Dr Lyndall Mollart

Background: Caesarean section (CS) rates are continuing to rise worldwide. Elective repeat CS (ERCS) greatly contribute to the rising rate which increases unnecessary risks of maternal and neonatal morbidity and mortality. Vaginal birth after caesarean (VBAC) is a safe mode of birth for most women; however, uptake remains low. Our objective is to find the factors that influence women¿s decisionmaking to support informed choices for the mode of next birth after caesarean section (NBAC). Methods: A literature search was conducted in CINAHL, Maternity and Infant Care, Embase, EmCare, Cochrane Library and Medline databases. Primary, qualitative, peer reviewed, English language research articles were assessed according to inclusion/exclusion criteria. Articles were systematically assessed for inclusion or exclusion. Included studies were assessed using the Critical Appraisal Skills Programme qualitative studies checklist, Noblit and Hare¿s seven-step meta-ethnography approach synthesised themes. Results: Fourteen primary research articles were included. Six studies on 287 women focused on VBAC, and eight studies examined both VBAC and ERCS with 1861 women and 311 blogs. Thematic analysis yielded four primary themes: Influence of health professionals, impact of previous birth experience, optimal experience, and being in control. Conclusion: This meta-ethnography highlights health professionals¿ influence on women¿s decision making. To assist in decision-making, women need supportive health professionals who provide the current evidence-informed information about risks and benefits of each mode of birth. Health professionals need skills to provide supportive shared decision-making, debrief women regarding indications for their primary caesarean, and address issues of safety, fear, and expectations of childbirth.

Objectives: This integrative review aimed to synthesize studies that investigated the effects of acupressure on sleep quality, depression, anxiety, and agitation in older people, and to describe the acupressure procedures and techniques applied in the included studies. Methods: A literature search was conducted using electronic databases including CINAHL, Cochrane Library, EMBASE, and MEDLINE. The inclusion criteria for the review were studies examining the effect of acupressure in older people aged 60¿years and above, measured the outcomes for sleep quality, depression, anxiety or agitation, applied body acupressure, and published in English language. The exclusion criteria were studies using auricular acupoints only, and articles published in any language other than English. Methodological quality of studies was assessed using the critical appraised tools developed by the Joanna Briggs Institute. The information about study design, findings, and description of acupressure intervention were extracted, summarized, and synthesized. Results: A total of 255 articles were identified from the search and as well one article from cross-references. From there, a total of 19 studies were included in this review. Nine studies consistently showed positive effects of acupressure on sleep quality, and four studies consistently showed that acupressure reduced depression. The outcomes of acupressure on anxiety and agitation showed inconsistent findings, in which three studies measured anxiety and five studies measured agitation. There was also variation of acupressure techniques applied in the reviewed studies. Conclusion: This review found some emerging evidences that acupressure can be beneficial for older people who suffer from sleep problems and depression. Use of specific acupressure points, with standardized acupressure treatment protocols, may improve sleep quality and possibly psychological wellbeing of older people. Future research with well-designed mixed method studies are required to produce stronger evidence, as well as in-depth understanding of acupressure intervention in aged care context.

Complementary and Alternative Medicine/Therapies (CAM) options have increasingly been used by pregnant women, however literature describing midwives¿ views and beliefs towards CAM is sparse. This study aimed to investigate Australian midwives¿ views and beliefs about CAM. Methods: A national survey of Australian College of Midwives midwife members (n = 3552) (UTSHREC 2015000614) included questions on midwives¿ views and support of CAM, and beliefs using a validated CAM Health Belief Questionnaire (CHBQ). Results: The response rate was 16%. Most respondents believed women should have the right to choose CAM (93.3%); and didn't view CAM a threat to public health (91.7%). Nearly half (49.5%) believed that their hospital/service did not have guidelines/procedures on CAM. The CHBQ mean score was 45.43 (SD9.98). Conclusion: Most respondents agreed with the fundamental beliefs of CAM. This study confirms the need for a national CAM policy for midwives; and research on midwives¿ CAM training.

Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Literature describing CAM and self-help options midwives recommend to women experiencing a post-date pregnancy is sparse. This study aimed to investigate if Australian midwives¿ personal CAM use impacts on discussions and recommendations of CAM/Self-help strategies. Methodology/design: A survey of a national midwifery association midwifery members (n = 3,552) was undertaken at a midwifery conference (October 2015) and via e-bulletins (November 2015¿March 2016). The self-administered survey included questions on what self-help and CAM strategies midwives discuss and recommend to women with a post-date pregnancy, midwives¿ confidence levels on discussing or recommending CAM, midwives¿ own personal use of CAM. Findings: A total of 571 registered midwives completed the survey (16%). Demographics (age, years as a midwife, state of residence) reflected Australian midwives and the midwifery association membership. Most respondents discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. The top five CAM recommended were Acupuncture (65.7%), Acupressure (58.1%), Raspberry Leaf (52.5%), Massage (38.9%) and Hypnosis/Calmbirthing/Hypnobirthing (35.7%). Midwives were more likely to discuss strategies if they personally used CAM (p <.001), were younger (p <.001) or had worked less years as midwives (p =.004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p =.001). Conclusion: Midwives¿ personal use of CAM influenced their discussions and recommendations of CAM/self-help strategies to women experiencing a post-date pregnancy. This study has implications for inclusion of CAM in midwifery education curricula.