangeneralpracticesforfemaleGPpatientsexperiencingintimatepartnerabuse

14 Women’sDisclosureStudy:disclosingpartnerabuseandperspectivesoninterventioninprimarycare

15 OtHer cOllaBOratiONS15 Cosmeticendocrinology:(re)

reconstructingfemininityintallgirls

16 EDUCATION AND CAPACITY BUILDING

16 POSTGRADUATESTUDY2009

16 PostgraduateProjects

17 SEMINARSATMCHR

17 JOURNAL CLUB

17 TEACHING

17 VISITINGACADEMICSIN2009

18 PUBLICATIONS18 ARTICLESINREFEREEDJOURNALS

18 ARTICLESINPRESS

19 ARTICLESSUBMITTED

19 ANNOTATIONS,COMMENTARIES,EDITORIALSANDOTHERINVITEDCONTRIBUTIONSTOREFEREEDJOURNALS

19 BOOKCHAPTERS

19 BOOKREVIEWS

20 CONFERENCEABSTRACTS

21 ADVOCACY & OTHER ACTIVITIES

21 PUBLICHEALTHADVOCACY

21 TALKSANDLECTURES

21 MCHRREFERENCEGROUPS

21 CONFERENCESANDWORKSHOPSATTENDED

21 COURSESATTENDED

21 REVIEWINGPAPERS

21 COMMITTEES

22 MEMBERSHIPSOFEDITORIALBOARDS

22 ASSESSINGRESEARCHGRANTS

22 THESISEXAMINATION

23 STAFF & STUDENTS

27 CURRENT GRANTS, SCHOLARSHIPS & AWARDS

28 FUNDS


Director’s Report

2009wasayearofpostgraduatecompletionsandsuccessatMCHR.LynWatson,KaralynMcDonaldandJoRaynergraduatedwithPhDs,andFionaBruinsmaandTouranShafieisubmittedtheirdoctoraldissertationslateintheyear.Boththeseshavenowalsobeenpassedandtheygraduatein2010.InJunewealsocelebratedMary-AnnDavey’sreceivingoftheStephenDuckettAwardforthebestpostgraduatedissertationintheFacultyofHealthSciencesfor2008.Buildingpublichealthresearchcapacityfromgraduatelevelthroughsupportforpostgraduatestudiesamongstaffandfull-timestudentshasalwaysbeenakeystrategyatMCHR,anditisgratifyingtoseetheseeffortsbringfruit,bothfortheCentreandfortheindividualsinvolved.

JudithLumley,ourformerDirector,wasawardedthetitleofProfessorEmeritabyLaTrobeUniversityinMayinrecognitionofheroutstandingcontributionstoperinatalepidemiology,publichealthandmaternityservicesresearch,andherleadershipofMCHRsinceitsfoundationin1991.MuchofourresearchcontinuestobeinspiredbywhatJudithtaughtusallabouttheimportantperinatalquestions,andtheappropriatemethodstoinvestigatethem.

MOSAIC,ourclustertrialofnon-professionalmentormothersupportforchildbearingwomenexperiencingintimatepartnerabuse,ledbyAngelaTaft,completedfinaldatacollectionduringtheyear,withthefindingstobepublishedin2010.Thecaseloadtrialofone-to-onemidwifery(COSMOS)ledbyHelenMcLachlan,continuedtorecruitwell,withmorewomenwishingtotakepartthancouldalwaysbeaccepted.Recruitmentwillbecompletein2010.AndLisaAmirbeganamajorstudyofbreastandnipplepaininlactatingwomen(CASTLE)atthebeginningoftheyear,withrecruitmentofwomennowalsounderway.AllthreestudiesreceivedfundingthroughtheNationalHealthandMedicalResearchCouncil,whichcontinuestobethemajorsourceoffundingforresearchattheCentre.OurNHMRCCapacityBuildinggrantinPopulationHealthResearchalsocontinuestosupportsevenpostdoctoralstaff,infullorpart-timecapacities.Thefocusofdevelopmentactivitiesduringtheyearwasonmethodsforcomplexpublichealthresearch,collaborativeparticipatoryapproachestoresearchandresearchpartnerships,thechallengesofimplementingcomplexinterventionsandwritingforpublication.

LaTrobeUniversitytookasignificantsteptowardsprovidingbetterjobsecurityforgrant-fundedresearchstaff,withthesigningofanewCollectiveEnterpriseAgreementinDecember2009,whichincludedthecreationofanewcategoryof‘ResearchContinuingEmployment’forstaffwithmorethanfouryearsofcontinuousservice.SixstaffattheCentretransfertothisnewemploymentcategoryin2010.

Asalways,weenjoyedtheenrichmentprovidedbyvisitingacademicsduringtheyear.ProfessorJillAstbury(VictoriaUniversity)spentamonthattheCentreinMayandProfessorLeahAlbers(UniversityofNewMexico),aninvestigatorwithCOSMOS,visitedagaininNovember.Aswell,anumberofstaffspenttimeoverseasduringtheyearestablishingorcontinuingresearchcollaborationsinEuropeandNorthAmerica.Someoftheseinternationalcollaboratorswillbenewinvestigatorsonourresearchgrantapplicationsin2010.

2009hasalsobeenaproductiveyearforresearchpublications:27paperspublishedorinpressinrefereedjournals,with11furthermanuscriptssubmitted.StaffarealsoactiveinreviewingmanuscriptsforawiderangeofinternationalandnationaljournalsandseveralaremembersofEditorialBoards.

IwrotethisreportlastyearasMCHR’sActingDirector.InDecember2009IwasappointedDirector.HavingworkedattheCentresinceitsestablishmentin1991,Icontinuetobeexcitedabouttheworkthatstaffandstudentsaccomplishhere,inpartnershipwithourmanycollaborators.AndastheCentrebeginsits20thyear,Ifeelcertainthatwewillcontinuetomakeacontributiontopublichealthresearchtoimprovethehealthandcareofwomenandbabies.

rhonda Small Director April2010


Research program

TheprimaryresearchfocusofMCHRisinthefollowingareas:

•Healthservicesresearchfocusedonpregnancyandbirth

•Perinataloutcomes

•Cross-culturalissues

•Women’shealthandreproduction

Thecriteriaforchoosingspecifictopicsisthattheyareallmajorpublichealthissuesintermsofburdenofdisease,theimplicationsfor women and their families and the resource implications of theconditionforhealthservicesorforsocietyasawhole.MCHRhasastronginterestinhealthservicesresearch,andbuildsonobservationalstudiestodesignandimplementinterventionstudiesinhospitals,primarycareandcommunitysettings.Thisinvolvesworkingwithhealthservicemanagers,caregivers,communityorganisationsandlocalcouncilstoimplementandevaluateinterventions.Techniquesofevaluationincludehealthoutcomeassessmentandprocessandimpactmeasures,makinguseofbothquantitativeandqualitativemethods.

AmajorfocusofanumberofMCHRprojectsisonthematernalsequelaeofreproductiveevents,inparticularantecedentsofpretermbirthandphysicalandpsychologicaldisordersinitiatedoraggravatedbypregnancy,labourorbirth.Studiesaddressingtheseissuesincludeuseofroutinelycollecteddataandrecordlinkage,observationalsurveysandinterviewstudies,cohortstudiesandrandomisedtrialswithlongtermfollow-upofparticipants.AnotherfocusofMCHRworkisthehealthandchildbearingexperienceofwomenoflinguisticallydiversebackgrounds,andthedevelopmentofculturallyrelevantresearchmethodsandapproaches.

HEALTH SERVICES RESEARCH

a study of the provision of the emergency contraceptive pill (ecP) over-the-counter (Otc) in australiaAngela Taft, Judith Lumley and Melissa Hobbs in collaboration with Kay Stewart and Colin Chapman, Victorian College of Pharmacy, Monash University; Julia Shelley, School of Health and Social Development, Deakin University; and Anthony Smith, Australian Research Centre in Sex, Health and Society, La Trobe University

Thereisnationalconcernabouttherisingrateofunwantedandunplannedpregnanciesandpregnancyterminations.Thisstudysoughttoexaminetheknowledge,attitudesandpracticesofanational random sample of Australian women and pharmacists abouttheuseoftheemergencycontraceptivepill(ECP)levonorgestrel.ECPwasrescheduledtooverthecounterprovisioninpharmaciesin2004.WeexaminedfactorsinvolvedinuseofECPamongwomenandunderwhatcircumstancespharmacistswouldrefusesupply.

427(29%)Australianpharmacistsrespondedtoanationalpostalsurvey.Amajority(75%)haddeclinedtosupplyECPoncertainoccasions.Factorssignificantlyassociatedwithsupplypracticesincludedpharmacistattitudestowardsacceptabilityofadvancesupply,theirageandgenderandpharmacyaccessibility.

Wealsoconductedanationalcomputer-assistedtelephoneinterviewwith632women(74.4%),aged16to35years.26%hadeverusedECP,and66%ofthesehaddonesowithoutaprescription.Themostcommonreasonfornotusingit(57%)wasthatwomendidnotthinktheywereatriskofgettingpregnant.32%believedincorrectlythatECPwasanabortionpill,andonly48%wereawareitwasavailablefromapharmacywithoutprescription.FUNDiNG:AustralianResearchCouncilLinkagegrant

StatUS:Datacollectionandanalysiscomplete.Onepaperandoneletterpublished,twopaperssubmittedandanotherplanned

the emergency contraceptive pill rescheduled: knowledge, attitudes and practice among womenMelissa Hobbs, Angela Taft, Lisa Amir and Judith Lumley

Theaimofthisstudyistoassesswhetherthereschedulingoftheemergencycontraceptivepill(ECP),levonorgestrel,inAustraliahasimproveditsaccessibilityandusebywomenatriskofunwantedpregnancy.Thestudyhasusedbothqualitativeandquantitativemethods,involvingfocusgroupswithusersofECPtoexploreknowledgeof,accessto,attitudestowardsandexperiencesofusingECP.TheinformationobtainedfromthesefocusgroupsinformedthedevelopmentofComputerAssistedTelephoneInterviews(CATI)witharandomsampleof632Australianwomenaged16-35.

Sixfocusgroupswithwomenhavebeencompletedandanalysed.ThenationalCATIsurveywasconductedbytheHunterValleyResearchFoundationbetweenMayandAugust2008.FUNDiNG:AustralianPostgraduateAward(Industry)2006-2008

StatUS:Projectcompleted,onepaperpublishedandonesubmitted,PhDthesiswritingup(MH)

Research program 2009


Why are women using complementary medicine to enhance fertility?Jo Rayner and Della Forster in collaboration with Helen McLachlan and Rhian Cramer, Division of Nursing and Midwifery, La Trobe University

InfertilitytreatmentisanincreasingphenomenoninAustraliaandcurrenttrendsinwomen’sageatfirstbirthsuggestmoreAustraliancoupleswillseekassistedreproductivetechnologies(ART)toachieveparenthood.Complementarymedicine(CM)hasbecomeapopularhealthcareoptionforavarietyofchronichealthconditionsandwomenaretheprimaryusers.WhilethenationalandinternationalevidencedemonstrateswidespreaduseofCMtoalleviatereproductiveandobstetricproblems,therearemanyunknownsregardingCMusetoenhanceorsupportfertility.

TheaimofthestudywastoexploreanddescribewhywomenuseCMforfertilityenhancementfromtheirperspectiveandtheperspectiveofthepractitionerstheyconsult.Focusgroupswereundertakeninlate2007,onewithCMpractitionersandtwowithwomenwhouseCM.ThefindingssuggestincreasingnumbersofwomenseekingtocomplementARTwithCMbecauseofunsuccessfulornegativeexperiencesandwomenreportpositiveandempoweringrelationshipswithCMpractitionersirrespectiveofpregnancyoutcomes.Furtherresearchisrequiredontheprevalence,safetyandoutcomesofCMuseforfertilityenhancement.FUNDiNG: None

StatUS:Onepaperpublished,MasterofMidwiferythesiswritingup(RC)

the views, experiences and referral patterns of victorian fertility specialists regarding fertility enhancement by complementary and alternative medicine Jo Rayner, Helen McLachlan, Della Forster and Michelle Kealy in collaboration with Marie Pirotta, Department of General Practice, University of Melbourne; and David Ellwood, Department of Medicine, Australian National University

InfertilitytreatmentisincreasinginAustraliaandcurrenttrendsinwomen’sageatfirstbirthsuggestmoreAustraliancouplesmayneedtoseekassistedreproductivetechnologies(ART)toachieveparenthood.IncreasinglyAustraliansareusingcomplementaryandalternativemedicines(CM),oftenwithouttheknowledgeoforthodoxmedicalpractitioners,potentiallyincreasingtheriskofinteractionsandadverseeffects.ThereisverylittledataontheuseofCMinfertilityenhancement(e.g.extentofuse;costs;women’swillingness-to-pay;whatCMmodalitiesarecommonlyused;andwhatproportionofmedicalfertilityspecialistsrefertoCMpractitioners),andlimitedknowledgeofpotentialsideeffectsofmanyCMproducts,particularlywithrespecttotheiruseinthepericonceptionalperiod.

Inananonymouspostalsurvey,thisstudyexploredVictorianfertilityspecialists’viewsonwomen’suseofCMforfertilityenhancement.AllmedicalspecialistsapprovedundertheInfertilityTreatmentAct1995andlistedwiththeInfertilityTreatmentAuthority(ITA)topractiseinVictoriawereinvitedtoparticipate.Ninespecialistsreturnedcompletedsurveys,aresponsefractionof18%.AnattempttoexpandthestudytoincludefellowsoftheRoyalAustralianandNewZealandCollegeofObstetriciansandGynaecologists(RANZCOG)wasunsuccessfulwithpermissiontoconductthestudydeclinedbytheRANZCOGQualityCommittee.FUNDiNG:LaTrobeUniversityFacultyofHealthSciencesresearchgrant2007

StatUS:onepaperpublished

What motivates general practitioners working in integrated medical practices to use complementary medicine as treatment modalities? Jo Rayner in collaboration with Karen Willis, Department of Sociology and Social Work, University of Tasmania and Marie Pirotta, Department of General Practice, University of Melbourne

Theuseofcomplementarymedicine(CM)asahealthcareoptionhasgrownexponentiallyinAustraliaandelsewhere.CMisdifficulttodefineasitencompassesadiverserangeofbeliefs,practices,andtreatments.InternationallyCMisincreasinglybeingintegratedintogeneralmedicalpractice,possiblydrivenbyconsumerdemand.Whatmotivatesgeneralpractitioners(GPs)toembraceCMiscurrentlyunclear,asisanyunderstandingofwhatevidence-basesGPsdrawontoadviseortreattheirpatients.Most research has focused on why consumers choose CM rather thanonproviderrationales.Usingin-depthinterviews,thisprojectaimstoinvestigatethereasonswhyGPschoosetointegrateCMmodalitiesintotheirmedicalpracticebyexploring:

1.GPsviewsonevidenceintheirtreatmentdecisionmaking;

2.whetherthereisdifferentiationintheirchoiceofCMtreatmentmodalities;and

3.theextenttowhichtheirreasonsforusingCMareinfluencedbyconsumerdemand,economicconsiderationsordissatisfactionwithcurrenttreatmentoptions.

Thisstudywillinformalargerbodyofresearchthatexploreswomen’suseofCMtoenhancetheirfertilityandthefindingswillinformthedevelopmentofanationallycompetitivegrantapplication.FUNDiNG:FacultyofHealthScienceresearchgrant2008

StatUS:23interviewscomplete;analysisunderway;preliminaryfindingspresentedattwoconferencesin2009;onepaperinpreparation

Diabetes & antenatal Milk expressing (DaMe): a pilot project to inform the development of a randomised controlled trialDella Forster in collaboration with Kerri McEgan, Gillian Opie, Susan Walker and Cath McNamara, Mercy Hospital for Women; and Anita Moorhead and Rachael Ford, Royal Women’s Hospital

Infantsofwomenwithdiabetesareatincreasedriskofhypoglycaemia.Somehospitalsencouragewomenwithdiabetestoexpressbreastmilkbeforebirth,yetthereislimitedevidenceforeffectiveness.Apilotstudywasconductedtoestablishthefeasibilityofconductinganadequatelypoweredrandomisedcontrolledtrialtoevaluatethispractice.

Werecruited43pregnantwomenwithpre-existingorgestationaldiabetes(requiringinsulin)andattendingtheMercyHospitalforWomen(MHW).Tobeeligiblewomenneededtobe:34-36weeksgestation;withasingletonpregnancyinacephalicpresentation;abletospeak,readandwriteEnglish;andplanningtobreastfeed.Womenwereexcludediftheyhadahistoryofspontaneouspretermbirth;hadanantepartumhaemorrhageorplacentapraeviainthecurrentpregnancy;oriftherewereanysignsoffetalcompromise.Womenwereencouragedtoexpresscolostrumtwiceadayfrom36weeksgestation,andadvisedhowtostorethecolostrum,whichwasfrozenfortheirbaby’suseafterbirth.Datawerecollectedatrecruitment,afterbirthandatsixandtwelveweekspostpartum.AconcurrentauditwasconductedofsimilarinfantsbornattheMHWorRoyalWomen’sHospitalduringthesameyear,asacomparisongroup.

Ourfindingshavebeenusedtoinformthedevelopmentofarandomisedcontrolledtrial.FUNDiNG:MercyHospitalforWomenandNovo-nordisk

StatUS:Onepaperpublished,trialprotocolsubmittedforfunding


a pilot study to underpin a large trial on the role of acupuncture in reducing formal induction of labour and use of epidural analgesia in labour in women with uncomplicated pregnancies having a first birth at 40 plus weeks’ gestationMary-Ann Davey, in collaboration with Caroline Smith, University of Western Sydney

Thereiswidespreadconcernatthehighrateofcaesareansection(CS)–currentlymorethan30%ofbirthsinVictoria.BothinductionoflabourandepiduralanalgesiaareassociatedwithCS,soreducingtherateofthesehasthepotentialtoaffecttheCSrate.Thereismixedevidenceontheeffectivenessofacupunctureininitiatinglabour,andassistingwomentomanagepaininlabour.ThisstudywillexplorethefeasibilityofconductingalargerandomisedcontrolledtrialtoinvestigatetheroleofacupunctureinreducingtherateofCS.FUNDiNG:FacultyofHealthScienceresearchgrant2009

StatUS:Planning

are women really scared of giving birth? Women’s explanations for choosing elective caesareans for their first birthKaralyn McDonald, Jo Rayner and Rhonda Small

Australiahashighratesofcaesareanbirth(>30%)andtheliteraturesuggeststhismayinpartberelatedtofactorssuchaswomen’sfear,maintainingasenseofcontrolandobstetricians’concernsaroundriskandlitigation.Onlyonequalitativestudywasfoundexploringmaternalrequestforcaesareanbirthamongprimiparouswomen.NosuchresearchhasbeenundertakeninAustralia.Usingin-depthinterviews,thisprojectwillexplorewomen’sexplanationsforchoosingnon-medicallyindicatedcaesareanbirthduringtheirfirstpregnancy.FUNDiNG:FacultyofHealthScienceresearchgrant2009

StatUS:Planning

cOmparing Standard Maternity care with One to one midwifery Support (cOSMOS): a randomised trial Helen McLachlan, Della Forster, Mary-Ann Davey, Lisa Gold, Judith Lumley, Mary Anne Biro and Michelle Newton in collaboration with Tanya Farrell and Jeremy Oats, Royal Women’s Hospital; Ulla Waldenstrom, Karolinska Institute; and Leah Albers, University of New Mexico

ContinuityofcarerintheprovisionofmaternitycarehasbeenstronglyrecommendedandencouragedinVictoriaandthroughoutAustralia.TheVictorianDepartmentofHumanServices(DHS)releasedapolicydocument“FuturedirectionsforVictoria’smaternityservices”inJune2004whichendorsedandpromotedtheexpansionofpublicmodelsofmaternitycarethatoffercontinuityofcarer.Manyhospitalshaverespondedbyintroducingcaseloadmidwifery,aonetoonemidwiferymodelofcareinwhichwomenarecaredforbyaprimarymidwifethroughoutpregnancy,birthandtheearlypostnatalperiod.However,thismodelofcarehasyettobesubjectedtorigorousevaluation.

“Onetoonemidwifery”orcaseloadcareisbeingimplementedundertrialconditionsattheRoyalWomen’sHospital.Wewillevaluatewhethercaseloadmidwiferydecreasesinterventionsduringchildbirth(suchascaesareanbirths,instrumentalvaginalbirths,andinductionoflabour)comparedwithstandardmaternitycare.Wewillalsocomparearangeofotheroutcomessuchasperinealtrauma;postnataldepression;maternalsatisfactionwithcare;initiationanddurationofbreastfeeding;costs;healthoutcomesformothersandbabies;andtheimpactofthemodelonmidwivesandotherstaffintheorganisation.TwothousandwomenatlowriskofmedicalcomplicationswillberecruitedtotheCOSMOStrial.WecommencedrecruitmentinSeptember2007andtodate1750womenhaveagreedtoparticipateand1200womenhavegivenbirth.Thisstudyisthefirstrandomisedcontrolledtrial

inAustraliaofcaseloadmidwiferycare.Theresultsareurgentlyneededandwillassistpolicymakersandmaternityservicesinplanningforfuturemodelsofmaternitycare.FUNDiNG:NHMRCprojectgrant2007-2010

StatUS:Recruitmentinprogress

Wave: Women’s and staff views: an evaluation of maternity care at Barwon HealthHelen McLachlan, Della Forster, Mary-Ann Davey and Jane Morrow, in collaboration with Michelle Newton, Division of Nursing and Midwifery La Trobe University; and Therese Cotter and Jenny Kelly, Barwon Health

In2008BarwonHealthimplementedtwomajorchangestoitsmaternityserviceprovision:are-organisationofpostnatalcare and the implementation of a caseload midwifery model of maternitycare.Postnatalcareprovisionwasalteredtobeamoreflexible,individualisedmodelofcarefocusedonpromotingthenormalisationofthepostnatalperiod.ChangescommencedinJanuary2008andincludedencouragingwomentoselfcaterforbreakfast;toindependentlycareforthemselvesandtheirbabywhereappropriate;promotingrest;providingcommunalspaceforsocialisation;encouragingandprovidinggroupeducation;cessation of the use of maternal and neonatal clinical pathways toguidecareforwomenwhohavehadavaginalbirth;andimplementingafocusedtimewheremidwivesspecificallysitanddiscusstheeducationandsupportneedsidentifiedbywomenthemselvesinsteadofundertakingroutinepostnatalobservations.

Caseloadmidwifery(calledMidwiferyGroupPractice(MGP))wasimplementedinJuly2008.Womenreceivingcaseloadcarereceiveantenatal,intrapartumandpostpartumcarefromaprimaryMGPmidwifewithoneortwoantenatalvisits(andothercareasrequired)bya‘back-up’midwife.MGPmidwivescollaboratewithobstetriciansandotherhealthprofessionalsasnecessaryandprovidecareuntilafterthebirthofthebabyandattendforsomepostnatalcareanddomiciliarycarefollowingdischargefromhospital.

Anevaluationofthechangesincludesthreecross-sectionalsurveysofwomen(550ateachtimepoint);twocross-sectionalsurveysofmidwives(allmidwivesinmaternityservicesateachtimepoint);keyinformantinterviewswith10-15women,10-15midwivesandotherkeystakeholders;andtwofocusgroupswith8to10midwivesineach.Specificaimsareto:

•Exploretheviews,experiencesandhealthoutcomesofwomenwhogivebirthatBarwonHealthfollowingtheimplementationofchangestopostnatalcare,andfollowingtheintroductionofcaseloadmidwiferyandcomparethesetotheviews,experiencesandhealthoutcomesofwomenwhogavebirthpriortothechanges;and

•Exploretheviewsandexperiencesofthecliniciansandotherkeystakeholdersinvolvedintheprovisionofpostnatalcareandcaseloadmidwifery.FUNDiNG:DepartmentofHumanServicesVictoriaandBarwonHealth

StatUS:Datacollectionongoing,analysisunderway,firstreportsubmittedtoBarwon Health


a review of postnatal care in the victorian private hospital sector (PinC Private)Jo Rayner and Della Forster in collaboration with Helen McLachlan and Louise Peters, Division of Nursing and Midwifery, La Trobe University; and Jane Yelland, Murdoch Childrens Research Institute

Thefirstreviewofpostnatalcarefromtheperspectiveofpublichospitalcareproviders(PinC)wasundertakenin2004andinvolvedasurveyofpublicmaternityfacilitiesinVictoriaandinterviewswithkeyinformantsfromselectedhospitals.ThefindingsrevealedadiversityofpracticesintheprovisionofcareacrosstheState,includingdifferencesintheorganisationofcare,staffingarrangements,facilitiesandroutinepractices.Barrierstoprovisionofhighqualitypostnatalcarewerealsoidentifiedincludingthebusynessoftheunits,theinadequacyofstaff-patientratios,andtheprioritygiventootherepisodesofcare.

GiventhatapproximatelyonethirdofVictorianbirthsoccurintheprivatesectorareviewofpostnatalcareintheprivatesector(PinCprivate)wasundertakenin2006toprovideacomprehensiveunderstandingofthestructureandprovisionofpostnatalcareinVictoria.Apostalquestionnairewassenttoallprivatehospitals(n=19)providingmaternityservicesandin-depthinterviewswereconductedwithcareproviders(n=11)atselectedregionalandmetropolitanhospitals.Whiletheresponseratewaslowerintheprivatesector(14/19hospitals,76%),thepostalsurveyrevealedsimilarbarrierstotheprovisionofpostnatalcarehighlightedinthepublicreview,despitesomedifferencesintheorganisationofpostnatalcare.Analysisoftheinterviewssuggestsamismatchbetweenwomen’sexpectationsofpostnatalcareandthatofcareprovidersintheprivatesector.FUNDiNG:FacultyofHealthSciencesresearchgrant2006,MCHRGrant2006

StatUS:projectcomplete,onepapersubmitted,MastersofMidwiferyminorthesispassed(LP)

a review of postnatal care documentation in victoriaDella Forster and Helen McLachlan in collaboration with Tracey Savage, Division of Nursing and Midwifery, La Trobe University

Asdocumentationislikelytohaveasignificantinfluenceontheprovisionofpostnatalcare,weaimedtoanalysealldocumentationusedinpostnatalcareinVictoria.Hospitalsresponding(80/88,91%)tothestate-widesurveysofpostnatalcare(PinC and PinC Private)wereaskedtoprovideanydocumentsusedintheprovisionofpostnatalcare.Alldocumentswerecategorisedandanalysedforcontent.ClinicalpathwaysweresystematicallyreviewedusingtheIntegratedCarePathwayAppraisalTool(ICPAT).Providers’commentsrelatingtopostnataldocumentationandclinicalpathwayscollectedinthesurveyswerealsosummarisedtogainamoreindepthunderstandingofthedocumentsinuse.

Atotalof1611documentsfrom73oftheparticipatinghospitalsincluding:clinicalpathways(n=146);educationalmaterial(n=776);andother(n=689).Therewereover100uniquesourcesofeducationalmaterialforwomen,althoughonly10%werereferencedand55%dated.Therewasahighlevelofduplicationof clinical documentation of medication administration as well as neonatalbirthweightandscreening.Ninetypercentofhospitalsreportedusingclinicalpathwaysand131differentclinicalpathwayswereappraised.Nonemetallappraisalcriteria:37%weretask,notoutcomefocused;9%couldactasadecisionsupporttool;50%promotedindividualisedcare;and38%weremultidisciplinary.Providersweregenerallysupportiveofclinicalpathways,claimingtheyareusefulandstandardisecarebutthatinpracticetheyinhibitedmultidisciplinarycommunication.Commentsinvolvinggeneraldocumentationforpostnatalcarewerefarlesspositive,andrelatedtopoordocumentation,excessivetimedemandsandageneralneedforimprovement.Preliminaryfindingssuggestastate-wideapproachmayberequiredtoregulatethequantityandqualityofpostnataldocumentationandeducationalmaterials.Thiswillminimisetimeandresourceuse,reduceareasofduplication,

decreasecostsandaddressriskmanagementissues.Itisalsotimelytoredesign(usingcurrentevidenceorICPATtemplates)andstandardise or reconsider the role of clinical pathways in postnatal careandexploretheimpacttheymayhaveonindividualisedandmultidisciplinarycare.FUNDiNG: none

StatUS:projectcomplete,MastersofMidwiferyminorthesispassed(TS),threepapers in preparation

an alternative approach to early postnatal care: a pilot studyHelen McLachlan, Della Forster, Jo Rayner in collaboration with Tanya Farrell and Tracey Savage the Royal Women’s Hospital; Jane Yelland, Murdoch Childrens Research Institute; and Lisa Gold, Deakin University

AdecadeofVictorianresearchhasidentifiedwomen’slowlevelsofsatisfactionwiththehospitalstayfollowingbirth.Whilstthelengthofthehospitalstayhasdeclineddramaticallysincethe1980sinAustralia,researchevidenceevaluatingearlydischargeislimited.Pressureonhospitalpostnatalbedshasincreased,withearlypostnataldischargebecomingcommondespitelackofrigorousevidenceregardingassociatedoutcomes.Weaimtodeterminethefeasibilityofimplementinganadequatelypoweredrandomisedcontrolledtrialtoinvestigatethisissue.

Wepreviouslyexploredwomen’sviewsonpostnatalcareandtheacceptabilityofalternativepackagesofcare;womenthoughtpostnatallengthofstayneededtobeindividualised.Wearethereforepilotinganinterventionthatismoreasthewomensuggested;individualisedflexiblehome-basedearlypostnatalcare,exploring:feasibility;theresourceimplications;andwomen’sandstaffviewsandexperiences.

WomenexpectingtogivebirthbetweenNovember2007andMarch2008wereofferedparticipationinmid-pregnancyuntil108womenwererecruited.Womenwereintroducedtotheconceptofearlyhome-basedcare,withlengthofstayinverselyproportionaltonumberofhomemidwifevisits,toamaximumof5homevisitswithdischargelessthan12-24hours(or48hoursfollowingacaesareanbirth).Womenwereseenagainat36weekstodiscusstheirindividualplan.Womencompletedquestionnairesatrecruitmentand8weekspostpartum.Obstetricdatawereobtainedfromthemedicalrecord.Focusgroupsandinterviewsexploredmidwives’views.Aneconomicevaluationwasundertaken.FUNDiNG:FacultyofHealthSciencesresearchgrant2007;granttotheRoyalWomen’sHospitalfromtheVictorianDepartmentofHumanServices

StatUS:interventionanddatacollectioncompleteandanalysisunderway;papers in preparation


alternative approaches to early postnatal care: exploring women’s viewsDella Forster, Helen McLachlan and Jo Rayner, in collaboration with Sharon Rayner as part of the Public Health Training Program; Jane Yelland, Murdoch Childrens Research Institute; and Lisa Gold, Deakin University

ThereisgrowingevidencefromAustraliaandoverseasthatthecareprovidedinhospitalintheearlypostnatalperiodislessthanidealforbothwomenandcareproviders.Inaddition,inmanyhealthservicesinVictoria,particularlymetropolitan,thepressureonhospitalbedshasincreased,andthephysicalspaceavailabletocareformothersandtheirbabiesmaybelimited.Manyservices,especiallytertiaryreferralhospitals,havehadtorespondbydischargingwomenmuchearlierthanplannedorexpected,oftenwithlittleornopreparationduringpregnancy.EightfocusgroupsandfourindividualinterviewsinbothruralandmetropolitansectorsofVictoriaaimedtoexplorewomen’spreferencesforpostnatalcareandtheacceptabilityofproposedalternativepackagesofcare.Proposedpackagesrelatedforthemostparttoashorterlengthofhospitalstaywithvariouscareoptions.

Participantsdidnotgenerallyrespondfavourablytowardsthepackagesthatweresuggested;theyfeltthatthepackageswouldnotprovidethelevelofcarethattheyexpected.Manysuggestedthatpostnatalcareneededtobeflexibletomeettheneedsofeachindividual.Women’smainconcernsrelatedtoashorterlengthofstay,especiallyforfirsttimemothers.Generally,participantsdidnotbelievethatdomiciliaryvisitscompensatedforforgoingtheperceivedsecurityandvalueofstayinginhospital.Thewomeninthisstudyweregenerallyoftheviewthatbeinginhospitalduringthefirstdaysafterthebirthoftheirbabywassaferforthebabythaniftheywerehome.Manylackedconfidenceinthemselvesasnewmothersregardingtheirabilitytocarefortheirbaby.Therewasaconsistentviewthatthephysicalpresenceandavailabilityofprofessionalsupporthelpedalleviatetheseconcerns,andthiswasespeciallythecaseforwomenhavingafirstbaby.

Giventhissituation,womenunderstandablyhaveconcernsaboutanymovestoshortenthelengthofthepostnatalhospitalstay.Womendonotbelievethatincreaseddomiciliaryvisitscancompensateforforgoingtheperceivedsecurityandvalueofstayinginhospital.Itiscrucialthatwomen’sconcernsandneedsbeconsideredwhenservicedeliverychangesareplanned.Henceitisimportantthatanymovetowardsashorterpostnatallengthofstayisevaluated,intermsofthephysicalandmentalhealthofbothmotherandbaby,andthemother’ssatisfactionwiththecarereceived.FUNDiNG:FacultyofHealthSciencefacultygrant2006,MCHRgrant2006

StatUS:reportdisseminated,twopaperspublished

PinC ANEW: Supporting women after childbirthHelen McLachlan, Della Forster, Jo Rayner and Rebecca Collins in collaboration with Kelsey Hegarty and Jane Gunn, Department of General Practice, University of Melbourne; Jane Yelland and Stephanie Brown, Murdoch Childrens Research Institute; Lisa Love and Margie Cass, Mercy Hospital for Women; and Jenny Kelly, Barwon Health

Analternativeapproachtopsychosocialriskscreeningwhichfocusedonadvancedcommunicationskillsformidwivesanddoctorswasimplementedasasix-montheducationprogram(ANEW)andevaluatedusingabefore/afterdesign.Theprogramevaluationshowedthatmidwivesanddoctorsself-reportedcomfortandcompetencywhenidentifyingandcaringforwomenwithpsychosocialdifficultiesincreased.IntherecentVictorianstate-widereviewofhospitalpostnatalcare(PinC),55%ofkeyinformantsraisedtheissuethatsomemidwivesarenotcomfortabledealingwithpsychosocialissues.ThePinCreviewrecommendedthat an ANEWstyleprogrambeconsideredforstaffwhocareforwomenduringthepostnatalperiod.Giventhecontextofthepostnatalenvironment,women’slowratingsofsatisfactionwithcare,limitationsofpsychosocialriskscreening,andthechallengesforcareprovidersindealingwithsensitiveissues,are-emphasisonanindividualneeds-basedapproachislikelytobebeneficialtowomenafterchildbirth.Anewapproachtopostnatalcarefocusing

onadvancedcommunicationskillsofmidwivesandnursesmayalsoimprovewomen’ssatisfactionwithcareandenhancewomen’scomfortindisclosingpsychosocialissueswiththepotentialtoimpactonotherhealthoutcomessuchasbreastfeeding.In2006weredesignedtheoriginalANEWprogramtomakeitsuitabletothepostnatalenvironment.Theredesignedpackageshavebeenpilotedattwositesandevaluatedusingabefore/afterdesign.Thisprogramalsoincreasedtheself-reportedcomfortandcompetencyofmidwivestoidentifyandcareforwomenwithpsychosocialissuesduringthepostnatalperiod.FUNDiNG:FacultyofHealthSciencesresearchgrant2006

StatUS:studycompleted,minorthesispublished(RC),papersubmitted

a review of home-based postnatal care in victoriaHelen McLachlan, Della Forster, Michelle Kealy in collaboration with Tanya Farrell and Rachael Ford, Royal Women’s Hospital

Thecarewomenreceiveafterhavingababyislikelytohaveasignificantimpactontheirhealthandwell-being.Withtherisingnumberofbirths,manyhealthservicesinVictoria(includingtertiaryreferralhospitals),havehadtorespondbydischargingwomenmuchearlierthanplannedorexpected.Womenreceiveoneortwohomevisitsbyahospitalmidwife,yettherehasbeennoevaluationoftheprovisionofhome-basedpostnatalcareinVictoria,andthereisverylittleevidencetoguidecare.Theaimoftheprojectistoexplorehome-basedpostnatalcareintermsofwhatiscurrentlyprovided;whatwomenexpect;andhowpreparedmidwivesaretoprovidehome-basedpostnatalcare.Thisprojectincludesthreecomponents:focusgroups(withmidwives),semi-structuredinterviewswithpostpartumwomenandasurveyofpublichospitalmanagersofmaternityservices.

Theprojectwillbethefirsttoprovideurgentlyneededinformationregardingthestructureandcontentofpostnataldomiciliarycare.Itisourintentionthatthisexploratorystudywillprovidevaluabledatatoinformclinicalpracticeaswellaspolicy.Itwillalsoguidefutureresearchandifappropriate,mayinformafuturerandomisedcontrolledtrialtoexploretheassociationbetweendifferenttypesofpostnatalcareprovisionandclinicaloutcomes.FUNDiNG:FacultyofHealthSciencesresearchgrant2008

StatUS: Data collection

Medications and breastfeeding women: Knowledge, attitudes and practices of general practitionersLisa Amir and Jeanne Daly in collaboration with Marie Pirotta, Department of General Practice, University of Melbourne, and Swee Wong, Pharmacy Department, Royal Women’s Hospital

Attimes,womenwhoarebreastfeedingwillconsidertakingmedicines.Thesemayincludecomplementaryandover-the-counteraswellasprescribedmedicines.Generalpractitionerstendtorelyonpharmaceuticalcompaniesforinformationaboutmedicines.Thecompanies’usualadviceistobecautiousaboutprescribingmedicinestobreastfeedingwomen.However,thereareveryfewmedicineswhichneedtobeusedwithcautionwhilebreastfeeding.Thisstudyaimstoinvestigategeneralpractitioners’knowledge,attitudesandpracticesabouttheuseofmedicinesinbreastfeedingwomen.Theseissueswillbeexploredusingin-depthinterviewswithasmallnumberofGPsandasurveyofalargergroup(n=650).FUNDiNG:FacultyofHealthSciencesresearchgrant2007

StatUS:Resultspresentedatconferencesin2008;onepaperpublished,onesubmitted


PERINATAL OUTCOMES

Perinatal outcomes following treatment for cervical dysplasiaFiona Bruinsma and Judith Lumley, in collaboration with Michael Quinn, the Royal Women’s Hospital

Theaimofthisprojectwastomeasurepretermbirth,perinataldeathandlowbirthweightinbirthstowomenwhowerereferredtotheDysplasiaClinicattheRoyalWomen’sHospitalfrom1982-2000afteradiagnosisofbiopsy-provenprecancerouschangesofthecervix,andtocomparetheirriskoftheseoutcomeswiththerisksinthewholeVictorianpopulation.ThestudywasaretrospectivecohortstudyinwhichrecordsfromtheDysplasiaClinicwerelinkedtobirthrecordsintheVictorianPerinatalDataCollectionfortheyears1983-2002.Theanalysisofthelinkeddatafilestookintoaccountotherriskfactorsforpretermbirthpresentinthebirthdata(e.g.maternalageatbirth,countryofbirth,parity,gravidity,socio-economicstatus)aswellastheseverityofthecervicallesions,theextentoftreatmentrequiredandthetreatmentmodality.Thestudyfoundthatdiagnosisofpre-cancerouschangesinthecervix(regardlessoftreatment)wasassociatedwithanincreasedriskofpretermbirth.FUNDiNG:NHMRCprojectgrant2003-2004

StatUS:Onepaperpublished,doctoralthesispassed(FB)

impact of size of the excision for treatment for cervical dysplasia on subsequent pregnancy outcomeFiona Bruinsma and Judith Lumley in collaboration with Michael Quinn and Jeffrey Tan, the Royal Women’s Hospital

Thefindingsofpooreroutcomesassociatedwithexcisionaltreatments,inparticularlargeloopexcisionofthetransformationzone(LLETZ),raisesthequestion:isitthetreatmentpersethatisassociatedwiththeincreasedriskoraspectsofthetreatmentsuchastheamountoftissueremoved?UsingdataheldbytheRoyalWomen’sHospitalDysplasiaClinicwehaveatimelyopportunitytoexaminepregnanciesfollowingLEETZtreatmentandtoanalysethedatabyspecificaspectsofthetreatmentsuchastheamountoftissueremoved.Ifthistreatmentoraspectsofthistreatmenthaveahigherriskofadversepregnancyoutcomesthisisvitalpublichealthinformationbothforcliniciansandwomen.FUNDiNG:FacultyofHealthSciencessmallgrant2008

StatUS: data analysis underway

Birth outcomes and maternal and perinatal morbidity associated with induction and augmentation of labour in uncomplicated first birthsMary-Ann Davey and Judith Lumley in collaboration with James King, the Royal Women’s Hospital

RoutinelycollecteddataonallbirthsinVictoriain2000-2005wereanalysedtoexploretheassociationbetweeninductionoflabourintheabsenceofmedicalindication,andmethodofbirthandmaternalandperinatalmorbidity.Thestudyincludeddataon42,950womenhavingafirstbabyat37to40weeks’(259-286days)gestationfollowinganuncomplicatedpregnancy.Multivariatelogisticregressionwasusedtoadjusttherelationshipsofinterestforanumberofpotentialconfoundingfactors(maternalage,baby’sbirthweight,gestation,useofepiduralanalgesia,publicorprivateadmissionstatus).Womenwhoselabourwasinducedweresignificantlymorelikelytohaveacaesareansectionorinstrumentalvaginalbirth;andtoexperienceapostpartumhaemorrhageandperinealtraumarequiringrepair.Theirbabiesweremorelikelytorequireadmissiontonurserycareandtorequireactiveresuscitationatbirth.Oxytocininfusionsinparticularwereassociatedwithanincreaseinshoulderdystocia,postpartum

haemorrhageandneonataljaundicerequiringphototherapy.Thesefindingswillinformfutureinterventionsandtrailsaimedatreducingtheseadverseoutcomes.FUNDiNG:InitiallyfundedbyanAustralianPostgraduateAward.

StatUS:Doctoralthesispassed(M-AD);papersinpreparation

Perinatal morbidity among australian women aged 35 years and older Mary-Ann Davey and Michelle Kealy in collaboration with Mary Anne Biro, School of Midwifery, Monash University; and Mary Carolan, School of Nursing and Midwifery, Victoria University

Analysisofroutinely-collecteddataonallbirthstowomenaged35to44yearsinVictoriain2005and2006,comparinginterventions,methodofbirthandmaternalandneonatalmorbiditywiththoseforwomenaged25-29years.FUNDiNG: None

StatUS: Papers in preparation

early Births – a case-control study of very preterm birthLyn Watson, Judith Lumley, and Jo Rayner in collaboration with David Henderson-Smart, Director, Centre for Perinatal Health Services Research; and James King, Chair, Consultative Council on Obstetric and Paediatric Mortality and Morbidity

ThisstudyaimstodescribethesocialanddemographicassociationsofverypretermbirthinsingletonsandtwinsinVictoria(includingthosewithgestationalage);todescribetheclinicalsubtypesofverypretermbirthinbothsingletonsandtwinsinVictoria;andtoprovidepreliminaryinformationonthecontributionsofexposuretoviolence,infertilityandinfertilitytreatmentandneighbourhoodlevelfactorstoverypretermbirthinVictoria.Thecasesaremothersofbabiesbornbetween20and32weeksgestationandtheircharacteristicswillbecomparedwiththoseofthe control mothers selected from the Victorian population whose babiesarebornat37weeksgestationorlater.Datacollectionincludesasemi-structuredinterview,eitherface-to-faceorbytelephone,andmedicalrecorddataextraction.

Analysisofthedataisnowcomplete.Paperspublishedincludeevaluationofthedatacollectionprocess,responseissuesandtheethicsapprovalprocess.Twopapersonthestudyfindingshavebeensubmittedforpublicationandtwomoreareinpreparation.FUNDiNG:NHMRCprojectgrant2001-2003;SIDS&KidsVictoria2003-2004;FacultyHealthSciencesresearchenhancementgrant2003;TelstraCommunityDevelopmentFund2003

StatUS:Datacollectioncomplete,dataanalysiscomplete,fourpaperspublished,twounderreview,PhDawarded(LW)

Milc (mothers’ and infants’ lactation cohort): a multi-site studyDella Forster, Lisa Amir and Helen McLachlan, in collaboration with Anita Moorhead, Helene Johns and Rachael Ford, the Royal Women’s Hospital; Kerri McEgan, Mercy Hospital for Women; Chris Scott, Frances Perry House; and Kinga Pemo, Division of Nursing and Midwifery, La Trobe University

AhighproportionofwomeninAustraliainitiatebreastfeedingbutmanystopintheearlymonths.Anecdotallymorewomenareleavinghospitalfeedingtheirbabiesexpressedbreastmilk,andcontinuingtodosoathome.Littleisknownabouttheeffectofexpressingbreastmilkonalongertermbasisintermsofbreastfeedingoutcomesandotherfactorssuchasmaternalfatigue,stressandanxiety.

Weareusingthreemethodstoexplorethisissue.Firstly,weconductedauditsattheMercyHospitalforWomen(MHW),theRoyalWomen’sHospital(RWH)andFrancesPerryHouse(FPH),andfoundthatonly35%ofwomenhavingtheirfirstbabywereleavinghospitalfullyattachingandfeedingfromthebreast.Sixtypercentofthosewhowerenothavingafirstbabywerefullyattachingandfeeding.Wesubsequentlyconductedfocus


groupswithmidwivesfromeachsitetoascertaintheirviewsontheexpressionofbreastmilkintheearlypostpartumperiod,andfoundtwoglobalthemesemerged:thenormalisationofexpressingandthepressuredpostnatalenvironment.

Aprospectivecohortstudyisunderway.Onethousandwomenwhoplantobreastfeedwillberecruitedfromthreehospitals(MHW,FPH,andRWH)beforedischargehomefromhospitalpostnatally.Thestudyinvolvescompletionofaninitialstructuredinterviewtocollectdemographicdetails,breastfeedingintentionsandcurrentfeedingdetails.Otherrelevantinformationiscollectedfromthemedicalrecordwiththewoman’sconsent.Structuredtelephoneinterviewsarebeingconductedatthreeandsixmonthspostpartum.Theprimaryoutcomeforcomparisonisfeedinganybreastmilkatsixmonths.Secondaryoutcomesincludedexclusivebreastfeeding,maternalconfidenceandsatisfactionwithinfantfeeding.FUNDiNG:FacultyofHealthSciencesresearchgrant2008

StatUS:Twoofthreecomponentscompleted,Minorthesissubmitted(KP),cohort study recruitment and data collection commenced

the role of micro-organisms (S. aureus & C. albicans) in the pathogenesis of breast pain and infection in lactating women (caStle Study)Lisa Amir and Meabh Cullinane, in collaboration with Suzanne Garland and Sepehr Tabrizi, Bio21 Molecular Science & Biotechnology, University of Melbourne; Susan Donath, Murdoch Childrens Research Institute; and Catherine Bennett, Deakin University

Thisprojectisadescriptivestudyof400breastfeedingwomenrecruitedfromtheRoyalWomen’sHospitalandFrancesPerryHouse.Theaimofthestudyistoinvestigatetheroleofmicro-organismsinnippleandbreastpaininbreastfeedingwomen.Atpresent,thereiscontroversyaboutwhetherburningnipplepainassociatedwithradiatingbreastpainiscausedbyfungalinfection(Candida albicans,knownas“thrush”)orbacterialinfection(Staphylococcus aureus,knownas“goldenstaph”).

Swabswillbecollectedfrommothers’nosesandnipplesandtheirbabies’mouths.Breastmilkwillalsobecollected.Thesesampleswillbecollectedafterthebirth,thenonceperweekforfourweeks.Womenwillalsocompletequestionnairesatrecruitment,thenweeklypostpartumforfourweeks.Thestudywillconcludewithatelephoneinterviewateightweekspostpartum,tocollectfurtherinformationaboutbreastfeedingproblemssuchasnippleandbreastpain.FUNDiNG:NHMRCHealthProfessionalResearchFellowship2006-2010(LA);NHMRCprojectgrant2009-2010;NHMRCequipmentgrant(2009/2010)

StatUS:RecruitingcommencedOctober2009

Women’s attitudes and experiences of breastfeeding – Does maternal weight make a difference?Lisa Amir, Della Forster, Jo Rayner and Karalyn McDonald in collaboration with Kate Stern, Endocrine and Metabolic Service, Royal Women’s Hospital

Althoughoverweightandobesewomenarelesslikelytobreastfeedthanwomenofnormalweight,careproviderscurrentlyofferthesamemanagementastheyprovideotherwomen.Weneedtounderstandwomen’sattitudestoinfantfeedingandtheirexperienceswithbreastfeedingbeforewecandevelopinterventionswhichaimtoincreasebreastfeedinginitiationanddurationinoverweightandobesewomen.Theaimofthisstudyistoexploreobesewomen’sattitudestoandexperiencesofbreastfeedinginordertoinformthedesignofaninterventiontoincreasebreastfeedinginthisgroupofwomen.Thestudyinvolvesin-depthinterviewsandfocusgroupswithpregnantandpostpartumwomenwhoareovertheiridealweight.FUNDiNG:LaTrobeUniversityResearchGrantsScheme2007

StatUS:EthicsapprovalfromLaTrobeUniversityandtheRoyalWomen’sHospital.Focusgroupsandinterviewsunderway

Breastfeeding women’s use of breast pumps: a descriptive studyLisa Amir and Sarah Clemons in collaboration with the Australian Breastfeeding Association.

ThereisatrendinAustraliaandotherdevelopedcountrieswheremothersareincreasinglyexpressingbreastmilk.Howeverthereislimitedresearchastothereasonswomenexpressbreastmilkandusebreastpumps.Thisstudyprovidesdescriptiveinformationonbreastfeedingwomen’suseofpumpsandtheirexperiencesofexpressingbreastmilk.AsurveyofVictorianmembersoftheAustralianBreastfeedingAssociationwasconductedonlinein2008.FUNDiNG: None

StatUS:Surveyconducted,publicationsubmitted

Systematic Reviews

interventions to help women to stop smoking in pregnancyJudith Lumley and Lyn Watson in collaboration with Catherine Chamberlain, 3Centres Collaboration, Women and Children’s Program, Southern Health; Therese Dowswell, Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, University of Liverpool, UK; Sandy Oliver, Social Science Research Unit, Institute of Education, University of London; and Laura Oakley, Non-communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine

Tobaccosmokinginpregnancyremainsoneofthefewpreventablefactorsassociatedwithcomplicationsinpregnancy,lowbirthweight,pretermbirthandhasseriouslong-termhealthimplicationsforwomenandbabies.Smokinginpregnancyisdecreasinginhigh-incomecountriesandincreasinginlow-tomiddle-incomecountriesandisstronglyassociatedwithpoverty,loweducationalattainment,poorsocialsupportandpsychologicalillness.Smokingcessationinterventionsinpregnancyneedtobeimplementedinallmaternitycaresettings.Giventhedifficultymanypregnantwomenaddictedtotobaccohavequittingduringpregnancy,population-basedmeasurestoreducesmokingandsocialinequalitiesshouldbesupported.FUNDiNG: None

StatUS:CochraneReviewupdated2009

risk scoring systems for predicting preterm birth with the aim of reducing associated adverse outcomes (Protocol) Mary-Ann Davey, Lyn Watson and Jo Rayner in collaboration with Shelley Rowlands, Department of Obstetrics and Gynaecology, the Royal Women’s Hospital

Theconceptofusingrisk-scoringsystemsinmaternitycareisquiteappealing.Iftheycouldbeshowntopredictpooroutcomesmoreaccuratelythanclinicaljudgement,theirusewouldenabletargetedinterventionstobeapplied.Manysuchinstrumentshavebeendevelopedandusedovertheyears,butmosthavenotbeenevaluated.Inaddition,knowingthatanindividualisathigher-than-averageriskforaparticularoutcomeisnothelpfulifnoeffectiveinterventionexists.Weplantousetheprotocoltoreviewtheevidenceregardingtheuseofsuchsystemsinpredicting,andpreventingpretermbirth.FUNDiNG: None

StatUS:CochraneProtocolpublishedJuly2004,reviewunderway


Collaborative Work

the Women and Babies Wellbeing: action through trials (WOMBat) collaborationThe WOMBAT Collaboration Advisory Group: Caroline Crowther, Jodie Dodd, Jeffrey Robinson & Philippa Middleton, Adelaide; Lex Doyle and Rhonda Small, Melbourne; Vicki Flenady, Brisbane; David Henderson-Smart, William Tarnow-Mordi, Christine Roberts and Jonathon Morris (Chair, IMPACT Committee), Sydney; Karen Simmer, Perth; Vic/Tas Regional Coordinator: Michelle Kealy (until April 2009)

ThespecificaimoftheWOMBATCollaborationistopromoteandsupporthighqualityrandomisedclinicaltrialsintheperinatalareainordertoimprovethehealthandwellbeingofwomenandtheirchildren.Itwilldothisthroughidentifyingnationalpriorityresearchareasandencouragingappropriateclinicalandmethodologicaltrials;providinghighlevelsupporttoresearchersundertakingmulti-centretrialsatnationalandregionallevels;providingeducationandtrainingintrialdesignandconduct.

TheWOMBATCollaborationorganisedaseriesofworkshopsforperinatalresearchersandcliniciansacrossAustralia.TheannualmeetingofAdvisoryGroupmembers,invitedguestsandRegionalCoordinatorswasheldinAdelaideinSeptember.

TheWOMBATCollaborationhasdevelopedawebsite:www.wombatcollaboration.netwithlinkstoresourcesusefulforperinatalresearchersandclinicians.Anelectronicdatabaseofperinataltriallistsandothershasbeenestablishedforthedistributionofmonthlyelectronicnewsletters,informationaboutupcomingeducationalworkshopsandotherevents.FUNDiNG:NHMRCenablinggrant2005-2010

StatUS:Nationaldatabaseofcurrentandrecentlycompletedmaternalandperinataltrials;researchgapsidentified;uptodatewebsitefornewsandevents;trainingandeducationworkshopsongoing

CROSS-CULTURAL ISSUES

South asian Women’s experiences of living with Gestational Diabetes Mellitus Mridula Bandyopadhyay, Rhonda Small, Mary-Ann Davey, Della Forster in collaboration with Jeremy Oats and Amanda Aylward, the Royal Women’s Hospital

WomenfromtheIndiansub-continenthaveahighincidenceofgestationaldiabetesmellitus(GDM)withadversepregnancyoutcomes.Ouraimwastoexplore,understandanddocumentwomen’sexperiencesandviewsonGDMpostdiagnosisandtheirunderstandingoftype2diabetes.Aqualitativeresearchdesignwasemployedtocollectdatainface-to-facein-depthinterviewswith17immigrantwomenfromtheIndiansub-continentattwotimepoints:inpregnancyandatsixweekspostpartum.WomenwererecruitedfromthediabetesclinicofthelargestmaternityhospitalinMelbourne.Interviewswereconductedinwomen’spreferredlanguageandlasteduptoanhour.Thematicanalysishasbeenconductedtoidentifycommonpatternsandsalientthemeswithinandacrossnarratives,alsotakingintoaccountanydivergentexperiences.FUNDiNG:LaTrobeUniversityFacultyofHealthSciencesresearchgrant2008

StatUS:Finalpostpartuminterviewsbeingcompleted;paperinpreparation

Maternity care and health after birth: the experiences of iranian and afghan women in Melbourne, australiaTouran Shafiei, Rhonda Small in collaboration with Helen McLachlan, Division of Nursing and Midwifery, La Trobe University

Inordertoexplorewomen’sexperiencesofmaternitycareandwell-beingafterbirth,47womenfromAfghanistanandIranwererecruitedatfourMelbournehospitals.Datacollectionincludedabriefinterviewatrecruitment;amaintelephoneinterviewfourmonthsafterthebirthandanin-depth,face-to-faceinterviewwith14participantsnineto15monthsafterthebirth.Thestudyfindingsdemonstratedthatinteractionswithstaffwerethemostimportantfactorsinwomen’sexperiencesofmaternitycare.Asignificantnumberofwomenreportedfeelingdepressedorveryunhappysincethebirthandsome of them were reluctant to discuss their emotional difficulties withhealthprofessionalsanddidnotexpectthathealthprofessionalswouldnecessarilyprovideassistance.Women’scommentsillustratedthattheirexperiencesofemotionaldistressandhelp-seekingrepresentanintensificationoftheirmigrantexperience,mostofteninrelationtotheavailabilityofsupportwhenitwasneeded.UnderstandingthisandpayingcarefulattentiontoindividualneedsandpreferencesareimportantinprovidingappropriatematernityandpostnatalcareforAfghanandIranianwomen.FUNDiNG:LaTrobeUniversityPostgraduateResearchscholarship2008-2009;DiamondConsortiumSeedandCapacityBuildingGrant2006-2007

StatUS:PhDpassed(TS);papersinpreparation

immigrant and australian-born women’s experiences of life with a new baby: a comparisonMridula Bandyopadhyay, Rhonda Small and Lyn Watson, in collaboration with Stephanie Brown, Murdoch Childrens Research Institute

Immigrantwomen,especiallythosefromnon-Englishspeakingcountriesareoftenunder-representedinresearch,andweknowverylittleabouttheiroverallpostpartumexperiences.OuraimwastoanalysethedatacollectedinPRISM–alargecommunity-randomised trial in Victoria that aimed to reduce depression and improvemothers’physicalandpsychologicalhealthsixmonthsafterbirth–toexploresimilaritiesanddifferencesinexperiencesoflifewithayoungbabyforAustralian-born(n=9,796)andimmigrantwomenfromnon-Englishspeakingcountries(n=644).

WomeninthePRISMcohorthadrespondedtoapostalsurveysixmonthsaftergivingbirth(fromAugust2000-February2002).Arangeofexperiencesinearlymotherhoodwereexplored,including:physicalandemotionalhealth;practicalandemotionalsupportreceived;viewsaboutpartners,friendships,healthservicesupportandtheperceivedmother-and-baby-friendlinessoflocalcommunities.

Immigrantwomenbornoverseasinnon-EnglishspeakingcountriesinthePRISMsamplecamefromvariousregionsofEurope,theformerUSSR,theMiddleEast,Africa,Asia,SouthAmerica,andtheCaribbean.OuranalysesshowthatimmigrantwomenweremorelikelythanAustralian-bornwomentobebreastfeedingatsixmonthsandwereequallyconfidentincaringfortheirbabyandintalkingtohealthcareproviders.Nodifferenceswerefoundinanxietyorrelationshipproblemswithpartners.However,comparedwithAustralian-bornwomen,immigrantmotherslessproficientinEnglishdidhaveahigherprevalenceofdepression(28.8%vs15%)andweremorelikelytoreportwantingmorepractical(65.2%vs55.4%)andemotional(65.2%vs44.1%)support.Theywerealsomorelikelytohaveno‘timeout’frombabycare(47%vs28%)andtoreportfeelinglonelyandisolated(39%vs17%).FUNDiNG:MBsupportedbyCOMPASS,NHMRCCapacityBuildingGrant(2007-2012)

StatUS:Completed;paperinpress


improving maternity care and obstetric outcomes for immigrant womenRhonda Small in collaboration with the Victorian Perinatal Data Collection Unit and the NSW Midwives’ Data Collection

Thisprojectisinvestigatingidentifiedproblemsofpublichealthimportanceinrelationtoobstetricoutcomesandexperiencesofmaternitycareforimmigrantwomenofnon-EnglishspeakingbackgroundsinAustralia.Theseincludearangeofunexplainedvariationsbymaternalcountryofbirth(egincaesareansectionandotherobstetricprocedures);evidenceforhigherstandardisedperinatalmortalityratiosamongwellgrownterminfantsofwomenborninNES-countries(suggestingpossiblecauseforconcernabouttheroleofcommunicationdifficultiesindecision-makingduringlabourandbirthinthesepooreroutcomes);andconsistentlypoorerratingsofmaternitycarebyimmigrantwomenfromNES-countries.

Thefocusin2009hasbeenonvariationsincaesareansectionbymaternalcountryofbirthwithtwoconferencepresentationsandapaperinpreparation.ChangesinoutcomesforVietnamese-bornwomenovertime(1983-2007)arealsobeinginvestigated.FUNDiNG:NHMRCCareerDevelopmentAward(2005-2009)

StatUS:onepaperpublished;analysescontinuing;furtherpapersinpreparation

Collaborative Work

reproductive Outcomes and Migration (rOaM): an international collaborationRhonda Small and Mridula Bandyopadhyay in collaboration with Anita Gagnon, McGill University, Canada; Sophie Alexander, Université libre de Bruxelles, Belgium; Béatrice Blondell, INSERM, France; Simone Buitendijk and Dineke Korfker, TNO Institute, Prevention and Health, The Netherlands; Marie Desmeules and Sarah McDermott, Public Health Agency of Canada; Dominico DiLallo, Agency for Public Health of Rome, Italy; Girgitta Essen, Uppsala University, Sweden; Mika Gissler, STAKES, Finland; Richard Glazier, Institute for Clinical Evaluative Sciences, Canada; Maureen Heaman, University of Manitoba, Canada; Anders Hjern, National Board of Health and Welfare, Sweden; Alison Macfarlane, City University of London, UK; Edward Ng, Statistics, Canada; Carolyn Roth, University of Keele, UK; Donna Stewart, University Health Network of Toronto, Canada; Babill Stray-Pederson and Siri Vangen, University of Oslo, Norway; Marcelo Urquia, University of Toronto, Canada; Jennifer Zeitlin and Meg Zimbeck, INSERM, France and EURO-PERISTAT

Thecollaborationaimstoundertakecomparativeworkonmigrant,refugeeandasylum-seekingwomen’sreproductivehealthoutcomesandtheirviewsofmaternitycareinEurope,NorthAmericaandAustralia.ThecollaborationbeganwithaninitialgrantawardedfromtheCanadianInstitutesofHealthResearch(CIHR)InternationalOpportunityDevelopmentGrantSchemetoestablishresearchlinksbetweenCanadaandAustraliaforcomparingreproductivehealthoutcomesofimmigrantandrefugeewomen.ThefirstmeetingofawidercollaborativenetworkwithresearchersfromtheUK,Italy,France,Belgium,andFinlandwasheldattheEuropeanCongressofEpidemiologyinPorto,PortugalinSeptember2004.Sincethencollaboratorsfromarangeofothercountrieshavejoinedthecollaborativenetwork.AfurthergrantwasawardedbyCIHR(2007-2008)tosupportthecollaboration’swork.

Aone-dayROAMcollaborators’meetingwasheldinPolandinAugust2009,atwhichcompletedworkwaspresentedandfurtherresearchplanned.Asaresult,twofurtherapplicationsforfundingweremadetotheCanadianInstitutesofHealthResearchinOctober2009to:1)undertakeaninternationalvalidationofmigrationindicatorsforperinatalhealth,and2)conductasystematicreviewfocusedoninternationalmigrationandcaesareansection.FUNDiNG:CanadianInstitutesofHealthResearchInternationalCollaborationgrant2007-2008;furtherfundingsoughtfor2010

StatUS:fourpaperspublished;severalinpreparation

WOMEN’S HEALTH AND REPRODUCTION

the experience of postnatal depression in a rural australian communitySue Armstrong and Rhonda Small

ThisactionresearchprojectaimstoinvestigatepathwaystocareinaVictorianruralcommunityforwomenexperiencingdepressionafterchildbirth.ThestudywasundertakeninthreephasesinaruralshireinGippsland,whereroutinescreeningforpostnataldepressionusingtheEdinburghPostnatalDepressionScale(EPDS)hasbeeninoperationforthelasttenyearsbutnotpreviouslyevaluated.

Phase1consistedofanauditofallwomenpotentiallyeligibleforscreeningtoidentifymoreclearlytheproportionofwomenscreenedandtheresultsofscreening.Phase2consistedofinterviewswithcareprovidersresponsibleforcarryingouttheprogram-maternalandchildhealthnurses(MCHNs)andlocalgeneralpractitioners(GPs)-withtheaimoffindingouthowtheprogramworkedandtheresultsofanyreferralsforwomenidentifiedasprobablydepressed.Phase3involvedanauditofwomen’sscreeningrecordsforanentireyearApril2005-April2006toseewhetherchangestothescreeningprogramhadresultedinanydifferencestonumbersofwomenbeingscreenedandimprovedoutcomesforthesewomen.Apostalsurveywassenttothisentirecohort(n=265women)invitingthemtoparticipateinfurthercontactabouttheirexperienceofscreeningforpostnataldepressionandthefirstpostnatalyear.Twentywomenwereinterviewedindepthcoveringawiderangeofexperiences,includingwomenwhowerediagnosedasdepressedandotherswhowerenot.Theseinterviewsadddepthtotheresearchandallowwomen’svoicestobeheard.FUNDiNG:LaTrobeUniversityResearchScholarship(2007-2008),DiamondConsortiumSeedandCapacityBuildingGrant(2006-2007)

StatUS:Alldatacollected,onepaperpublished,oneinpreparationandPhDthesiswritingupinprogress(SA)

improving maternal and child healthcare for vulnerable mothers (MOve)Angela Taft and Rhonda Small in collaboration with Cathy Humphreys, Department of Social Work and Kelsey Hegarty, Department of General Practice, University of Melbourne

TheMOVEpragmatictrialexamineswhetheraninterventionmodelof maternal and child health nurse practice with new mothers experiencingpartnerviolenceimprovesoutcomesformothersandtheirchildren.

Weundertookasystematicreviewofguidanceforcommunity-basednursescombinedwithparticipatoryactionresearchinvolvingnurseconsultantsfromourfourinterventionMCHteams.Throughthesemethodswearedevelopingconsensusrecommendationsandstrategiesforthenewmodel.FollowingevidenceofitsbenefitfromtheUK,wehavealsosoughtcollaborationwiththefamilyviolenceservicestoprovidemoredirectinvolvementwithmaternalandchildhealthnurseteams.TheinterventionwillcommenceinMarch2010andbeimplementedover12months.

MultimethodprocessevaluationofthisinterventionwillbeundertakenwithinthetheoreticalframeworkprovidedbyNormalisationProcessTheory(May,2007).Theoutcomesoftheinterventionwillbeexaminedinapostalsurveyof10,000mothersusingtheMCHservicesoverthepreviousyearinboththefourinterventionandfourcomparisoncommunities.FUNDiNG:ARCLinkageProject2008-2011

StatUS:Ongoing


MOSaic (MOtherS’ advocates in the community) a cluster randomised trialAngela Taft, Rhonda Small and Judith Lumley, in collaboration with Kelsey Hegarty, Department of General Practice, University of Melbourne; and Lisa Gold, Deakin University

MOSAIC’sprimaryaimwastoreduceorpreventpartnerviolenceanddepressionamongwomenpregnantorwithchildrenunderfiveandtostrengthenwomen’shealthandwellbeingandtheirattachmenttotheirchildren.Theintervention,supportfromtrainedmentormothersforuptoayearafterrecruitment,wasofferedtoabusedoratriskwomenwhowereidentifiedbytheirgeneralpractitioners(GPs)ormaternalandchildhealth(MCH)nurses.MOSAICincludedanadditionalsubstudywiththeVietnamesecommunity.

MOSAICinvolved106primarycareclinics(82MCHclinicsand24GPclinics).Ofthese106,65(61%)clinicsreferred215eligiblewomen(144interventionand71comparison)betweenJanuary2006andDecember2007,ofwhom174(81%)wererecruited.TheinterventioncontinueduntilDecember2008,when133women(76%)(91interventionand42comparison)completedthe12monthsfollow-upsurvey.AllnursesandGPsweresurveyedtwice,firstduringtheinterventionperiodandthensubsequently,toexploretheimpactofparticipationinMOSAIContheirpractice.35women(11Vietnamese)fromtheinterventionarmandtheir19mentors(fourVietnamese)wereinterviewedindepthtoexploretheirviewsabouttheimpactofbeingmentored,orprovidingmentoring,ontheirlives.Acostconsequencesanalysishasalsobeenundertaken.Adraftoutcomespaperhasbeenpreparedforpublicationandfurtheranalysesofdata,includingqualitativedataareunderway.FUNDiNG:NHMRC,VicHealth,CommunitySupportGrantsFundandbeyondblue

StatUS:Studycompleted,analysiscontinuing;threepaperspublished,twoinpreparation

Systematic Reviews

interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who experience intimate partner abuse: a suite of systematic reviews Thecollaborativegroupincludes Angela Taft leading Screening interventions review collaborating with Jean Ramsey, Gene Feder and Yvonne Carter, Department of General Practice and Primary Care, Barts and the London School of Medicine and Dentistry; Leslie Davidson and Joseph L Mailman, Department of Population and Family Health, School of Public Health, Columbia University; Kelsey Hegarty, Department of General Practice, University of Melbourne; and Alison Warburton, Centre for Women’s Mental Health Research, Department of Psychiatry and Behavioural Sciences, Manchester University FUNDiNG:UKNHS;CochraneCollaboration(HealthPromotion);VicHealth;andFacultyofHealthSciencesresearchgrant

StatUS:Ongoing;twoprotocolspublished,systematicreviewofadvocacyinterventionsnowpublished

Debriefing for the prevention of psychological trauma in women following childbirthRhonda Small in collaboration with Maria Helena Bastos, Debra Bick, Catherine Rowan, Thames University, UK; Kirstie McKenzie-McHarg, National Perinatal Epidemiology Unit, University of Oxford, UKFUNDiNG: None

StatUS:CochraneprotocolpublishedApril2008,reviewinprogress

Collaborative Work

Weave: a cluster randomized trial of a multi-faceted practice based system intervention implemented in victorian general practices for female GP patients experiencing intimate partner abuse Angela Taft in collaboration with Kelsey Hegarty and Jane Gunn, Department of General Practice, University of Melbourne; Gene Feder, University of London; Jill Astbury, Department of Psychology, Victoria University; and Stephanie Brown, Murdoch Childrens Research Institute

Theaimsaretoevaluateifaninterventioningeneralpracticeinvolvingscreeningforintimatepartnerabuse,healthprovidereducation,guidelines,briefproblemsolvinginterventionandpracticeorganisationalchangeincreases:abusedwomen’ssafetybehavioursandplanningandtheirmentalhealthandqualityoflife.

Insummary,49ofthetargetof50generalpractitioners(GPs)havebeenrecruitedandalmost20,000Victorianwomenattendinggeneralpracticehavebeenscreenedforpartnerorex-partnerfearinthelast12months.Thirty-twopercentofwomenreturnedsurveysand8%wereeligibleforthetrial(screenpositiveforabuseandwillingtobecontacted).220womenarecurrentlyenrolledinthetrial(target250).Theprojectisruninfourconsecutiveoverlappingstreams.Instream1,GPshavebeentrainedandthewomenhaveundergonecounselling.Theyareduetoreceivethe12-monthevaluationsurveyinFeb2010.Instream2,GPtrainingiscompleteandthewomenhavebeeninvitedtocounsellingandcompletedtheinterim(6month)survey.Stream3GPsaretrainedandthewomenareduetheirsix-monthevaluationinMarch2010.ThereisonelastGPtoberecruited.Womenarecurrentlybeingrecruitedintowave4.ThelastroundofGPtrainingwillbeconductedinFeb-Mar2010.In2009adatamonitoringcommitteewasconvenedandthestudyprotocolwasacceptedforpublicationinBMCPublicHealth.Screeningdataforthefirstthreewaveswerecodedandenteredandthebaselineanalysisisunderway.FUNDiNG:NHMRC2008-2010

StatUS:Ongoing;onepaperpublishedandoneacceptedforpublication

Women’s Disclosure Study: disclosing partner abuse and perspectives on intervention in primary careAngela Taft in collaboration with Lorna Jane O’Doherty, Kelsey Hegarty, and Janita Clewett, Department of General Practice, University of Melbourne

Thenumberoftrialsinvestigatinginterventionforpartnerabuseisontheincrease.Howevertherehasbeenalackofresearchintowomen’sperspectivesaboutwhattheywouldlikefrominterventionforpartnerabuseinhealthcaresettings.Thestudyinvolvessubjectsformthe‘weave’trialofsupportforwomenpatientsingeneralpracticeexperiencingpartnerabuse,

Theaimofthisstudyistoexplorereasonsfordisclosureamongwomenwithcurrentorpreviousexperiencesofpartnerabuseandwhatwomenwantfromhealthcareinterventionsforpartnerabuse.Drawingonaprimarycaresampleofwomenwhoscreenedpositiveforcurrentorpreviousfearofapartnerorex-partner,thisqualitativeenquiryproposestointerviewwomenatdifferentstagesofrecognisingrelationshipproblemsabouttheirviewsaboutdisclosureandinterventionforpartnerabuse.Theaimistobuildunderstandingaboutthefactorsthatprecipitateexpressionofrelationshipproblemsandwhatwomenwouldliketogainfromintervention.FUNDiNG:EarlyCareerDevelopmentAward,UniversityofMelbourne

StatUS:Ethicsapprovalgrantedandinterviewscommenced


OTHER COLLABORATIONS

cosmetic endocrinology: (re) reconstructing femininity in tall girls Jo Rayner and Judith Lumley in collaboration with Priscilla Pyett, Department of Rural and Indigenous Health, Monash University; Jill Astbury, School of Psychology, Victoria University; and Alison Venn, Menzies Research Institute, University of Tasmania

InlightofthehighprevalenceofmajordepressionfoundamongwomenparticipatingintheTallGirlsStudythisprojectaimedtoexaminetheexperiencesoftallwomenwhoasadolescentgirlswereassessedand/ortreatedwithsyntheticoestrogenstoreducetheirestimatedadultheight.Datacollectionincluded:twoin-depthinterviewseachwith35tallwomen:25fromtheTallGirlsStudycohortand10womenneverassessedortreatedfortallstature;a discourse analysis of the medical literature on treatment of tall staturepublishedoverthethreedecadestreatmentwasatitspeakinAustralia;examinationoftheempiricalliteratureonheight;andanalysisofunpublisheddatacollectedintheTallGirlsStudy.Findingssuggestthe‘tall’girlwasamedicalconceptinventedinresponsetotheavailabilityofatechnology–syntheticoestrogens.Socio-culturalgendernorms,inparticularprevailingconceptsoffemininity,andtheambiguityoftallstatureinwomen,stigmatised‘tall’girls.Thosewomenassessedfortallstatureduringadolescencereportedthattheirheightwasproblematisedbysignificantothers(parentsandpeers),andthatthemedicalassessmentfurtherstigmatisedtheminducingfeelingsofhumiliationandshame,feelingstatesknowntobeassociatedwithdepressioninwomen.FUNDiNG:NHMRCPublicHealthPhDscholarship(2005-2007)

StatUS:PhDthesispassed(JR),onepaperacceptedforpublicationandoneinpreparation


Director’s report

DEVELOPING PUBLIC HEALTH RESEARCH CAPACITY COMPASS:Buildingpublichealthcapacity forcomplexquestions,complexsettings, complexinterventions

COMPASSisafive-yearNationalHealthandMedicalResearchCouncilCapacityBuildingGrantinPopulationHealthResearch($2,333,750),awardedinOctober2006totheCentre,inpartnershipwiththePrimaryCareResearchUnitintheDepartmentofGeneralPracticeatTheUniversityofMelbourneandtheHealthyMothersHealthyFamiliesResearchGroupatMurdochChildrensResearchInstitute.COMPASScommencedinApril2007.

TheLeadInvestigatorsare:ProfRhondaSmall,A/ProfStephanieBrown(HealthyMothers,HealthyFamilies,MurdochChildrensResearchInstitute),ProfJaneGunn(PrimaryCareResearchUnit–PCRU,DepartmentofGeneralPractice,UniversityofMelbourne),EmeritusProfessorJudithLumley,A/ProfJeanneDalyandProfChristineMacArthur(UniversityofBirmingham)

TheTeamInvestigatorsare:atMCHR–DrAngelaTaft,DrLisaAmir,DrDellaForster,DrHelenMcLachlan,FionaBruinsma,DrLynWatson,DrArthurHsueh,DrMridulaBandyophadhyay,DrMary-AnnDavey,DrJo-AnneRayner,DrKaralynMcDonald;atPCRU– DrRenataKokanovicandDrVictoriaPalmer;andatHealthyMothersHealthyFamilies–DrJaneYellandandTanyaKoolmatrie.

ThefocusforCOMPASSisbuildingpublichealthresearchcapacityfor:

• conceptualisingcomplexquestions;

•workingwithpopulationswhoareoftenexcludedfromresearch,includingIndigenouscommunities,immigrantandrefugeewomenandwomenexperiencingintimatepartnerviolence;and

• designingandevaluatingcomplexinterventionsindiversesettingsrangingfromhospitalstoprimarycareandcommunities.

COMPASShasamajorinterestinthehealthandcareofmothersandchildren.

In2009,amajorfocusofCOMPASSdevelopmentactivitieswasawritingretreatfacilitatedbyEmeritusProfessorBarbaraKamler,inMayandaseriesofdiscussionsaboutpapersforaspecialjournalissueoncomplexityinpublichealthresearchforpublicationin2010.Ourmonthlyseminarsfocusedonmethodsforcomplexpublichealthresearch,participatorypartnershipsandthechallengesofimplementationincomplexinterventionresearch.

MoreinformationaboutCOMPASSactivitiescanbefoundat:http://www.latrobe.edu.au/mchr/compass.html

POSTGRADUATE STUDY 2009MCHRsupportsalivelyeducationalprogramforadiversegroupofpostgraduatestudentswithbackgroundsinmidwifery,statistics,communityhealth,maternalandchildhealth,socialworkandwomen’shealth.

In2009MCHRstaffandstudentsweredelightedbythreedoctoralsuccesses.JoRaynergraduatedinOctoberandFionaBruinsmaandTouranShafieilearntthattheyhadpassedtheirPhDsandwillgraduatein2010.WealsocongratulateMary-AnnDaveywhowasawardedtheStephenDuckettprizeforbestpostgraduatestudyinpublichealthfor2009.

Wehadmanyinquiriesfromoverseasstudents.AsaresultZaharahSulaimon(DrLisaAmir–cosupervisor)joinedtheMCHRPhDstudentgroup.DrAngelaTaftwasapproachedbyMarcosSignorelli,apublichealthlecturer,tospendaBraziliangovernment-fundedfivemonthstudyprogramatMCHRin2010developinghisPhDresearchofprimarycareresponsestointimatepartnerviolence.

MCHRcontinueditspostgraduatesupportprogramforourdiverserangeofAustralianandoverseasPhDstudentsandvisitingscholars.Throughouttheyearstudentsandpresentedtheirworkandengagedindebateaboutmethodologicaldilemmasorresearchprogress.Invitedspeakersalsopresentedonarangeoftopics.

Postgraduate co-ordinator 2009:AngelaTaft,(for2010DellaForster,LisaAmir)

POSTGRADUATE PROJECTSDetailsofthepostgraduateprojectsareincludedinthe2009ResearchProgramundertheirappropriateresearcharea.

the experience of postnatal depression in a rural australian communitySue Armstrong supervised by Rhonda Small

Perinatal outcomes following treatment for cervical dysplasiaFiona Bruinsma supervised by Judith Lumley

the emergency contraceptive pill rescheduled: knowledge, attitudes and practice among womenMelissa Hobbs supervised by Angela Taft and Lisa Amir

Wave: Women’s and staff views: an evaluation of maternity care at Barwon HealthJane Morrow supervised by Della Forster, Mary-Ann Davey and Helen McLachlan

the experience of maternity care and depression after birth among women from iran and afghanistan in MelbourneTouran Shafiei supervised by Rhonda Small and Helen McLachlan

Education and capacity building


SEMINARS AT MCHRTheMCHRSeminarProgramisheldonthe4thWednesdayofeverymonthfrom12.30to1.30pm,excludingJanuaryandDecember.Extraordinaryseminarsarealsoofferedtoshowcasetheworkofnationalandinternationalacademics/researchersvisitingMCHR.

Thankstoallthespeakersin2009.IfyouwouldliketobeaddedtothemailinglisttoreceivetheSeminarProgram,phone83418500.Formoredetailspleasegotothewebsite:www.latrobe.edu.au/mchr/

Seminar convenor:LisaAmir,(for2010,Mary-AnnDavey)

Seminar Program 2009

February:MsCatherineChamberlain,ProjectCoordinator,3CentresCollaboration.Cochranereviewupdateofinterventionstoreducesmokinginpregnancy.

March:AssociateProfessorKelseyHegarty,DepartmentofGeneralPractice,UniversityofMelbourne.Women’sevaluationofabuseandviolencecareinGeneralPractice:AclusterRCT.

May:DrKaralynMcDonald,Mother&ChildHealthResearch.TheimpactofstigmaonHIV-positivemothersinAustralia.

June:ProfessorPraneeLiamputtong,PersonalChairinPublicHealth,SchoolofPublicHealth,LaTrobeUniversity.Researchingthevulnerable:Methodologicalconsiderations.

July:AssociateProfessorRhondaSmallandDrLynWatson,Mother&ChildHealthResearch,andAssociateProfessorStephanieBrown,HealthyMothersHealthyFamilies,MurdochChildrensResearchInstitute.PRISM:Longer-termoutcomesofacommunity-randomisedtrialtoreducematernaldepressionandimprovephysicalhealth.

august:DrAngelaTaft,SeniorResearchFellow,Mother&ChildHealthResearch.MOSAIC(MOtherS’AdvocatesIntheCommunity):preliminaryfindingsfromaclusterrandomisedtrialofmentormothersupportforabusedoratriskpregnantorrecentmothersreferredbytheirGPormaternalandchildhealthnurse.

September:MsMandiCooklin,PhDCandidate,KeyCentreforWomen’sHealthinSociety,UniversityofMelbourne.“Timeoffwork”?Maternityleave,postnatalemploymentandwomen’swell-being.

October:DrMariePirotta,SeniorLecturer,DepartmentofGeneralPractice,UniversityofMelbourne.WomenandHPV:psychosocialaspectsofdiseaseandscreening.

November:ProfessorLeahAlbers,ProfessorofMidwifery,UniversityofNewMexicoCollegeofNursing.Minimizinggenitaltracttraumaandrelatedpainfollowingchildbirth.

JOURNAL CLUBJournalclubisheldmonthly,andprovidesanopportunitytoreview,critiqueanddiscusstwojournalarticlespermonth.Staffandstudentsparticipatebypresentingonepaperforjournalclubduringtheyear,onarosteredbasis.

convenors 2009:DellaForsterandHelenMcLachlan(in2010,JaneMorrow)

TEACHINGMCHRstaff,students,andassociatescontributetoundergraduateandpostgraduateteachingatLaTrobeUniversity,otheruniversitiesandhospitals.Seewebsitefordetails:www.latrobe.edu.au/mchr/

VISITING ACADEMICS IN 2009EachyearMCHRisfortunatetohostanumberofvisitingscholars.InMaythisyear,ProfessorJillAstburyvisitedMCHR,aspartofhersabbaticalleavefromVictoriaUniversitywheresheistheProfessorofResearchintheSchoolofPsychology.Jillisalong-standingcollaboratorwithMCHRandduringhervisitshepresentednewworkonwomen’smentalhealth:‘Socialcausesofdepression:aquestionofrightsviolated?’fromachaptershehasauthoredforanewbook.

LeahAlbers,ProfessorattheCollegeofNursing,UniversityofNewMexico,USA,visitedthecentreinNovember.LeahisanassociateinvestigatorwiththeCOSMOStrial.Shehasabroadprogramofclinicalmidwiferyresearchandherworkiswidelypublishedinmidwiferyandmedicaljournals.Leahgaveapresentation“Minimisinggenitaltracttraumaandrelatedpainfollowingchildbirth”.ThiswasLeah’sthirdvisittoMCHR.


Publications 2009

ARTICLES IN REFEREED JOURNALSJ224 FloodM,SmallR.Researchinglabourandbirthevents

usinghealthinformationrecords:methodologicalchallenges.Midwifery2009;25(6):701-10

J228 ForsterD,WillsG,DenningA,BolgerM,McCarthyE.TheuseoffolicacidandothervitaminsbeforeandduringpregnancyinagroupofwomeninMelbourne,Australia.Midwifery2009;25:134-46

J246 GisslerM,AlexanderS,MacfarlaneA,SmallR,Stray-PedersenB,ZeitlinJ,ZimbeckM,GagnonAJ.Stillbirthsandinfantdeathsamongmigrantsinindustrialisedcountries.Acta Obstet Gynecol Scand2009;88(2):134-48

J247 BandyopadhyayM.ImpactofritualpollutiononlactationandbreastfeedingpracticesinruralWestBengal,India.International BreastfeedJ2009;4:2

J248 BrownS,SmallR,ArgusB,DavisPG,KrastevA.Earlypostnataldischargefromhospitalforhealthymothersandterminfants.Cochrane Database Syst Rev2009;Issue2.Art.No.:CD002958.DOI:10.1002/14651858.CD002958

J249 HobbsM,TaftA,AmirL.Theemergencycontraceptivepill(ECP)rescheduled:afocusgroupstudyofwomen’sknowledge,attitudesandexperiences.J Fam Plann Reprod HealthCare2009;35(2):87-91

J250 WillisK,GreenJ,DalyJ,WilliamsonL,BandyopadhyayM.Perilsandpossibilities:Achievingbestevidencefromfocusgroupsinpublichealthresearch.Aust N Z J Public Health 2009;33:131-36

J251 TaftA,SmallR,HegartyJ,LumleyJ,WatsonLF,GoldL.MOSAIC(MOthers’AdvocatesIntheCommunity):protocoland sample description of a cluster randomised trial of mentormothersupporttoreduceintimatepartnerviolenceamongpregnantorrecentmothers.BMC Public Health 2009;9:159

J252 LumleyJ,ChamberlainC,DowsellT,OliverS,OakleyL,WatsonL.Interventionsforpromotingsmokingcessationduringpregnancy.Cochrane Database Syst Rev 2009;Issue3Art.No.:CD001055.DOI:10.1002/14651858.CD001055

J253 SawS,MandersonL,BandyopadhyayM,SeinTT,MonMM,MaungW.Publicand/orprivatehealthcare:Tuberculosispatients’perspectivesinMyanmar.Health Res Policy Sys 2009;7:19

J254 WelchN,HunterW,ButeraK,WillisK,ClelandV,CrawfordD,BallK.Women’swork.Maintainingahealthybodyweight.Appetite2009,53(1):9-15

J255 GagnonAJ,ZimbeckM,ZeitlinJ,ROAMCollaboration:AlexanderS,BlondelB,BuitendijkS,DesmeulesM,DiLalloD,GagnonA,GisslerM,GlazierR,HeamanM,KorfkerD,MacfarlaneA,NgE,RothC,SmallR,StewartD,Stray-PedersonB,UrquiaM,VangenS,ZeitlinJ,ZimbeckM.Migrationtowesternindustrialisedcountriesandperinatalhealth:asystematicreview.Soc Sci Med 2009;69:934-46

J256 FelixAS,BruinsmaF,KlemettiR,GisslerM,Lerner-GevaL,TaioliE.Internationalpooledanalysisofcancerincidenceinchildrenafterassistedreproductivetechnologies:interimreport.Future Oncol 2009;5(6):901-06

J257 McLachlanH,ForsterD.Thesafetyofhomebirth:Istheevidencegoodenough?Can Med Assoc J2009;181(6-7):359-60

J258 RamsayJ,CarterY,DavidsonL,DunneD,EldridgeS,FederG,HegartyK,RivasC,TaftA,WarburtonA.Advocacyinterventionstoreduceoreliminateviolenceandpromotethephysicalandpsychosocialwell-beingofwomenwhoexperienceintimatepartnerabuse.Cochrane Database Syst Rev2009;Issue3.Art.No.:CD005043.DOI:10.1002/14651858.CD005043

J259 AdlerNR,GovanB,CullinaneM,HarperM,AdlerB,BoyceJD.Themolecularandcellularbasisofpathogenesisinmelioidosis:howdoesBurkholderiapseudomalleicausedisease? FEMS Microbiol Rev 2009;33(6):1079-99

J260 McLachlanH,GoldL,ForsterD,YellandJ,RaynerJ,RaynerS.Women’sviewsofpostnatalcareinthecontextoftheincreasingpressureonpostnatalbedsinAustralia.Women Birth2009;22(4):128-33

J261 RaynerJ,McLachlanH,ForsterD,CramerR.Australianwomen’suseofcomplementaryandalternativemedicines(CAM)toenhancefertilityexploringtheexperiencesofwomenandpractitioners.BMC Complement Altern Med 2009;9:52

ARTICLES IN PRESSAghlmandS,LameeiA,SmallR.AHands-onexperienceoftheVoiceofCustomeranalysisinmaternitycarefromIran.Int J Health Care Qual Ass

AmirLH,PirottaMV.Medicincesforbreastfeedingwomen:apostalsurveyofknowledge,attitudesandpracticesofgeneralpractitionersinVictoria.Med J Aust

BandyopadhyayM,SmallR,WatsonLF,BrownS.Lifewithanewbaby:HowdoimmigrantandAustralian-bornwomen’sexperiencescompare? Aust N Z J Public Health

FarrellG,ShafieiT,SalmonP.Facingupto‘challengingbehaviour’:amodelfortraininginstaff-clientinteraction.J Adv Nurs

ForsterDA,McEganK,MoorheadA,FordR,OpieG,WalkerS,McNamaraC.Diabetes&AntenatalMilkExpressing(DAME):apilotprojecttoinformthedevelopmentofarandomisedcontrolledtrial.Midwifery

McDonaldK,SlavinS.Mybody,mylife,mychoice:practicesandmeaningsofcomplementaryandalternativemedicineamongasampleofAustralianpeoplelivingwithHIV/AIDSandtheirpractitioners.AIDS Care

ForsterD,McLachlanH.Women’sviewsandexperiencesofbreastfeeding:positive,negative,orjustgoodforthebaby?Midwifery

McLachlanH,ForsterD,CollinsR,GunnJ,HegartyK.Identifyingandsupportingwomenwithpsychosocialissuesduringthepostnatalperiod:evaluatinganeducationalinterventionformidwivesusingabeforeandaftersurvey.Midwifery

RaynerJ,ForsterD,McLachlanH,KealyM,PirottaM.Women’suseofcomplementarymedicinetoenhancefertility:theviewsoffertilityspecialistsinVictoria,Australia.Aust N Z J Obstet Gynaecol


ARTICLES SUBMITTEDAmirL.BreastfeedingWomen’sexperiencesofexpressing:Adescriptivestudy.

HobbsM,TaftAJ,AmirLH,StewartK,ShelleyJM,SmithAMA,ChapmanCB,HusseinySY.Theemergencycontraceptivepill(ECP)rescheduled:anationalsurveyofarandomsampleofAustralianwomen.

HusseinyS,StewartK,ChapmanC,TaftA,AmirL,HobbsM,ShelleyJH,SmithAMA.Provisionoftheemergencycontraceptivepill(ECP)withoutprescription:attitudesandpracticesofpharmacistsinAustralia.

JayawickrameH,AmirLH,PirottaMV.GP’sdecision-makingwhenprescribingmedicinesforbreastfeedingwomen:Contentanalysisofasurvey.

McDonaldK,KirkmanM.HIV-PositivewomeninAustraliaexplaintheiruseandnon-useofantiretroviraltherapyinpreventingmother-to-childtransmission.

NichollsD,GaynorN,ShafieiT,BosanacP,FarrellG.Mentalhealthnursinginemergencydepartments:Thecaseforanursepractitionerrole.

RaynerJ,PyettP,AstburyJ.Themedicalisationof‘tall’girls:Adiscourse analysis of medical literature on the use of synthetic oestogentoreducefemaleheight.

RaynerJ,McLachlanH,ForsterD,PetersL,YellandJ.AstatewidereviewofpostnatalcareinprivatehospitalsinVictoria,Australia.

SimsN,WhileC,RaynerJ.Howdodistrictnursesperceivethecaretheyprovidetopeoplewithdementia?

WatsonLF,RaynerJ,KingJF,JolleyD,ForsterD,LumleyJ.Modellingpriorreproductivehistorytoimprovedpredictionofriskforverypretermbirth.

WatsonLF,RaynerJ,KingJF,JolleyD,ForsterD,LumleyJ.Modellingsequenceofpriorpregnanciesonsubsequentriskforverypretermbirth.

ANNOTATIONS, COMMENTARIES, EDITORIALS AND OTHER INVITED CONTRIBUTIONS IN REFEREED JOURNALSWatsonLF,DaveyM-ABiroMA,KingJF.Re:AdverseoutcomesoflabourinpublicandprivatehospitalsinAustralia:apopulation-basedstudy.[Letter]Med J Aust2009;190:519

AmirL,PirottaM.Medicinesforbreastfeedingwomen:ApostalsurveyofgeneralpractitionersinVictoria.[Letter]Med J Aust2009;191(2):126

TaftAJ,WatsonL.Abortionandmentalhealth–establishedfactsreconsidered.[Letter] Br J Psychiatry2009;194:377-78

BOOK CHAPTERSBandyopadhyayM.Women’sMentalHealthintheContextofHIV/AIDS.InFisherJ,AstburyJ,CabraldeMelloM,SaxenaS(Eds).Mental Health Aspects of Reproductive Health: A Global Review of the Literature.Geneva:WorldHealthOrganization&UnitedNationsPopulationFund,2009;pp.113-27

KealyM,LiamputtongP.ContemporaryCaesareanSectionTheory:Risk,UncertaintyandFear.InBryarRM,CameronJ(Eds.)Theory for Midwifery Practice,2ndEd.Macmillan.PressLtd:London. Inpress

McLachlanH,ForsterD.Infantfeedingfollowingmigration:attitudesandpracticesofwomenborninTurkeyandVietnamaftermigrationtoAustralia.InPLiamputtong(Ed.)Infant Feeding Practices: A Cross-Cultural Perspective.Springer:NewYork.Inpress

BOOK REVIEWSWatsonL.EssentialsofBiostatisticsinPublicHealth&EssentialsofBiostatisticsWorkbook:StatisticalComputingUsingExcel.ByLisaMSullivan.PublishedbyMassachusettsUS,2008.Aust N Z J Public Health 2009;33(2):196-97

WatsonL.TheCollectorsofLostSouls:turningKuruscientistsintowhitemen.ByWarwickAnderson.PublishedbyJohnHopkinsUniversityPress:BaltimoreUS,2008.Aust N Z J Public Health2009;33(2):197

Bandyopadhyay,M.BureaucratsandBleedingHearts:IndigenousHealthinNorthernAustralia.ByTessLea.PublishedbyUNSWPress:SydneyAustralia,2008.Aust N Z J Public Health 2009;33(4):396


CONFERENCE ABSTRACTSDaveyM-A,OatsJ.Placentalcomplicationsinsubsequentpregnanciesfollowingcaesareansection:adoseresponse?PerinatalSocietyofAustraliaandNewZealand13thAnnualCongress,Darwin,19th-22ndApril.J Paed Child Health,2009;44(Suppl1):A22

NewtonM,ForsterD,McLachlanH.Comparingburnoutandsatisfaction:asurveyofcaseloadandnon-caseloadmidwives.PerinatalSocietyofAustraliaandNewZealand13thAnnualCongress,Darwin,19th-22ndApril.J Paed Child Health,2009;44(Suppl1):A32

McLachlanH,ForsterD,SavageT,YellandJ,FarrellT,GoldL,RaynerJ.Anindividual,flexibleapproachtopostnatalcare:apilotprojecttoinformthedevelopmentofarandomisedcontrolledtrial.PerinatalSocietyofAustraliaandNewZealand13thAnnualCongress,Darwin,19th-22ndApril.J Paed Child Health,2009;44(Suppl1):A65

TooheyR,MiddletonP,CrowtherC,DoyleL,DavisP,CarlinJ,KealyM,FlenadyV,DoddJ,forWOMBATCollaboration.Increasingmaternalandperinatalresearchcapacity:trainingmembersofdatamonitoringcommitteesforrandomisedclinicaltrials.PerinatalSocietyofAustraliaandNewZealand13thAnnualCongress,Darwin,19th-22ndApril. J Paed Child Health,2009;44(Suppl1):A74

WatsonL,RaynerJ.Singletonverypretermbirthandpriorinducedandspontaneousabortion:datafromacasecontrolstudy(EarlyBirthsStudy).PerinatalSocietyofAustraliaandNewZealand13thAnnualCongress,Darwin,19th-22ndApril.J Paed Child Health,2009;44(Suppl1):A18

TaftA.Anewmodelondisclosureofminoritysexualorientationingeneralpractice.GeneralPractice&PrimaryHealthCareResearchConference,Melbourne,Australia,15th-17thJuly,npn

AmirL,ClemonsS.Breastfeedingwomen’suseofbreastpumps:adescriptivestudy.GeneralPractice&PrimaryHealthCareResearchConference,Melbourne,Australia,15th-17thJuly,npn

AmirL,JayawickramaH,PirottaM.GPs’decision-makingwhenprescribingmedicinesforbreastfeedingwomen:Contentanalysisofasurvey.GeneralPractice&PrimaryHealthCareResearchConference,Melbourne,Australia,15th-17thJuly,npn

TaftA,WatsonL.TheimpactofpartnerviolenceonthementalhealthofyoungAustralianwomenreportingterminationofpregnancy:cohortanalysisofanationalpopulationsample.GeneralPractice&PrimaryHealthCareResearchConference,Melbourne,Australia,15th-17thJuly,p116

SmallR.Variationsincaesareansectionbymaternalcountryofbirth:Anothercauseforconcern?IEA-EEFEuropeanEpidemiologyConference,Warsaw,Poland,26th-29thAugust.Eur J Epidemiol,2009;24(Suppl1):26

AmirL.SocioeconomicstatusandratesofbreastfeedinginAustralia:apublichealthperspective.AustralianLactationConsultants’AssociationNationalConference,NationalConference,Canberra,Australia,September2009,npn

AmirL,ForsterD,McDonaldK,RaynerJ,SternK.Women’sattitudesandexperiencesofbreastfeeding-doesmaternalweightmakeadifference?AustralianLactationConsultants’AssociationNationalConference,NationalConference,Canberra,Australia,September2009,npn

AmirL,JayawickramaH,PirottaM,WongS,DalyJ.GP’sdecision-makingwhenprescribingmedicinesforbreastfeedingwomen:Contentanalysisofasurvey.AustralianLactationConsultants’AssociationNationalConference,NationalConference,Canberra,Australia,September2009,npn

ForsterD,McLachlanH,FordR.AnevaluationoftheDivision2employmentmodelforstudentmidwivesatTheRoyalWomen’sHospital.AustralianCollegeofMidwives16thNationalConference,Adelaide,September2009,npn

KelsoG,AmirL,JamesJ,MoorheadA.Accreditationofmidwifelactationconsultantstoperformtongue-tierelease.AustralianLactationConsultants’AssociationNationalConference,NationalConference,Canberra,Australia,September2009,npn

McLachlanHL,ForsterDA,AmirL,PemoK,MoorheadA,McEganK,JohnsH,FordR.AnexplorationofcurrentbreastexpressingpracticesintheearlypostpartumperiodusinganauditandfocusgroupsinthreeMelbournehospitals.AustralianLactationConsultants’AssociationNationalConference,Canberra,September2009,npn

MoorheadA,AmirL,WongS,O’BrienP.Aprospectivestudyoffluconazoletreatmentforbreastandnipplethrush..AustralianLactationConsultants’AssociationNationalConference,Canberra,Australia,September2009,npn

HobbsM,TaftA,AmirL.ECPover-the-counter:theAustralianexperience.InternationalConsortiumforEmergencyContraception(ICEC)andAmericanSocietyforEC(ASEC)Annualmeeting,NewYork,23rd-24thSeptember2009,npn

SmallR.Variationsincaesareansectionbymaternalcountryofbirth:Anothercauseforconcern?39thPublicHealthAssociationofAustraliaAnnualConference,Canberra,Australia,28th-30thSeptember,p39

TaftA,SmallR,HegartyK,WatsonL.Methodologicalchallengesincomplexinterventiontrials-successesandchallengesofMOSAIC,aclusterrandomisedtrialofsocialsupportforabusedmothersamongprimaryhealthcarepopulations.15thWONCAEuropeConference,Basel,Switzerland,16th-19thSeptember.Swiss Med Weekly,2009;139(Suppl175):p62

RaynerJ,WillisK,PirottaM.WhatmotivatesGeneralPracitioners(GPs)workinginintegratedmedicalpracticestouseComplementaryandAlternativeMedicines(CAM)astreatmentmodalities.15thInternationalHolisticHealthConference,Melbourne,Australia,8th-10thOctober2009,npn

RaynerJ,WillisK,HsuehA.BuildingcollaborationwithCAMpractitionersandpublichealthresearchers-thecaseofwomen’suseofCAMforfertilityenhancement.InauguralNetworkofResearchersinPublicHealthandComplementaryandAlternativeMedicine(NORPHCAM)Conference,Brisbane,Australia,17th-18thOctober2009,npn

WillisK,RaynerJ,PirottaM.Integrativemedicalpracticeandtheroleofevidence.InauguralNetworkofResearchersinPublicHealthandComplementaryandAlternativeMedicine(NORPHCAM)Conference,Brisbane,Australia,17th-18thOctober2009,npn

TaftA.Theimpactofabortionondepression:Whatroledoespartnerviolenceplay?FindingsfromtheAustralianlongitudinalstudyofwomen’shealth.NationalConferenceonHealthandDomesticViolence,NewOrleans,USA,8th-10thOctober,p40

AmirL,MoorheadA.Aprospectivestudyoffluconazoletreatmentforbreastandnipplethrush.TheAcademyofBreastfeedingMedicine14thAnnualInternationalMeeting,Williamsburg,Virginia,November2009,npn


PUBLIC HEALTH ADVOCACYThisyear,intheirjointroleasmembersoftheVictorianPHAAbranchexecutiveandthenationalcommitteeoftheWomen’sHealthSpecialInterestGroup,RhondaSmallandAngelaTaftcoordinatedawell-attendedpublicforumentitled‘PreventionofunwantedpregnancyinVictoriapostthedecriminalisationofabortion’.

TALKS AND LECTURESMCHRstaff,studentsandassociatesplaceahighpriorityondisseminatingresearchfindingstoconsumers,clinicians,andpolicymakers.In2009MCHRstaffandstudentsdelivered17talksandlectures,manyasinvitedspeakers,toavarietyofaudiencesbothnationalandinternational. Seewebsitefordetails:www.latrobe.edu.au/mchr/

MCHR REFERENCE GROUPS MCHRprojectsoftenhavereferencegroupscomprisingpeoplewithexpertiseinareasrelatedtothetopicofresearch.Eachreferencegroupactsinanadvisorycapacitytotheresearchteam,contributingideasandadviceatallstagesoftheresearchprocessalthoughresponsibilityfortheconductoftheresearch,itsanalysisandpublicationrestswiththeresearchers.Workingwithreferencegroupsisanimportantwayofreceivingvaluableinputfromawiderangeofserviceproviders,consumersandresearchersandawayoffacilitatingdiscussionofourresearchaimsandfindingsinpracticesettings.Wethankthemembersofourreferencegroupsfortheircontributionin2009.Pleaseseewebsitefordetailsofreferencegroups:www.latrobe.edu.au/mchr/

CONFERENCES AND WORKSHOPS ATTENDEDIn2009,MCHRstaffandstudentsattendedavarietyofnationalandinternationalconferencesthatcoveredabroadrangeoftopicsincludingethics,methodology,publichealth,women’shealth,perinatalandpregnancyissues,migration,orpolicy.Seewebsiteformore detail: www.latrobe.edu.au/mchr/

COURSES ATTENDEDMCHRstaffandstudentsendeavourtocontinuetheireducationandextendtheirskillsbyparticipatingintrainingandcoursesthroughouttheyear.In2009avarietyofongoingeducationwasundertakeninAustraliaandoverseas.

COMMITTEESMCHRstaffandstudentsparticipateonanumberofcommitteesandadvisorygroups.Thesecommitteesdealwithprofessional,educational,policyandsocialandethicsissues.Seewebsiteformore detail: www.latrobe.edu.au/mchr/

REVIEWING PAPERSIn2009staffandstudentsatMCHRwereinvitedtoreviewpapersforthefollowingnationalandinternationalpeer-reviewedjournals:

AIDSCare(KM)

AmericanJournalofObstetricsandGynecology(DF)

Asia-PacificJournalofPublicHealth(KM,RS)

AustralianandNewZealandJournalofPublicHealth(LA,MB,FB,M-AD,AH,JR,RS,AT,LW)

Birth(M-AD)

BMCComplementaryandAlternativeMedicine(DF)

BMCHealthEconomics(AH)

BMCPregnancyandChildbirth(DF,RS)

BMCPublicHealth(KM,AT)

BritishMedicalJournal(FB,M-AD,RS)

BritishJournalofObstetrics&Gynaecology(LA,FB,M-AD,LW)

EuropeanJournalofObstetrics&GynecologyandReproductiveBiology(JR)

HumanReproduction(FB)

InternationalBreastfeedingJournal(M-AD,DF,KM,HMc)

JournalofHealthServiceResearchandPolicy(RS)

JournalofHumanLactation(LA,M-AD)

JournalofPsychosomaticObstetricsandGynaecology(MB,JR,RS)

MedicalJournalofAustralia(LA,LW)

Midwifery(M-AD,DF,MB,RS)

Pediatrics(LA)

ReproductiveHealth(M-AD)

RuralandRemoteHealth(AT)

WomenandBirth(DF)

Advocacy & other activities


MEMBERSHIPS OF EDITORIAL BOARDSAnumberofMCHRstaffandstudentsarealsojournalEditorsormembersofEditorialBoards,including:

AustralianandNewZealandJournalofPublicHealth,BookEditor(JR)

BMCHealthEconomics(AH)

JournalofPsychosomaticObstetricsandGynaecology(RS)

JournalofHumanLactation,EditorialBoard(LA)

InternationalBreastfeedingJournal,Editor-in-Chief(LA),EditorialBoard(DF,JL,HMc)

WomenandBirth(DF,HMc)

ASSESSING RESEARCH GRANTSAustralianResearchCouncil(AT)

CanadaInstitutesofHealthResearch(LA)

ClinicalFellowships,HealthResearchBoard,Ireland(JR)

NHMRCFellowships(JL)

NHMRCProjectGrants(LA,RS,LW)

NewZealandHealthResearchCouncil(AT)

ResearchGrants,FacultyofHealthSciences,LaTrobeUniversity(RS)

Sexual&ReproductiveHealthcare(MK)

SocialScienceandHumanitiesResearchCouncilofCanada(RS)

QueenslandNursingCouncil(HMc)

THESIS EXAMINATIONPhD,UniversityofWesternAustralia(LA)

MastersofMidwifery,RMIT(HMc)

AMS,UniversityofMelbourne(JR)

PhD,UniversityofQueensland(AT)


Fiona BruinsmaBSc,GradDipAppPsych,MAppSc(Res)

FionahasworkedonanumberofstudiesduringhertimeatMCHRincluding:prevalenceofobstetricultrasound;cancerafterinfertilityandIVF,women’sexperiencesofmaternitycareinVictoriaandtheTallGirlsstudy.Fiona’smostrecentworkhasinvestigatedpregnancy

outcomesaftercervicaldysplasia.In2007FionajoinedtheCOMPASSteamasateaminvestigatorandin2009shesuccessfullycompletedaDoctorateinPublicHealth.

Melanie Callander BComm,GradDipPsychStud

MelaniejoinedMCHRin2007asapart-timeadministrationofficerandalsoworksonprocessingaccounts.SheiscurrentlycompletingherstudiesinPsychology.

Méabh CullinaneBSc,PhD

MéabhhasabackgroundinmicrobiologyandjoinedMCHRinMay2009totakeupthepositionofprojectco-ordinatorfortheCASTLEstudy,underthesupervisionofLisaAmir.TheCASTLEstudyisanNHMRC-fundedprojectwhichaimstoinvestigatetheroleofmicro-

organisms(Staphylococcusaureus&Candidaalbicans)inthepathogenesisofbreastpainandinfectioninlactatingwomen.

Mary-Ann DaveyRN,RM,DipAppSc,BEd,GradDipSoc,DPH

Mary-Anncametohealthresearchfromseniorclinicalrolesinnursing,midwifery,andmaternalandchildhealth.ShehasworkedatMCHRsince1999onanumberofprojectsrelatedtomaternitycare,andhasbeenateaminvestigatoronCOMPASSfrom2007-2010.Sheis

alsoanepidemiologistattheVictorianConsultativeCouncilonObstetricandPaediatricMortalityandMorbidity.Mary-AnngraduatedwithherDoctorofPublicHealthin2008.ShewillcompleteaMasterofEpidemiologyprogramin2010withamajorfocusonbiostatistics.

Catina Adams BA(Hons)DipEd,BNrsgDipMid,MNrsgSci

CatinaAdamsjoinedtheMOVEprojectinlate2009for12monthsasco-ordinator,havingtakenleavefromherrole as a maternal and child health nurse withtheCityofHume.

Lisa Amir MBBS,MMed(WomHlth),PhD,IBCLC

LisaisamedicalgraduateandanInternationalBoardCertifiedLactationConsultant.ShereceivedaNHMRCHealthProfessionalFellowship (mid-2006tomid-2010)tocontinueworkingatMother&ChildHealthResearch.In2007,shewaspromoted toSeniorResearchFellowandisa

TeamInvestigatoronwithCOMPASS.

Staff & students

MCHRbringstogetherateamofresearcherswithqualificationsandexperiencein:epidemiology,women’shealthpolicy,psychology,education,socialresearch,healtheconomics,biomedicalresearch,microbiology,statistics,medicine,nursingandmidwifery.

Sue Armstrong DipSocStud,BSW,MSW

Sueiscurrentlystudyingpart-timeaswellasworkinginaruralcommunity.Herthesis,supervisedbyRhondaSmall,isacasestudyofwomenbeingscreened for postnatal depression and theirexperienceofthefirstpostnatalyear.Itaimstouncovermoreaboutthe

complexitiesofscreeningandpathwaystocareforwomenlivinginruralareas.

Mridula BandyopadhyayMSc,MPhil,PhD

MridulajoinedMCHRinlate2007asateaminvestigatorwithCOMPASSspecifically to continue her research into immigrantandrefugeewomen’shealthissues.

Mary Anne Biro RN,RM,BA,PhD

MaryAnnejoinedMCHRinMay2007astheprojectcoordinatorfortheCOSMOScaseloadmidwiferytrial.ShewasawardedherPhDin2003onthetopicofteammidwifery.MaryAnneleftMCHRearlyin2009totakeupapostasseniorlecturerinthenewlyestablished

midwiferyprogramatMonashUniversity.


Michelle Kealy RN,RM,MPHC,PhD

MichellebeganatMCHRin2002asaPhD candidate and her thesis passed in2007.DuringhertimeatMCHRsheworkedonHARP,TallGirls,EarlyBirthsandCOSMOSprojectsaswellastheNHMRCfundedWOMBATCollaboration.Michelleresignedfromherpositionwith

COSMOSinApril2009tomovetoKatherine,NorthernTerritory.SheremainsanHonoraryAssociateatMCHR.

Judith Lumley MA,MBBS,PhD,GradDipChildDev,FAFPHM,FFPH(UK)

Judithisanepidemiologistandpublichealthphysician,withlong-standingresearchinterestsinreproductiveandperinatalhealthandhealthservices.ShedevelopedandthenmanagedtheVictorian Perinatal Data Collection Unit (1981-1994),andchairedtheVictorian

MinisterialReviewofBirthingServices(1988-1990).Judith,DirectorofMCHRsinceitsfoundationin1991,retiredin2008andwasawardedanEmeritusProfessorshipin2009.

Karalyn McDonald BA,MA,PhD

KaralynjoinedMCHRin2007aspartoftheMOSAICteamandhassincebeeninvolvedinWomen’sattitudesandexperiencesofbreastfeeding–Doesmaternalweightmakeadifference?(2008-2009).Inearly2009Karalyncommenced her position as a team

investigatorwithCOMPASS.SheisalsoaResearchFellowattheAustralianResearchCentreinSex,HealthandSociety(ARCSHS)atLaTrobeUniversity.

Helen McLachlan RN,GradDipAdvNurs(Mid),MNursStud,PhD

HelenhasaclinicalandresearchbackgroundinmidwiferyandisaSeniorLecturerinmidwiferyintheDivisionofNursingandMidwifery,LaTrobeUniversity.ShejoinedMCHRin1999asjointprojectco-ordinatoroftheABFABbreastfeedingtrial.Sincethenshehasbeenacollaboratoronanumber

ofjointprojectsbetweenMCHRandtheDivisionofNursingandMidwifery,isachiefinvestigatorontheCOSMOSprojectandateaminvestigatorwithCOMPASS.

Jane Morrow RN,RM,BHSc(Nurs),MHSc(HlthMgmnt),GradDipTeachLearn

Jane is a lecturer in midwifery and has many years of clinical midwifery experiencebothinAustraliaandintheUnitedKingdom.JanejoinedMCHRin2008asaparttimePhDstudentworkingontheWAVEprojectforBarwonHealthandisbeingsupervisedbyHelen

McLachlan,DellaForsterandMary-AnnDavey.

Melissa Hobbs RN,BA,MPH

MelissajoinedMCHRinJuly2006asafull-timePhDstudent.Herdoctoralresearch,whichisbeingsupportedbyanAustralianPostgraduateAward(Industry),isastudyoftheprovisionoftheemergencycontraceptivepill(ECP)over-the-counterinAustralia.Melissa

completedaMasterofPublicHealthattheUniversityofNSWin1997andhasaresearchbackgroundinwomen’shealth.

Maggie Flood RN,RM,GradCertHSc(ClinDataMan),DipWrit&Edit

MaggierejoinedMCHRinMarch2009astheprojectcoordinatoroftheCOSMOStrial.Maggiehasanursingandmidwiferybackgroundwithaparticularinterestinmaternalhealthandwellbeing.ShehasworkedpreviouslyatMCHRfrom2000-07onSRM,PRISM,theHealthandRecovery

AfterBirth(HARP)projectandtheMaternalHealthStudy.

Della Forster RN,RM,DipAppSci,BHealthSci,MMid,PhD

DellajoinedMCHRin1999asjointprojectco-ordinatoroftheABFABbreastfeedingtrialandcompletedherPhDin2005.ShewasajointchiefinvestigatorofthestatewidereviewofPublicIn-hospitalpostnatalCare(PinC)andisoneofthechiefinvestigators

forCOSMOSandateaminvestigatorwithCOMPASS.DellaalsoworksparttimeasaMidwiferyConsultantattheRoyalWomen’sHospital.

Arthur Hsueh BPH,MHSA,MA,PhD

Arthur is a health economist with expertiseineconomicevaluation,assessmentandimprovementofhealthcareefficiency,equity,safetyandquality.His position at MCHR is for four years (commencingJanuary,2008)asaresourceteaminvestigatoronCOMPASS,

withafocusoneconomicevaluationofcomplexinterventionsincommunityandclinicalsettings.

Olivia Ellis OliviafinishedVCEattheendof2007andjoinedMCHRinMay2008asafull-timeadministrativeassistantandreceptionist.SheprovidesadministrationsupporttoMCHRstaffandhasakeyroleinmaintainingandupdatingthewebsite.


Wendy Thornton RN,RM,BaHS(Nursing),GradDipC&FN

WendyThorntonjoinedMCHRinOctober2009totakeupthepositionofresearchofficerfortheCASTLEstudy.Wendyhasanursingbackgroundandhasbroadexperienceinpaediatric,midwiferyandmaternalandchildhealthfields.PriortojoiningMCHR,sheworkedasamaternal

andchildhealthnurseinbothruralandurbansettings.

Paul Toomey DipAcctg,GradDipCostMgmnt,CIS

Paulcompletedgraduateandpost-graduatestudiesinaccountingandmanagementwhileonacadetshipwiththeCommonwealthpublicserviceinSydney.Afteramanagementroleina national finance corporation and a professionaladvisoryservicescareer,

PaulcommencedatMCHRin2003andnowistheExecutiveManagerofbothMCHRandtheAustralianResearchCentreinSex,HealthandSociety.

Eve Urban RM,BNrsg,MEd

EveUrbanjoinedMCHRinOctober2009asaresearchofficerfortheCASTLEstudy.Evehasabackgroundinnursingandwomen’shealthandcompletedher Masters in Education at Monash Universityin2003.SincethenshehasworkedasacommunityeducatoratThe

AlfredHospitalandasaresearchassistantonvariousprojectswiththeUniversityofMelbourneandBurnetInstitute.

Ruby WaltersBNrsg(Hons)PhD

RubyjoinedMCHRinFebruary2009astheprojectcoordinatoroftheMOVEproject.Rubyhasanursingbackgroundandhasworkedasaqualitativeresearcherforthepastsixyears,mostrecentlyattheCentreforAdolescentHealth,andpriortothatwiththeNursesBoardofWesternAustralia.Rubyiscurrentlyonmaternityleave.

Lyn Watson BSc,MSc,PhD

LynWatsonhasbeenthestatisticianattheCentresince1992andhasbeeninvolvedinmanyprojectsincludingPRISMandEcoPRISM,theMulti-centrestudy of cancer after infertility and analysisoftheAustralianLongitudinalStudyofWomen’sHealth.In2008,she

completedherPhDonpretermbirth.ShecontinuestoprovidestatisticalinputtomanyprojectsatMother&ChildHealthResearch,includingCOMPASS,PRISMandMOSAIC.

Matthew Payne BSc,PhDMatthewhasabackgroundinmicrobiologyandjoinedMCHRinOctober2009tocarryoutthemicrobiologicalandmolecularinvestigationsfortheCASTLEstudy.MatthewhasabackgroundinmolecularmicrobiologyandreceivedaPhDfrom

theUniversityofQueenslandin2007.BeforejoiningMCHR, heheldapost-doctoralpositionatKing’sCollege,London.

Jo-Anne Rayner RN,BNrsg,GradDipWHlth,MWHlth,PhD

JojoinedMCHRin2000aspartof theTallGirlsStudyteamandhassincebeentheprojectcoordinatoroftheEarlyBirthsStudy(2001-2004)andthePinC Study(2004-2005).Inlate2007Jo wasappointedateaminvestigatorwithCOMPASS,specificallytodevelop

researchintowomen’suseofcomplementaryandalternativemedicinestoenhancefertility.Jo’sPhDwaspassedearly in2009.

Touran Shafiei BMid,PhD

Touran completed a Bachelor of MidwiferyinIranin1994.Sheenrolledfull-timeinaMasterofAppliedScience(Research)atMCHRinFebruary2006andupgradedtoaPhDinSeptember2007.Touranisresearchingthematernitycareexperiencesandwell-beingof

IranianandAfghanwomenandherPhDthesiswaspassedearlyin2010.

Rhonda Small BA,DipEd,GradDipLib,GradDipEpid,PhD

Rhondaworkedinitiallyineducation,welfareandlibrarianshipbeforemovingintopublichealthresearch.ShehasworkedattheCentresinceitsfoundationin1991.Herresearchinterestsincludewomen’sviewsandexperiencesofmaternitycare,cross-culturalissuesin

perinatalresearch,maternaldepression,women’shealthandrecoveryfollowingoperativebirthandintimatepartnerviolence.

Angela Taft BA,DipEd,MPH,PhD

Angela’smajorresearchinterestsincludethehealthimpactofviolenceagainstwomenandchildrenandwomen’sreproductivehealth.ShewasMCHRPostgraduateCoordinatorandistheprincipalinvestigatorofthreecompetitivelyfundedstudiesatMCHR.

SheisanassociateinvestigatorwiththeAustralianLongitudinalStudyofWomen’sHealthandanhonoraryfellowoftheDepartmentofGeneralPractice,UniversityofMelbourne.


VISITING STUDENTS 2009MCHRsupportsanumberofstudentsenrolledelsewhereincludingMichelleNewton,andRhianWalsh,enrolledthroughtheDivisionofNursingandMidwifery,LaTrobeUniversity;andKarinaBria,whoiscompletingPhDstudiesattheUniversityofAdelaide,afterre-locatingtoVictoria.

RESEARCH ASSOCIATES AND COLLABORATORS 2009ProfessorLeahAlbers,ProfessorofMidwifery,UniversityofNewMexico

ProfessorJillAstbury,ChairofPsychology,VictoriaUniversity,Melbourne

DrMichaelBauer,Lecturer,DivisionofNursingandMidwiferyandResearchFellow,AustralianCentreforEvidenceBasedAgedCare,LaTrobeUniversity

DrChrisBessell,ClinicalRiskManagement,RoyalWomen’sHospital,Melbourne

ProfessorShaunBrennecke,DepartmentofObstetricsandGynaecology,RoyalWomen’sHospital,UniversityofMelbourne

AssociateProfessorStephanieBrown,HealthyMothersHealthyFamilies,MurdochChildrensResearchInstitute

AssociateProfessorJeanneDaly,AdjunctAssociateProfessor,MCHR,LaTrobeUniversity

DrLisaDonohue,GeneralManager,RDNSHelenMcPhersonSmithInstituteofCommunityHealth,Melbourne

AssociateProfessorSusanDonath,ClinicalEpidemiologyandBiostatisticsUnit,MurdochChildrensResearchInstitute

MsTanyaFarrell,ManagerofMaternityServices,RoyalWomen’sHospital

MsAnneFleming,HonoraryResearchFellowMCHRandResearchMidwife

AssociateProfessorAnitaGagnon,SchoolofNursing,McGillUniversity,Canada

ProfessorSuzanneGarland,Director,DepartmentofMicrobiologyandInfectiousDiseases,RoyalWomen’sHospital,Melbourne

MsLisaGold,SchoolofSocialHealthandDevelopment,DeakinUniversity

ProfessorJaneGunn,DepartmentofGeneralPractice,UniversityofMelbourne

AssociateProfessorJaneHalliday,PublicHealthGeneticsUnit,MurdochChildren’sResearchInstitute,RoyalChildren’sHospital,UniversityofMelbourne

AssociateProfessorKelseyHegarty,DepartmentofGeneralPractice,UniversityofMelbourne

AssociateProfessorDamienJolley,MonashInstituteofHealthServicesResearch,MonashUniversity.

AssociateProfessorJamesKing,RoyalWomen’sHospital,UniversityofMelbourne

AssociateProfessorSusanKoch,DivisionofNursingandMidwifery,LaTrobeUniversity

ProfessorGabrielKune,EmeritusProfessor,FacultyofMedicine,DentistryandHealthSciences,UniversityofMelbourne

DrGeorgePatton,VicHealthProfessorofAdolescentMentalHealth,RoyalChildren’sHospital,UniversityofMelbourne

DrMariePirotta,DepartmentofGeneralPractice,UniversityofMelbourne

AssociateProfessorPriscillaPyett,IndigenousHealthResearch,MonashUniversityDepartmentofRuralandIndigenousHealth

ProfessorMichaelQuinn,RoyalWomen’sHospital,UniversityofMelbourne

DrJeffreyTan,RoyalWomen’sHospital,UniversityofMelbourne

ProfessorAlisonVenn,MenziesResearchInstitute,UniversityofTasmania

ProfessorUllaWaldenström,KarolinskaInstitute,Sweden

ProfessorGeorgeWerther,Director,CentreforHormoneResearch,MurdochChildren’sResearchInstitute,DepartmentofEndocrinologyandDiabetes,RoyalChildren’sHospital,UniversityofMelbourne

DrKarenWillis,AdjunctSeniorResearchFellowMCHRandSeniorLecturer,DepartmentofSociologyandSocialWork,UniversityofTasmania

DrJaneYelland,HealthyMothersHealthyFamilies,MurdochChildrensResearchInstitute


Current grants, scholarships & awards

NMHrc capacity Building Grant in Population Health researchBuildingpublichealthcapacityforcomplexquestions,complexsettings,complexinterventions

Rhonda Small, Stephanie Brown, Jane Gunn, Judith Lumley, Jeanne Daly, Christine MacArthur

2007-2012: $2,333,750

NHMrc Health Professional research FellowshipLisa Amir

2006-2009: $154,350

NHMrc Project GrantWomen’sEvaluationofarandomisedcontrolledtrialforAbuseandViolenceinGeneralPractice

Kelsey Hegarty, Jane Gunn, Angela Taft A, Gene Feder, Jill Astbury, Judith Lumley and Stephanie Brown

2007-2009: $654,525

Caseloadmidwiferyforwomenatlowriskofmedicalcomplications:arandomisedcontrolledtrial(COSMOS)

Helen McLachlan, Della Forster, Mary-Ann Davey, Judith Lumley, Tanya Farrell, Jeremy Oats, Lisa Gold, and Ulla Waldenström

2007- 2010: $583,125

NHMrc equipment Grant Theroleofmicro-organisms(Staphylococcusaureus&Candidaalbicans)inpathogenesisofbreastpainandinfectioninlactatingwomen

Lisa Amir

2009-2010: $8,000

vicHealth research Project Grant Exploringalcoholuseinpregnancy:whatquestionsshouldwebeasking?

Jane Halliday, Della Forster, Elisabeth Elliot, Cate Nagle, Colleen O’Leary, Melissa Wake, and John Carlin

2010: $105,032

J.O. & J. r. Wicking trustDescriptionandevaluationofSnoezelentherapyformanagingdementiarelatedbehavioursinVictorianresidentialaged-careservices

Michael Bauer, Jo Rayner and Susan Koch

2009-2010: $172,496

la trobe University, Faculty of Health Sciences research GrantsArewomenreallyscaredofgivingbirth?Women’sexplanationsforchoosingelectivecaesareansforfirstbirth

Karalyn McDonald, Jo Rayner and Rhonda Small

2009-2010: $9,986

MILC(MothersandInfantsLactationCohort):amulti-sitecohortstudy

Della Forster, Lisa Amir, Helen McLachlan, Anita Moorhead, Kerri McEgan, Rachael Ford, Chris Scott and Helene Johns

2010: $15,000

Theuseofcomplementaryandalternativemedicine(CAM)inVictorianresidentialagedcarefacilities

SusanKoch,JoRaynerandMichaelBauer

2009-2010: $9,999

Apilotstudytounderpinalargetrialontheroleofacupunctureinreducingformalinductionoflabourinwomenwithuncomplicatedpregnancieshavingafirstbirthat40plusweeks’gestation

Mary-Ann Davey and Caroline Smith

2009-2010: $14,835

Screeningwomenforintimatepartnerviolenceinhealthcaresettings:CochraneSystematicReview.

AngelaTaft

2009-2010: $9,695

la trobe University, Faculty of Health Sciences Postgraduate Support Grants Touran Shafiei, Melissa Hobbs, Jane Morrow

2009-2010: $1,900

AWARDSJudith lumleywasmadeProfessorEmeritaatLaTrobeUniversityon20thMay2009inrecognitionofhersignificantcontributionstoperinatalepidemiologyandmaternityservicesresearchoververymany years

Stephen Duckett Graduate research Prize for Higher Degree by researchMary-Ann Davey

Fellow, academy of Breastfeeding MedicineLisa Amir


Funds 2009

Fundsreceivedfromthesourceslistedheretotalled: $2,022,639

Thecontributionsfromallgrantingbodiesaregratefullyacknowledged.

National Health & Medical research council (NHMrc) 1,247,666

CapacityBuildingGrant-“COMPASS“ 562,992

ProjectGrant:Breastfeedinginfections-“CASTLE” 363,575

ProjectGrant:MidwiferyCaseload-“COSMOS” 155,974

CareerDevelopmentAward-Small,R 94,250

ProfessionalTrainingFellowship-Amir,L 55,125

ProjectEnablingGrant:UniversityofAdelaide-“WOMBAT” 15,750

la trobe University - Faculty of Health Sciences 433,143

Operatingbudgetandsupervisionofstudents(DEEWR&DEST) 326,982

FacultyResearchGrants(Bandyopadhyay,Forster,McLachlan,Rayner) 54,961

FacultyResearchInvestmentfor2009 50,000

PostgraduateResearchSupportGrants 1,200

victorian Health Promotion Foundation 150,000

PublicHealthResearchFellowship-Taft,A 100,000

Partnercontribution-ARCLinkageProject-“MOVE” 50,000

australian research council (arc) LinkageGrant-“MOVE” 96,050

Department of Planning & community Development (victoria) Partnercontribution-ARCLinkageProject-“MOVE” 5,000

Department of education, Science & technology (commonwealth) ResearchInfrastructureBlockGrant 53,518

consultancies and other income (incl interest) 37,262

Lonsdale St

Bourke St

Little Lonsdale St

La Trobe St

324-328 Lt Lonsdale St

N

Queen S

t

Elizabeth S

t

Sw

anston St

Hard

ware Ln

Little Bourke St

Mother & Child Health Research

Faculty of Health Sciences La Trobe University Telephone (03) 8341 8500 Facsimile (03) 8341 8555

Street Address 324-328 Little Lonsdale St Melbourne, 3000 Victoria, Australia

ISSN 1038-1066

Design and formatting Frank Design

This report is produced on an environmentally considered paper, consisting of 50% post consumer recycled waste and 50% FSC certified fibre and printed with vegetable based inks by an environmentally responsible printer. This reflects the Centre’s commitment to environmental sustainability.

Annual Report Working Group Jo Rayner, Rhonda Small, Olivia Ellis

2009€¦ · epidural analgesia in labour in women with uncomplicated pregnancies having a first...

Documents

Transcript of 2009€¦ · epidural analgesia in labour in women with uncomplicated pregnancies having a first...