
Professor Maralyn Foureur
Joint Chair and Professor
School of Nursing and Midwifery
Delivering new research for mums and midwives
During her impressive 40-year research career, Professor Maralyn Foureur’s work has contributed to globally significant advancements in maternity care and midwifery for women and their support teams.
Professor Maralyn Foureur is an internationally esteemed researcher and clinician in the field of maternity care and midwifery. Her work is highly acclaimed for its contribution to maternity care advancements in Australian hospitals. In fact, in the mid-1990s, Maralyn’s PhD study introduced an entirely new model of maternity care into Australia known as “continuity of care”, which is now championed as best practice in our country and many others worldwide.
Maralyn’s current research explores the impact of the built environment—specifically, birth units within Australian hospitals—on the birth experiences of women and their support teams, and therefore birth outcomes. For women and their families, Maralyn’s research is making a personal impact that will last generations.
“My work helps midwives and other maternity care staff who need excellent knowledge and skills to support women well during childbirth. I want to make childbirth a positive and enriching experience for mothers, who will then take on the role of nurturing the next generation.”
Seamless, personalised care
Maralyn’s PhD research in the mid-1990s was ahead of its time. Her randomised controlled trial was the first project to explore “continuity of care” within midwifery—not just for low-risk women, but for all. What she uncovered would help revolutionise Australia’s approach to midwifery care in the years that followed.
“My PhD had a major impact in Australia and internationally. This model enables women to meet a small group of midwives during pregnancy, one of whom will provide her with care throughout her labour and birth and in the early days with her new baby.”
Maralyn’s PhD research established the effectiveness of this new model,
“Women overwhelmingly regard continuity of midwifery care during pregnancy, childbirth and the early postnatal period as the gold standard of care models. It meets their needs for a knowledgeable professional companion to guide them and their family through the unknown experience of childbirth.
“Women report feeling listened to and supported so that they never feel like just another patient having a baby, but that their care is highly, individually tailored to meet their needs.”
Together with evidence from 15 similar studies, Maralyn’s work now informs health policy across Australia and is cited by globally respected entities such as the Cochrane Collaboration and the World Health Organization. The studies demonstrated that women who were provided with continuity of care were 24 per cent less likely to experience preterm birth or early pregnancy loss.
At the University of Newcastle and elsewhere, continuity of care is now the primary model taught to midwifery students. It forms a significant part of their clinical placement experience; at the University of Newcastle, Bachelor of Midwifery students participate in a minimum of 10 relationship-based continuity of care experiences with childbearing women over the course of their studies.
By the time students step into the workforce, they are expertly equipped to provide women and families with the highest level of personalised care.
“Students want to be able to learn within this model of care so that their education needs are individually met, and they are well-supported. Midwives also love working in this way and feel their professional skills are well-utilised when working in continuity of care.”
Creating space for new life
In the past decade, Maralyn’s research focus has shifted from continuity of care to the architecture and design of birth units in Australian hospitals.
Maralyn explains that the built environment can have a significant impact on a woman’s neurophysiology during childbirth. Despite this, Maralyn remains one of very few researchers who are exploring ways to improve birthing spaces for women and their support teams.
“For staff, walking into a well-designed birth unit helps them to feel supported, calm and confident, to think clearly and carry out their work efficiently and effectively.
“We want to provide women and their families—and the staff who care for them—with an environment that is more likely to result in positive birth experiences for all.”
Many women who give birth in the Hunter region will ultimately be able to see Maralyn’s work firsthand. Her research is influencing the design of maternity units across the region, including the newly planned birth units at John Hunter Hospital and Maitland Hospital. It also guided the best practice design of maternity units further afield, such as the Royal North Shore Hospital in Sydney.
“My birth unit design research is considered world-leading. I really enjoy the creative process of designing research, designing birth units, and also designing education so that others can learn the creative process too.”
Maralyn’s research—from continuity of care to birth unit design—has made Newcastle a national leader in maternity services and midwifery models of care research. Her work is helping to continually improve best practice and build a robust base of evidence that can benefit women, families, staff and communities.
“I love being a researcher and partnering with other brilliant researchers in nursing, midwifery and medical sciences to answer the myriad of questions and challenges we face in health services across our region, nationally and internationally.
“Together, we are working to improve the health and wellbeing of our communities, and this makes me proud.”
Delivering new research for mums and midwives
During her impressive 40-year research career, Professor Maralyn Foureur’s work has contributed to globally significant advancements in maternity care and midwifery for women and their support teams.
Career Summary
Biography
Maralyn is Professor of Nursing and Midwifery Research, a Joint Clinical Chair of the University of Newcastle and Hunter New England Local Health District (HNELHD). She also holds Adjunct Professorial appointments at University of Technology Sydney, Victoria University of Wellington, New Zealand and Sydansk Universitat (University of Southern Denmark).
She is a leading Australian midwifery researcher with a national and international reputation established over a 30year career in clinical practice and research. Her ground breaking 1995 RCT testing the effectiveness of continuity of midwifery care for women of all risk led the way for a further 4 RCTs of variations on the model in NSW, QLD and Victoria. This body of research has subsequently enabled the model to be translated into health policy in every state and territory in Australia and is cited in international reviews including the Cochrane Collaboration and WHO documents. Continuity of care has become the foundational model of health service delivery underpinning the educational preparation of midwifery professionals throughout Australia.
In the past 10 years Professor Foureur has been, or is currently, Chief Investigator on four NHMRC Project Grants (2 RCTs, 2 Cohort studies), an ARC Discovery Grant and a NSW Ministry of Health, Translational Research Grant. She has over 150 publications with 70 in the past 5 years. Her current research interests are in the areas of neuro-leadership, neurophysiology and genomics and she is internationally regarded as an expert in the interdisciplinary field of Birth Unit Design. The major focus of her current role is the development of the translational research capacity and capability of the nursing and midwifery workforce of the HNELHD.
She has supervised over 40 Doctoral, Masters and Honours students to successful completion of their degrees-in fields as diverse as nursing, midwifery, public health, health informatics, complementary health, interdisciplinary health education, health architecture and design; in universities in Australia, New Zealand and Denmark.
Qualifications
- Doctor of Philosophy, University of Newcastle
- Graduate Diploma in Clinical Epidemiology, University of Newcastle
Keywords
- Birth Unit Design
- Clinical Epidemiology
- Models of Care and Health Outcomes
- Neuroscience and architecture
- Nursing and Midwifery
Languages
- English (Mother)
- French (Working)
Professional Experience
UON Appointment
Title | Organisation / Department |
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Academic appointment
Dates | Title | Organisation / Department |
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10/1/2011 - 20/12/2018 | Professor of Midwifery Research | University of Technology Sydney Faculty of Health Australia |
24/1/2018 - 24/12/2018 | Director Centre for Midwifery, Child and Family Health | University of Technology Sydney Faculty of Health Australia |
1/6/2018 - 24/12/2018 | Chair: Maternal, Newborn and Women's Heath Clinical Academic Group | Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Australia |
24/7/2011 - 24/12/2012 | Professor of Midwifery | University of Technology Sydney Australia |
24/8/2007 - 24/6/2011 | Joint Clinical Chair: Professor of Midwifery | University of Technology Sydney Australia |
24/8/2006 - 24/8/2007 | Associate Professor Research | University of Technology Sydney Australia |
24/6/1998 - 24/8/2006 | Joint Clinical Chair: Professor of Midwifery | Victoria University of Wellington New Zealand |
24/3/1996 - 24/6/1998 | Senior Lecturer | Victoria University of Wellington New Zealand |
24/2/1995 - 24/12/1995 | Lecturer: Course Coordinator Graduate Diploma in Midwifery | School of Nursing and Midwifery University of Newcastle Australia |
Publications
For publications that are currently unpublished or in-press, details are shown in italics.
Book (3 outputs)
Year | Citation | Altmetrics | Link | ||
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2008 | Birth Territory and Midwifery Guardianship, Elsevier, Oxford, UK (2008) | ||||
McGann S, New Directions in Nursing History, Routledge
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Kirkham M, Exploring the Dirty Side of Women's Health, Routledge
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Chapter (14 outputs)
Year | Citation | Altmetrics | Link |
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2020 | Foureur M, Hammond A, ' Interconnectivity in the Birth Place ', Squaring the Circle: Researching Normal Birth in the Technological World., Printer and Martin, United Kingdom (2020) | ||
2019 | Hammond A, Maralyn F, 'Interconnectivity in the birth room', Squaring the Circle Researching Normal Birth in a Technological World, Pinter & Martin Ltd, London 180-192 (2019) | ||
2017 | Foureur M, Harte D, ' Salutogenic Design for Birth ', Health and Well-being for Interior Architecture, Routledge, New York (2017) | ||
Show 11 more chapters |
Journal article (137 outputs)
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2021 |
Ohr SO, Giles M, Munnoch S, Hunter M, Bolte M, Ferguson J, et al., 'What gets measured gets noticed. Tracking surgical site infection post caesarean section through community surveillance: A post intervention study protocol', Journal of Advanced Nursing, (2021) © 2021 John Wiley & Sons Ltd Aim: This study aims to evaluate the effectiveness of HealthTracker, a surgical site infection surveillance system that aims to improve the noti... [more] © 2021 John Wiley & Sons Ltd Aim: This study aims to evaluate the effectiveness of HealthTracker, a surgical site infection surveillance system that aims to improve the notification of surgical site infection for women after giving birth by caesarean section. Design: This protocol is an intervention study to evaluate the effectiveness of the surveillance system called ¿HealthTracker¿ in monitoring surgical site infections post caesarean section. Methods: This study will use a mobile web application to automatically send a text message inviting all women who give birth to a live baby by caesarean section over six months during 2020¿2021, at an Australian tertiary referral hospital. The text message invites women to complete a web-based validated Wound Healing Questionnaire. The estimated number of eligible women in six months is 700 (caesarean section rate: 34% of 4,000 births annually). Intervention: the proposed ¿HealthTracker¿ surveillance system facilitates active patient-reported surgical site infection identification through an automated mobile text message linking women to an individualized online Wound Healing Questionnaire. Discussion: This project aims to provide a consistent, reliable and cost effective surgical site infection surveillance tool to improve post caesarean section surgical site infection reporting, can be scaled for broader utilization and will provide valuable information to decision makers regarding surgical site infection prevention. Impact: Study findings will provide insights into whether HealthTracker is an efficient and cost effective platform for a systematic and consistent approach to surgical site infection surveillance that can be adopted more broadly, across the local health organization, the State and across other surgical specialty areas. This information will equip hospitals and clinicians with knowledge to better identify patient outcomes related to SSI post discharge from hospital and inform decision making related to preventative strategies, providing the necessary momentum to introduce practice change initiatives aimed at reducing surgical site infection rates. Trial Registration: ACTRN12620001233910.
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2021 |
Coates D, Donnolley N, Foureur M, Thirukumar P, Henry A, 'Factors associated with women's birth beliefs and experiences of decision-making in the context of planned birth: A survey study.', Midwifery, 96 102944 (2021)
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2021 |
Minooee S, Cummins A, Foureur M, Travaglia J, 'Catastrophic thinking: Is it the legacy of traumatic births? Midwives experiences of shoulder dystocia complicated births', Women and Birth, 34 e38-e46 (2021) © 2020 Australian College of Midwives Background: Shoulder dystocia (SD) is considered one of the most traumatic birth experiences not only for women, but for clinicians involved ... [more] © 2020 Australian College of Midwives Background: Shoulder dystocia (SD) is considered one of the most traumatic birth experiences not only for women, but for clinicians involved as well. Adverse effects of birth trauma on the emotions and psyche of midwives have been well established. Aim: To explore the impact of SD, as a birth trauma, on midwives¿ orientation towards normal births and on their clinical practice and the factors which may deteriorate or improve the experience of SD. Methods: In a qualitative descriptive study design, 25 in-depth interviews were undertaken with Australian midwives who had experienced at least one case of SD. Data were analysed thematically. Findings: A total of four themes emerged: 1) an unforgettable birth; a wake-up call, 2) from passion to caution, 3) factors worsening the experience, and 4) factors soothing the experience. Fear, anxiety and doubt about their professional competence were the most common feelings experienced by midwives after SD. For many, the first exposure to SD left them contemplating their previous attitude towards normal birth. Disturbed orientation of normal birth shifted midwives towards hypervigilance in practice. Not having effective relationships with women and receiving poor support from colleagues were perceived to worsen the traumatic experience, whereas working in a midwifery continuity of care model and the sense of being appreciated improved midwives¿ experience after the trauma. Conclusion: Shoulder dystocia is a birth emergency that midwives will inevitably experience. Involvement in such births can potentially direct midwives towards a ¿worst case scenario¿ mentality and affect the way they provide care for women in future.
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2021 |
Coates D, Donnolley N, Foureur M, Henry A, 'Women's experiences of decision-making and attitudes in relation to induction of labour: A survey study', Women and Birth, 34 e170-e177 (2021) © 2020 Australian College of Midwives Background: Rates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Altho... [more] © 2020 Australian College of Midwives Background: Rates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women's mode of birth preferences and experiences of shared decision-making for induction of labour. Method: An antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women's demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process. Results: Of 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making. Conclusion: A substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.
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2021 |
Fox D, Maude R, Coddington R, Woodworth R, Scarf V, Watson K, Foureur M, 'The use of continuous foetal monitoring technologies that enable mobility in labour for women with complex pregnancies: A survey of Australian and New Zealand hospitals', Midwifery, 93 (2021) © 2020 The Author(s) Objective: Freedom of movement and choice of positioning in labour and birth is known to enhance physiological processes and positive experiences for women du... [more] © 2020 The Author(s) Objective: Freedom of movement and choice of positioning in labour and birth is known to enhance physiological processes and positive experiences for women during childbirth. Continuous foetal monitoring technologies that enable mobility in labour for women with complex pregnancies, such as wireless CTG, have been marketed for clinical use in most high resource settings since 2003 but there is a paucity of midwifery literature about its clinical use. The aim of this survey was to determine how often, and for whom, wireless and beltless technologies are being used in maternity settings across Australia and New Zealand and to identify any barriers to their uptake. Design: A survey tool developed by Watson et al. (2018) for use in the United Kingdom was adapted for the Australian/New Zealand context. One Maternity Unit Manager or key midwifery clinician from each of 208 public and private hospitals across Australia and New Zealand was invited by email to participate in an online survey between October 2019 and January 2020. Descriptive statistics were used to describe the characteristics of the facilities and the frequency of availability of the monitors. Free text responses were thematically analysed. Findings: The survey received a high (71%) response rate from a range of public and private hospitals in urban and rural settings. Women's freedom of movement and sense of choice and control in labour were seen by most respondents to be positively influenced by wireless monitoring technology. Most facilities reported having at least one wireless or beltless foetal monitor available, however, results suggest that many women consenting to continuous monitoring still do not have access to technology that enables freedom of movement. Keyconclusions: Further research is required to explore the barriers and facilitators to enabling freedom of movement and positioning to all women in childbirth, including those women with complex pregnancies who may consent to continuous foetal monitoring.
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2020 |
Foureur M, Kumsa F, Cummins A, Hayen A, Dessie Y, 'Gestational Weight Gain and its Effect on Birth Outcomes in sub-Saharan Africa: Systematic Review and Meta-analysis', PLoS ONE, 15 (2020) [C1]
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2020 |
Griffiths N, Spence K, Galea C, Psaila K, Foureur M, Sinclair L, 'The effects of education levels of developmental care in Australia: Perceptions and challenges', Australian Critical Care, (2020) © 2020 Background: Developmental care consists of a range of clinical, infant-focused, and family-focused interventions designed to modify the neonatal intensive care environment ... [more] © 2020 Background: Developmental care consists of a range of clinical, infant-focused, and family-focused interventions designed to modify the neonatal intensive care environment and caregiving practices to reduce stressors on the developing brain. Since the inception of developmental care in the early 1980s, it has been recommended and adopted globally as a component of routine practice for neonatal care. Despite its application for almost 40 y, little is known of the attitude of neonatal nurses in Australia towards the intervention. Aims and objectives: The objective of this study was to establish Australian neonatal nurse perceptions of developmental care and explore associations between developmental care education levels of the nurses and personal beliefs in the application of developmental care. Design: This involves a cross-sectional survey design. Methods: An online questionnaire was completed by 171 neonatal nurses. Participants were members of the Australian College of Neonatal Nursing (n = 783). Covariate associations between key components of developmental care and respondents' geographical location, place of employment, professional qualifications, and developmental care education level were analysed. The reporting of this study is in accordance with the Enhancing the Quality and Transparency of Health Research Checklist for Reporting Results of Internet E-Surveys. Results: Differences were observed between groups for geographical location, place of employment, and professional qualification level. Rural nurses were less likely to support the provision of skin-to-skin care (odds ratio [OR]: 0.6, 95% confidence interval [ CI]: 0.2¿1.8) than nurses in a metropolitsan unit. Nurses working in a neonatal intensive care unit and nurses with postgraduate qualifications were more likely to support parental involvement in care ([OR: 2.3, 95% CI: 0.9¿6.2] and [OR: 2.1, 95% CI: 0.6¿7.4], respectively). Rural respondents were more likely to have attended off-site education (OR: 3.6, 95% CI: 1.3¿9.9) than metropolitan respondents. Conclusion: The application of developmental care in Australia may be influenced by inadequate resources and inequitable access to educational resources, and similar challenges have been reported in other countries. Overcoming the challenges requires a focused education strategy and support within and beyond the neonatal intensive care unit.
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2020 |
Coates D, Homer C, Wilson A, Deady L, Mason E, Foureur M, Henry A, 'Indications for, and timing of, planned caesarean section: A systematic analysis of clinical guidelines', Women and Birth, 33 22-34 (2020) [C1] © 2019 Australian College of Midwives Background: There has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice betwee... [more] © 2019 Australian College of Midwives Background: There has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in relation to the timing and indications for planned caesarean section as well as recommendations around the process of decision-making. Method: A systematic search of national and international English-language guidelines published between 2008 and 2018 was undertaken. Guidelines were reviewed, assessed in terms of quality and extracted independently by two reviewers. Findings: In total, 49 guidelines of varying quality were included. There was consistency between the guidelines in potential indications for caesarean section, although guidelines vary in terms of the level of detail. There was substantial variation in timing of birth, for example recommended timing of caesarean section for women with uncomplicated placenta praevia is between 36 and 39 weeks depending on the guideline. Only 11 guidelines provided detailed guidance on shared decision-making. In general, national-level guidelines from Australia, and overseas, received higher quality ratings than regional guidelines. Conclusion: The majority of guidelines, regardless of their quality, provide very limited information to guide shared decision-making or the timing of planned caesarean section, two of the most vital aspects of guidance. National guidelines were generally of better quality than regional ones, suggesting these should be used as a template where possible and emphasis placed on improving national guidelines and minimising intra-country, regional, variability of guidelines.
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2020 |
Fealy S, Davis D, Foureur M, Attia J, Hazelton M, Hure A, 'The return of weighing in pregnancy: A discussion of evidence and practice', Women and Birth, 33 119-124 (2020) [C1] © 2019 Australian College of Midwives Background: Inadequate or excessive gestational weight gain is associated with both short and long-term adverse maternal and infant health ou... [more] © 2019 Australian College of Midwives Background: Inadequate or excessive gestational weight gain is associated with both short and long-term adverse maternal and infant health outcomes. The practice of routine maternal weight monitoring has been suggested as an effective health promotion intervention, both as a screening tool for adverse maternal and infant outcomes and as a weight management strategy for addressing gestational weight gain. Discussion: The effectiveness of routine maternal weighing as part of maternity care has been debated for more than 30 years. The National Health and Medical Research Council of Australia have recently revised their pregnancy care clinical practice guidelines recommending maternal weight monitoring (clinician and/or self-weighing) be reintroduced into clinical practice. This paper presents a timely discussion of the topic that will contribute new insights to the debate. Conclusion: Weight gain in pregnancy is complex. Evaluation of the translation, implementation, acceptability and uptake of the newly revised guidelines is warranted, given that evidence on the practice remains inconclusive. Future research exploring social ecological interventions to assist pregnant women achieve optimal gestational weight gains are suggested to expand the evidence base.
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2020 |
Coates D, Donnolley N, Foureur M, Spear V, Henry A, 'Exploring unwarranted clinical variation: The attitudes of midwives and obstetric medical staff regarding induction of labour and planned caesarean section', Women and Birth, (2020) © 2020 Australian College of Midwives Background: Unexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section. Aim: To ... [more] © 2020 Australian College of Midwives Background: Unexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section. Aim: To map attitudes and knowledge of maternity care professionals regarding indications for planned birth, and assess inter-professional (midwifery versus medical) and intra-professional variation. Methods: A custom-created survey of medical and midwifery staff at eight Sydney hospitals. Staff were asked to rate their level of agreement with 45 ¿evidence-based¿ statements regarding caesareans and inductions on a five-point Likert scale. Responses were grouped by profession, and comparisons made of inter- and intra-professional responses. Findings: Total 275 respondents, 78% midwifery and 21% medical. Considerable inter- and intra-professional variation was noted, with midwives generally less likely to consider any of the planned birth indications ¿valid¿ compared to medical staff. Indications for induction with most variation in midwifery responses included maternal characteristics (age=40, obesity, ethnicity) and fetal macrosomia; and for medical personnel in-vitro fertilisation, maternal request, and routine induction at 39 weeks gestation. Indications for caesarean with most variation in midwifery responses included previous lower segment caesarean section, previous shoulder dystocia, and uncomplicated breech; and for medical personnel uncomplicated dichorionic twins. Indications with most inter-professional variation were induction at 41+ weeks versus 42+ weeks and cesarean for previous lower segment caesarean section. Discussion: Both inter- and intra-professional variation in what were considered valid indications reflected inconsistency in underlying evidence and/or guidelines. Conclusion: Greater focus on interdisciplinary education and consensus, as well as on shared decision-making with women, may be helpful in resolving these tensions.
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2020 |
Coates D, Homer C, Wilson A, Deady L, Mason E, Foureur M, Henry A, 'Induction of labour indications and timing: A systematic analysis of clinical guidelines', Women and Birth, 33 219-230 (2020) [C1] © 2019 Australian College of Midwives Background: There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may st... [more] © 2019 Australian College of Midwives Background: There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may stem from variability in clinical guidelines. This review aimed to identify to what extent induction of labour guidelines provide consistent recommendations in relation to reasons for, and timing of, induction of labour and ascertain whether inconsistencies can be explained by variability guideline quality. Method: We conducted a systematic search of national and international English-language guidelines published between 2008 and 2018. General induction of labour guidelines and condition-specific guidelines containing induction of labour recommendations were searched. Guidelines were reviewed and extracted independently by two reviewers. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument. Findings: Forty nine guidelines of varying quality were included. Indications where guidelines had mostly consistent advice included prolonged pregnancy (induction between 41 and 42 weeks), preterm premature rupture of membranes, and term preeclampsia (induction when preeclampsia diagnosed =37 weeks). Guidelines were also consistent in agreeing on decreased fetal movements and oligohydramnios as valid indications for induction, although timing recommendations were absent or inconsistent. Common indications where there was little consensus on validity and/or timing of induction included gestational diabetes, fetal macrosomia, elevated maternal body mass index, and twin pregnancy. Conclusion: Substantial variation in clinical practice guidelines for indications for induction exists. As guidelines rated of similar quality presented conflicting recommendations, guideline variability was not explained by guideline quality. Guideline variability may partly account for unexplained variation in induction of labour rates.
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2020 |
Fealy S, Attia J, Leigh L, Oldmeadow C, Hazelton M, Foureur M, et al., 'Demographic and social-cognitive factors associated with gestational weight gain in an Australian pregnancy cohort', Eating Behaviors, 39 (2020) [C1]
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2020 |
Giles M, Graham L, Ball J, King J, Watts W, Harris A, et al., 'Implementation of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use in four Australian hospitals: A cluster controlled study.', Journal of clinical nursing, 29 872-887 (2020) [C1]
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2020 |
Scarf VL, Yu S, Viney R, Lavis L, Dahlen H, Foureur M, Homer C, 'The cost of vaginal birth at home, in a birth centre or in a hospital setting in New South Wales: A micro-costing study', Women and Birth, 33 286-293 (2020) [C1] © 2019 Australian College of Midwives Background: Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services f... [more] © 2019 Australian College of Midwives Background: Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings. Aim: The aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales. Methods: A micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy. Findings: The median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings. Conclusion: In this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.
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2020 |
McLaughlin K, Jensen ME, Foureur M, Gibson PG, Murphy VE, 'Fractional exhaled nitric oxide-based asthma management: The feasibility of its implementation into antenatal care in New South Wales, Australia', Australian and New Zealand Journal of Obstetrics and Gynaecology, 60 389-395 (2020) [C1] © 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: The use of fractional exhaled nitric oxide (FeNO)-based asthma management durin... [more] © 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: The use of fractional exhaled nitric oxide (FeNO)-based asthma management during pregnancy can significantly reduce asthma exacerbations in non-smoking pregnant women. The feasibility of implementing this strategy into antenatal care has not been explored. Aims: To examine the feasibility of implementing FeNO-based asthma management into antenatal clinics in New South Wales (NSW) Australia. Materials and Methods: Semi-structured face-to-face interviews with video elicitation were conducted with healthcare professionals (HCPs) providing antenatal care in one of two hospital-based antenatal clinics in NSW, Australia. The video shown demonstrated the use of the FeNO instrument and other aspects of the management strategy, in antenatal care. Interviews were recorded, transcribed and analysed using qualitative content analysis. Results: A total of 20 interviews were conducted with 15 midwives, four obstetricians, and one general practitioner. Two main themes and ten sub-themes arose: Getting a number (sub-themes: engaging, technically easy, objective, predictive, reassuring); and Resourcing (sub-themes: time and timing, systems, staff, education and cost). Comments included: ¿It's easy, fast and effective¿ and ¿the main barrier is time¿. All HCPs felt capable of facilitating the FeNO-based management strategy, with appropriate education, and were willing to undertake this strategy, saying: ¿¿it would be perfectly acceptable for a midwife or doctor to do it¿; also, ¿they don't necessarily need to see a physician, it's something that midwives would take on generally¿¿. Conclusion: Participants in this study considered FeNO-based asthma management for pregnant women to be a feasible addition to antenatal care following appropriate provision of resources and education.
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2020 |
McLaughlin K, Jensen M, Foureur M, Murphy VE, 'Antenatal asthma management by midwives in Australia Self-reported knowledge, confidence and guideline use', Women and Birth, 33 e166-e175 (2020) [C1] © 2019 Australian College of Midwives Background: Asthma affects approximately 12.7% of pregnant women in Australia. Increased maternal and infant morbidity is closely associated ... [more] © 2019 Australian College of Midwives Background: Asthma affects approximately 12.7% of pregnant women in Australia. Increased maternal and infant morbidity is closely associated with poorly controlled asthma during pregnancy. Midwives are well placed to provide antenatal asthma management but data on current asthma management during pregnancy is not available, nor is the use of guidelines for clinical practice by this health professional group. Aim: To explore self-reported antenatal asthma management provided by midwives across Australia and how this reflects guideline recommendations. Method: An online survey was developed and distributed throughout Australia via the Australian College of Midwives, social media and healthcare facilities. Results: Responses from 371 midwives were obtained. Ten percent of midwives rated their knowledge as ¿good¿ and 1% as ¿very good¿, with 39% ¿poor¿ or ¿very poor¿. Being ¿somewhat¿ or ¿not at all¿ confident to provide antenatal asthma management was noted by 87% of midwives. Clinical guidelines were referred to by 50% of midwives and 40% stated that their main role was to refer women to other healthcare professionals. Only 54% reported that a clear referral pathway existed. Most respondents (>90%) recognised key recommendations for asthma management such as smoking cessation, appropriate vaccinations, and the continuation of prescribed asthma medications. Conclusion: Although midwives appear aware of key clinical recommendations for optimal antenatal asthma management, low referral to clinical practice guidelines and lack of knowledge and confidence was evident. Further research is required to determine what care pregnant women with asthma are actually receiving and identify strategies to improve antenatal asthma management by midwives.
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2020 |
McLaughlin K, Jensen ME, Foureur M, Gibson P, Murphy VE, 'The acceptability and feasibility of implementing a Fractional exhaled Nitric Oxide (FeNO)-based asthma management strategy into antenatal care: The perspective of pregnant women with asthma', Midwifery, 88 (2020) [C1]
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2020 |
Davis D, S Homer C, Clack D, Turkmani S, Foureur M, 'Choosing vaginal birth after caesarean section: Motivating factors', Midwifery, 88 (2020) [C1] © 2020 Elsevier Ltd Objectives: to examine the factors that motivate women who have had a previous caesarean section to consider planning a vaginal birth. Design: a qualitative de... [more] © 2020 Elsevier Ltd Objectives: to examine the factors that motivate women who have had a previous caesarean section to consider planning a vaginal birth. Design: a qualitative descriptive study with thematic analysis, drawing on interviews with women participating in a two arm, un-blinded randomised controlled trial (RCT) of midwifery continuity of care for increasing the proportion of women planning VBAC. Setting: A Maternity Unit attached to a district hospital in an outer metropolitan area of Sydney, Australia. Participants: a purposive sample of 18 women participating in an RCT who had experienced previous caesarean section and had no contraindications for vaginal birth. Findings: These women were committed to natural birth and drew on their previous experience of caesarean section to highlight the downside of recovery post caesarean section. Decision making for these women was complex. During the decision-making process, women individualised the information provided to balance risk and chance within the context of their own circumstance. Supportive healthcare providers were important in motivating women towards vaginal birth and midwives were identified as being more supportive than obstetricians. Conclusions: Recovery post caesarean section is an important consideration that is under emphasised in the informed consent process. There is opportunity for midwives to contribute proactively in promoting vaginal birth for women who have experienced a previous caesarean section. Implications for practice: women should be assisted to make informed choices with balanced information that includes recovery from surgical birth. Models of care that include a significant role for midwives and strategies that proactively encourage vaginal birth for women after previous caesarean section are needed.
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2020 |
Minooee S, Cummins A, Sims DJ, Foureur M, Travaglia J, 'Scoping review of the impact of birth trauma on clinical decisions of midwives', Journal of Evaluation in Clinical Practice, 26 1270-1279 (2020) [C1] © 2019 John Wiley & Sons, Ltd. Objective: The psychological and emotional impact of a traumatic birth experience on clinicians is well-established. It is also known that emo... [more] © 2019 John Wiley & Sons, Ltd. Objective: The psychological and emotional impact of a traumatic birth experience on clinicians is well-established. It is also known that emotions can generally influence decisions. However, it is not clear whether experiencing a birth trauma can affect the professional behaviour and decision-making of clinicians. This study explores the impact of birth trauma on clinical decision-making of midwives. Data Sources: Four databases (Medline, Scopus, CINAHL and ProQuest) were searched to identify English language studies published from 1990 to 2018. Due to the lack of studies with specific focus on clinical decision-making after birth trauma, we defined two main domains for our literature search. To be included, studies had to focus on either traumatic birth experience or clinical decision-making in midwifery. The findings of the two domains were then integrated. Study Selection: Of a total 2104 studies identified, 70 received full-text screening with 40 included in the review. Twenty-two articles were about traumatic birth events and 18 examined decision-making in midwifery. Data Extraction: Information were extracted on each article's purpose, study design, data collection, participants, definitions of birth trauma and the context in which clinical decisions were made. Results: Thematic analysis was conducted. The impact of birth trauma on midwives could be categorized into the following themes: psychological issues; professional concerns; changes in practice and positive impact. Review of literature indicated that clinical decision-making could be influenced through all these themes. Conclusion: Decision-making can be impacted by the midwife's affective state related to previous experience of birth trauma. The continuum of impact may vary from increased defensiveness to increased personal and professional growth. Being aware of this impact can help midwives to better manage their emotions while making decision after traumatic birth experiences.
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2020 |
Hainsworth N, Dowse E, Ebert L, Foureur M, ''Continuity of Care Experiences' within pre-registration midwifery education programs: A scoping review.', Women Birth, (2020)
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2020 |
Geia L, Baird K, Bail K, Barclay L, Bennett J, Best O, et al., 'A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.', Contemp Nurse, 56 297-308 (2020)
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2019 |
Braye K, Foureur M, de Waal K, Jones M, Putt E, Ferguson J, 'Group B streptococcal screening, intrapartum antibiotic prophylaxis, and neonatal early-onset infection rates in an Australian local health district: 2006-2016', PLOS ONE, 14 (2019) [C1]
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2019 |
Braye K, Foureur M, de Waal K, Jones M, Putt E, Ferguson J, 'Epidemiology of neonatal early-onset sepsis in a geographically diverse Australian health district 2006-2016', PLOS ONE, 14 (2019) [C1]
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2019 |
Mollart L, Stulz V, Foureur M, 'Midwives personal views and beliefs about complementary and alternative medicine (CAM): A national survey', Complementary Therapies in Clinical Practice, 34 235-239 (2019) [C1] © 2018 Elsevier Ltd Complementary and Alternative Medicine/Therapies (CAM) options have increasingly been used by pregnant women, however literature describing midwives¿ views and... [more] © 2018 Elsevier Ltd 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.
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2019 |
Coates D, Foureur M, 'The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review', Health and Social Care in the Community, 27 e389-e405 (2019) [C1] © 2019 John Wiley & Sons Ltd Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this... [more] © 2019 John Wiley & Sons Ltd Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question ¿what is the nature of the evidence relevant to the provision of mental health interventions by midwives?¿ To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems, and to develop and evaluate models of integrated perinatal mental healthcare.
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2018 |
Mollart L, Skinner V, Adams J, Foureur M, 'Midwives personal use of complementary and alternative medicine (CAM) influences their recommendations to women experiencing a post-date pregnancy', Women and Birth, 31 44-51 (2018) [C1] © 2017 Australian College of Midwives Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Litera... [more] © 2017 Australian College of Midwives 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.
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2018 |
McLaughlin K, Foureur M, Jensen ME, Murphy VE, 'Review and appraisal of guidelines for the management of asthma during pregnancy', Women and Birth, 31 e349-e357 (2018) [C1] © 2018 Australian College of Midwives Background: Asthma affects 12.7% of pregnancies in Australia. Poorly controlled asthma is associated with increased maternal and infant morbi... [more] © 2018 Australian College of Midwives Background: Asthma affects 12.7% of pregnancies in Australia. Poorly controlled asthma is associated with increased maternal and infant morbidity and mortality. Optimal antenatal management of asthma during pregnancy has the potential to reduce complications relating to asthma. Evidence-based clinical practice guidelines help to translate health research findings into practice and when implemented can improve health outcomes. National and International guidelines currently provide recommendations for optimal asthma care in pregnancy. Aim: To appraise the existing asthma in pregnancy guidelines with respect to their evidence for recommendations, consistency of recommendations and appropriateness for clinical practice. Method: The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to appraise four English language asthma in pregnancy guidelines, published or updated between 2007 and 2016. The recommendations, range and level of evidence was analysed. Results: Two of the four guidelines scored highly in most domains of the appraisal. Many of the recommendations made in the appraised guidelines were consistent. Due to the lack of randomised controlled trials involving pregnant women with asthma, most recommendations were evidenced by consensus and expert opinion rather than high quality meta-analysis, systematic reviews of randomised controlled trials. Conclusion: The recommended antenatal asthma management was generally consistent among the guidelines but lacked clarity in some areas which then leave them open to interpretation. More randomised controlled trials involving pregnant women with asthma are required to fortify the recommendations made and asthma management guidelines should be included in Australian Antenatal Care Guidelines as they currently are not.
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2017 |
Fealy SM, Taylor RM, Foureur M, Attia J, Ebert L, Bisquera A, Hure AJ, 'Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials', BMC PREGNANCY AND CHILDBIRTH, 17 (2017) [C1]
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2017 |
Fletcher R, May C, Kay-Lambkin F, Gemmill AW, Cann W, Nicholson JM, et al., 'SMS4dads: Providing information and support to new fathers through mobile phones a pilot study', Advances in Mental Health, 15 121-131 (2017) [C1]
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2017 |
Monk AR, Grigg CP, Foureur M, Tracy M, Tracy SK, 'Freestanding midwifery units: Maternal and neonatal outcomes following transfer', Midwifery, 46 24-28 (2017) © 2017 Elsevier Ltd Background the viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, ... [more] © 2017 Elsevier Ltd Background the viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, require transfer. Aim to compare the maternal and neonatal birth outcomes of women who planned, to give birth at freestanding midwifery units and subsequently, transferred to a tertiary maternity unit to the maternal and neonatal, outcomes of a low-risk cohort of women who planned to give birth in, tertiary maternity unit. Methods a descriptive study compared two groups of women with low-risk singleton, pregnancies who were less than 28 weeks pregnant at booking: women who, planned to give birth at a freestanding midwifery unit (n=494) who, transferred to a tertiary maternity unit during the antenatal, intrapartum or postnatal periods (n=260) and women who planned to give, birth at a tertiary maternity unit (n=3157). Primary outcomes were mode, of birth, Apgar score of less than 7 at 5¿minutes and admission to, special care nursery or neonatal intensive care. Key findings the proportion of women who experienced a caesarean section was lower, among the freestanding midwifery unit women who transferred during the, intrapartum/postnatal period compared to women in the tertiary maternity, unit group (16.1% versus 24.8% respectively). Other outcomes were, comparable between the cohorts. Rates of primary outcomes in relation to, stage of transfer varied when stratified by parity. discussion these descriptive results support the provision of care in freestanding, midwifery units as an alternative to tertiary maternity units for women, with low risk pregnancies at the time of booking. A larger study, powered, to determine statistical significance of any differences in outcomes, is, required.
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2017 |
Hammond A, Homer CSE, Foureur M, 'Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting', Midwifery, 50 133-138 (2017) © 2017 Elsevier Ltd Objective to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. Design this study used a qualit... [more] © 2017 Elsevier Ltd Objective to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. Design this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews and a thematic analysis guided by study objectives and the aims of exploratory research was undertaken. Setting the study was set at a recently renovated tertiary hospital in a large Australian city. Participants participants were 16 registered midwives working in a tertiary hospital; seven in delivery suite and nine in birth centre settings. Experience as a midwife ranged from three to 39 years and the sample included midwives in diverse roles such as educator, student support and unit manager. Findings three design characteristics were identified that supported midwifery practice. They were friendliness, functionality and freedom. Friendly rooms reduced stress and increased midwives' feelings of safety. Functional rooms enabled choice and provided options to better meet the needs of labouring women. And freedom allowed for flexible, spontaneous and responsive midwifery practice. Conclusion hospital birth rooms that possess the characteristics of friendliness, functionality and freedom offer enhanced support for midwives and may therefore increase effective care provision. Implications for practice new and existing birth rooms can be designed or adapted to better support the wellbeing and effectiveness of midwives and may thereby enhance the quality of midwifery care delivered in the hospital. Quality midwifery care is associated with positive outcomes and experiences for labouring women. Further research is required to investigate the benefit that may be transmitted to women by implementing design intended to support and enhance midwifery practice.
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2017 |
Patterson J, Foureur M, Skinner J, 'Remote rural women's choice of birthplace and transfer experiences in rural Otago and Southland New Zealand', Midwifery, 52 49-56 (2017) © 2017 Elsevier Ltd Background Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of ... [more] © 2017 Elsevier Ltd Background Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of serious perinatal outcomes for these women is comparable to similarly low risk women, who choose to birth in hospital. New Zealand women have a choice of Lead Maternity Carer (LMC) and birthplace; home, primary birthing unit, or a base hospital, though not all women may have all these choices available locally. Women in rural and rural remote areas can also choose to birth in their rural primary maternity unit. A percentage of these women (approx. 15¿17%) will require transfer during labour, an event which can cause distress and often loss of midwifery continuity of care. Objective To explore retrospectively the choice of birth place decisions and the labour and birth experiences of a sample of women resident in remotely zoned, rural areas of the lower South Island of New Zealand. Design A purposive sample of women living in remote rural areas, recruited by advertising in local newspapers and flyers. Individual semi-structured interviews were digitally recorded using a pragmatic interpretive approach. The data (transcripts and field notes) were analysed using thematic and content analysis. Ethical approval was obtained from the Health and Disability Ethics Committee (HEDC) MEC/06/05/045. Participants Thirteen women consented to participate. Each was resident in a remote rural area having given birth in the previous 18 months. The women had been well during their pregnancies and at the onset of labour had anticipated a spontaneous vaginal birth. Setting Rural remote zoned areas in Otago and Southland in the South Island of New Zealand Findings Five women planned to birth in a regional hospital and eight chose their nearest rural primary maternity unit. All of the women were aware of the possibility of transfer and had made their decision about their birthplace based on their perception of their personal safety, and in consideration of their distance from specialist care. Themes included, deciding about the safest place to give birth; making the decision to transfer; experiencing transfer in labour, and reflecting on their birth experience and considering future birthplace choices. Conclusions and implications for practice and policy The experiences of the women show that for some, distance from a base hospital influences their place of birth decisions in remote rural areas of New Zealand and increases the distress for those needing to transfer over large distances. These experiences can result in women choosing, or needing to make different choices for subsequent births; the consequences of which impact on the future sustainability of midwifery services in remote rural areas, a challenge which resonates with maternity service provision internationally. While choices about birth place cannot be reliably predicted, creative solutions are needed to provide rural midwifery care and birth options for women and more timely and efficient transfer services when required.
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2017 |
Harte JD, Homer CSE, Sheehan A, Leap N, Foureur M, 'Using video in childbirth research: Ethical approval challenges', NURSING ETHICS, 24 177-189 (2017)
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2017 |
Jepsen I, Mark E, Foureur M, Nøhr EA, Sørensen EE, 'A qualitative study of how caseload midwifery is experienced by couples in Denmark', Women and Birth, 30 e61-e69 (2017) © 2016 Australian College of Midwives Background Caseload midwifery is expanding in Denmark. There is a need for elaborating in-depth, how caseload midwifery influences the partne... [more] © 2016 Australian College of Midwives Background Caseload midwifery is expanding in Denmark. There is a need for elaborating in-depth, how caseload midwifery influences the partner and the woman during childbirth and how this model of care influences the early phases of labour. Aim To follow, explore and elaborate women's and their partner's experiences of caseload midwifery. Methods Phenomenology of practice was the analytical approach. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. Ten couples participated in the study. Most of the couples were observed from the onset of labour until childbirth. Afterwards, the couples were interviewed. Findings The transition from home to hospital in early labour was experienced as positive. During birth, the partner felt involved and included by the midwife. The midwives remembered and recognized the couple's stories and wishes for childbirth and therefore they felt regarded as ¿more than numbers¿. Irrespective of different kinds of vulnerability or challenges among the participants, the relationship was named a professional friendship, characterised by equality and inclusiveness. One drawback of caseload midwifery was that the woman was at risk of being disappointed if her expectations of having a known midwife at birth were not fulfilled. Key conclusions From the perspective of women and their partners, attending caseload midwifery meant being recognised and cared for as an individual. The partner felt included and acknowledged and experienced working in a team with the midwife. Caseload midwifery was able to solve problems concerning labour onset or gaining access to the labour ward.
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2017 |
Atchan M, Davis D, Foureur M, 'An historical document analysis of the introduction of the Baby Friendly Hospital Initiative into the Australian setting', Women and Birth, 30 51-62 (2017) © 2016 Australian College of Midwives Background Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century.... [more] © 2016 Australian College of Midwives Background Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century. The World Health Organization launched a global health promotion strategy to help create a ¿breastfeeding culture¿. Research on the programme has revealed multiple barriers since implementation. Aim To analyse the sociopolitical challenges associated with implementing a global programme into a national setting via an examination of the influences on the early period of implementation of the Baby Friendly Hospital Initiative in Australia. Methods A focused historical document analysis was attended as part of an instrumental case study. A purposeful sampling strategy obtained a comprehensive sample of public and private documents related to the introduction of the BFHI in Australia. Analysis was informed by a ¿documents as commentary¿ approach to gain insight into individual and collective social practices not otherwise observable. Findings Four major themes were identified: ¿a breastfeeding culture¿; ¿resource implications¿; ¿ambivalent support for breastfeeding and the BFHI¿ and ¿business versus advocacy¿. ¿A breastfeeding culture¿ included several subthemes. No tangible support for breastfeeding generally, or the Baby Friendly Hospital Initiative specifically, was identified. Australian policy did not follow international recommendations. There were no financial or policy incentives for BFHI implementation. Conclusions Key stakeholders¿ decisions negatively impacted on the Baby Friendly Hospital Initiative at a crucial time in its implementation in Australia. The potential impact of the programme was not realised, representing a missed opportunity to establish and provide sustainable standardised breastfeeding support to Australian women and their families.
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2017 |
Adams C, Dawson A, Foureur M, 'Competing Values Framework: A useful tool to define the predominant culture in a maternity setting in Australia', Women and Birth, 30 107-113 (2017) © 2016 Australian College of Midwives Objective To identify the predominant culture of an organisation which could then assess readiness for change. Design An exploratory design u... [more] © 2016 Australian College of Midwives Objective To identify the predominant culture of an organisation which could then assess readiness for change. Design An exploratory design using the Competing Values Framework (CVF) as a self-administered survey tool. Setting The Maternity Unit in one Australian metropolitan tertiary referral hospital. Subjects All 120 clinicians (100 midwives and 20 obstetricians) employed in the maternity service were invited to participate; 26% responded. Main outcome measure The identification of the predominant culture of an organisation to assess readiness for change prior to the implementation of a new policy. Results The predominant culture of this maternity unit, as described by those who responded to the survey, was one of hierarchy with a focus on rules and regulations and less focus on innovation, flexibility and teamwork. These results suggest that this unit did not have readiness to change. Conclusion There is value in undertaking preparatory work to gain a better understanding of the characteristics of an organisation prior to designing and implementing change. This understanding can influence additional preliminary work that may be required to increase the readiness for change and therefore increase the opportunity for successful change. The CVF is a useful tool to identify the predominant culture and characteristics of an organisation that could influence the success of change.
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2017 |
Jepsen I, Juul S, Foureur M, Sørensen EE, Nøhr EA, 'Is caseload midwifery a healthy work-form? A survey of burnout among midwives in Denmark', Sexual and Reproductive Healthcare, 11 102-106 (2017)
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2017 |
Dean S, Foureur M, Zaslawski C, Newton-John T, Yu N, Pappas E, 'The effects of a structured mindfulness program on the development of empathy in healthcare students', NursingPlus Open, 3 1-5 (2017)
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2016 |
Harte JD, Sheehan A, Stewart SC, Foureur M, 'Childbirth Supporters Experiences in a Built Hospital Birth Environment: Exploring Inhibiting and Facilitating Factors in Negotiating the Supporter Role', Health Environments Research and Design Journal, 9 135-161 (2016) © 2016, © The Author(s) 2016. Objective: To explore inhibiting and facilitating design factors influencing childbirth supporters¿ experiences. Background: Birthing women benefit f... [more] © 2016, © The Author(s) 2016. Objective: To explore inhibiting and facilitating design factors influencing childbirth supporters¿ experiences. Background: Birthing women benefit from the continuous, cooperative presence of supporters. However, little research has investigated how birth room design facilitates or inhibits supporters¿ role navigation. Methods: We conducted an exploratory video ethnographic single case study of childbirth supporters¿ experiences, within an Australian hospital birth environment. Video, field notes, and video-cued reflexive interviews with the woman, her midwives, and supporters were thematically analyzed using ethnographic/symbolic interactionist perspectives to frame supporters¿ understandings. Results: Findings suggest supporters¿ experiences are complex, made more complicated by sparse understanding or accommodation of their needs in the built environment. Supporters¿ presence and roles are not facilitated by the physical space; they experience ¿an unbelonging paradox¿ of being needed, yet uncertain and ¿in the way¿ during ¿tenuous nest-building¿ activities. Conclusions: Suggested design guidelines to facilitate supporters¿ well-being and their roles in designed hospital birth spaces are provided.
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2016 |
Bowden C, Sheehan A, Foureur M, 'Birth room images: What they tell us about childbirth. A discourse analysis of birth rooms in developed countries', Midwifery, 35 71-77 (2016) © 2016 Elsevier Ltd. Objective: this study examined images of birth rooms in developed countries to analyse the messages and visual discourse being communicated through images. De... [more] © 2016 Elsevier Ltd. Objective: this study examined images of birth rooms in developed countries to analyse the messages and visual discourse being communicated through images. Design: a small qualitative study using Kress and van Leeuwen's (2006) social semiotic theoretical framework for image analysis, a form of discourse analysis. Setting/participants: forty images of birth rooms were collected in 2013 from Google Images, Flickr, Wikimedia Commons and midwifery colleagues. The images were from obstetric units, alongside and freestanding midwifery units located in developed countries (Australia, Canada, Europe, New Zealand, United Kingdom and the United States of America). Main findings: findings demonstrated three kinds of birth room images; the technological, the 'homelike', and the hybrid domesticated birth room. The most dominant was the technological birth room, with a focus on the labour bed and medical equipment. The visual messages from images of the technological birth room reinforce the notion that the bed is the most appropriate place to give birth and the use of medical equipment is intrinsically involved in the birth process. Childbirth is thus construed as risky/dangerous. Key conclusions and implications for practice: as images on the Internet inform and persuade society about stereotypical behaviours, the trends of our time and sociocultural norms, it is important to recognise images of the technological birth room on the Internet may be influential in dictating women's attitudes, choices and behaviour, before they enter the birth room.
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2016 |
Jepsen I, Mark E, Nøhr EA, Foureur M, Sørensen EE, 'A qualitative study of how caseload midwifery is constituted and experienced by Danish midwives', Midwifery, 36 61-69 (2016) © 2016 Elsevier Ltd. Objective: the aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care ... [more] © 2016 Elsevier Ltd. Objective: the aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience working in caseload midwifery? Design and setting: phenomenology of practice was the analytical approach to this qualitative study of caseload midwifery in Northern Denmark. The methodology was inspired by ethnography, and applied methods were field observations followed by interviews. Participants: thirteen midwives working in caseloads were observed during one or two days in the antenatal clinic and were interviewed at a later occasion. Findings: being recognised and the feeling of doing high quality care generate high job satisfaction. The obligation and pressure to perform well and the disadvantages to the midwives' personal lives are counterbalanced by the feeling of doing a meaningful and important job. Working in caseload midwifery creates a feeling of working in a self-governing model within the public hospital, without losing the technological benefits of a modern birth unit. Midwives in caseload midwifery worked on welcoming and including all pregnant women allocated to their care; even women/families where relationships with the midwives were challenging were recognised and respected. Key conclusions: caseload midwifery is a work-form with an embedded and inevitable commitment and obligation that brings forward the midwife's desire to do her utmost and in return receive appreciation, social recognition and a meaningful job with great job satisfaction. There is a balance between the advantages of a meaningful job and the disadvantages for the personal life of the midwife, but benefits were found to outweigh disadvantages. Implications for practice: In expanding caseload midwifery, it is necessary to understand that the midwives' personal lives need to be prepared for this work-form. The number of women per full time midwife has to be surveilled as job-satisfaction is dependent on the midwives' ability of fulfilling expectations of being present at women's births.
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2016 |
Mondy T, Fenwick J, Leap N, Foureur M, 'How domesticity dictates behaviour in the birth space: Lessons for designing birth environments in institutions wanting to promote a positive experience of birth', Midwifery, 43 37-47 (2016) © 2016 Elsevier Ltd Background limited efforts have been made to understand the complex relationships between women's experiences of birth and the influence of the design and... [more] © 2016 Elsevier Ltd Background limited efforts have been made to understand the complex relationships between women's experiences of birth and the influence of the design and environment of a birth space. Domestic aesthetics in a birth space are believed to be an important aspect of optimal birth unit design. Aim to explore the concept of domesticity within the birth space. The specific objectives were to explore, describe and compare birth spaces with different domestic characteristics and subsequently, how laboring women worked within these spaces during the labour process. This project was situated within a larger ongoing body of work exploring birth unit design. Method a qualitative approach, using the techniques of video ethnography and reflexive interviewing, was used. Video data consisted of films of the labours of six Australian women who gave birth in 2012. Filming took place in two different tertiary hospitals in Sydney NSW (n=5 women), as well as a stand-alone Birth Centre (n=1 woman). Video footage of a woman labouring at home was used to compare and contrast women's experiences. Latent content analysis was used to analyse the data set. In addition there were 17 one-hour video-reflexive interviews that were audio-taped and fully transcribed (nine interviews with women and/or their support people and eight with midwives). Field note data accompanied both the video recording as well as the reflexive interviews. Findings in general, women labouring in conventional hospital labour and birth rooms acted and interacted with the environment in a passive way. The spaces clearly did not resemble homely or ¿domestic¿ spaces. This forced women to adapt to the space. In essence all but one of the women labouring and birthing in these spaces took on the role of a ¿patient¿. One participant responded quite differently to the conventional hospital space. ¿Domestication of the space¿ was the mechanism this woman used to retain a sense of ownership within the birth space. In contrast, in the domestic birth environments (Birth Centre and home) women effortlessly claimed ownership of the space, expressing their identity in a myriad of ways. In these domestic spaces, women were not required to change or modify their birth spaces as the design, furnishings and semiotics of the space openly encouraged them to be active, creative and take ownership of the space. Conclusion the findings of this study add to the existing literature on birth unit design and more specifically contribute to an understanding of how the features of domesticity within the birth setting may shape the experience of labouring women and their care providers. The evidence gained from the study will assist in the ongoing movement to humanise birth spaces and develop further understandings of how home-like birth spaces should look. Those designing, building, furnishing, managing, accessing and working in Birthing Services could all benefit from the consideration of how environments designed for the care of birthing women, may be affecting the outcomes and experiences of women and their families.
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2016 |
Atchan M, Davis D, Foureur M, 'A methodological review of qualitative case study methodology in midwifery research', Journal of Advanced Nursing, 72 2259-2271 (2016) © 2016 John Wiley & Sons Ltd Aim: To explore the use and application of case study research in midwifery. Background: Case study research provides rich data for the analysis... [more] © 2016 John Wiley & Sons Ltd Aim: To explore the use and application of case study research in midwifery. Background: Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. Design: A methodological review of midwifery case study research using recognized¿templates, frameworks and reporting guidelines facilitated comprehensive analysis. Data Sources: An electronic database search using the date range January 2005¿December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central. Review Methods: Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process. Results: The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes. Conclusion: This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting.
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2016 |
Townsend B, Fenwick J, Thomson V, Foureur M, 'The birth bed: A qualitative study on the views of midwives regarding the use of the bed in the birth space', WOMEN AND BIRTH, 29 80-84 (2016)
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2016 |
Maude RM, Skinner JP, Foureur MJ, 'Putting intelligent structured intermittent auscultation (ISIA) into practice', WOMEN AND BIRTH, 29 285-292 (2016)
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2015 |
Patterson J, Skinner J, Foureur M, 'Midwives' decision making about transfers for 'slow' labour in rural New Zealand', MIDWIFERY, 31 606-612 (2015)
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2015 |
Catling CJ, Medley N, Foureur M, Ryan C, Leap N, Teate A, Homer CSE, 'Group versus conventional antenatal care for women', Cochrane Database of Systematic Reviews, 2015 (2015) © 2015 The Cochrane Collaboration. Background: Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditi... [more] © 2015 The Cochrane Collaboration. Background: Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. Objectives: 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies. 2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. Selection criteria: All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. Main results: We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943). Satisfaction was rated as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes. No data were available on the effects of group antenatal care on care provider satisfaction. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth). Authors' conclusions: Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight.
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2015 |
Mollart LJ, Adam J, Foureur M, 'Impact of acupressure on onset of labour and labour duration: A systematic review', WOMEN AND BIRTH, 28 199-206 (2015) [C1]
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2014 |
Dixon L, Skinner J, Foureur M, 'The emotional journey of labour-Women's perspectives of the experience of labour moving towards birth', MIDWIFERY, 30 371-377 (2014)
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2014 |
Hammond A, Foureur M, Homer CSE, 'The hardware and software implications of hospital birth room design: A midwifery perspective', MIDWIFERY, 30 825-830 (2014)
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2014 |
Dahlen HG, Downe S, Kennedy HP, Foureur M, 'Is society being reshaped on a microbiological and epigenetic level by the way women give birth?', Midwifery, 30 1149-1151 (2014)
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2014 |
Maude RM, Skinner JP, Foureur MJ, 'Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women', BMC PREGNANCY AND CHILDBIRTH, 14 (2014)
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2014 |
Raymond JE, Foureur MJ, Davis DL, 'Gestational Weight Change in Women Attending a Group Antenatal Program Aimed at Addressing Obesity in Pregnancy in New South Wales, Australia', JOURNAL OF MIDWIFERY & WOMENS HEALTH, 59 398-404 (2014)
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2014 |
Davis Harte J, Leap N, Fenwick J, Homer CSE, Foureur M, 'Methodological insights from a study using video-ethnography to conduct interdisciplinary research in the study of birth unit design', International Journal of Multiple Research Approaches, 8 36-48 (2014) © eContent Management Pty Ltd. Little is known about how the physical design of a birthing unit can influence the experiences of labour and birth for women, their supporters and m... [more] © eContent Management Pty Ltd. Little is known about how the physical design of a birthing unit can influence the experiences of labour and birth for women, their supporters and midwives. We proposed that an interdisciplinary approach (disciplines of midwifery, architecture, design, communication and public health) was likely to be the most effective way to better understand the complexities and interactions of design, behaviour, communication and experiences. In this methodological paper we aim to provide a roadmap that other researchers may find helpful when considering the use of video as a data collection technique, especially in the study of the powerful and intimate setting of childbirth. The paper also outlines our process for engaging both researchers and participants in reviewing video footage with the aim to contribute multiple perspectives to the analysis process.
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2014 |
Atchan M, Davis D, Foureur M, 'Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system', WOMEN AND BIRTH, 27 79-85 (2014)
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2014 |
Hammond AD, Homer CSE, Foureur M, 'Messages from Space: An Exploration of the Relationship between Hospital Birth Environments and Midwifery Practice', HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL, 7 81-95 (2014)
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2014 |
Monk A, Tracy M, Foureur M, Grigg C, Tracy S, 'Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia', BMJ OPEN, 4 (2014)
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2014 |
Homer CSE, Thornton C, Scarf VL, Ellwood DA, Oats JJN, Foureur MJ, et al., 'Birthplace in New South Wales, Australia: An analysis of perinatal outcomes using routinely collected data', BMC Pregnancy and Childbirth, 14 (2014) Background: The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data st... [more] Background: The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labour in one Australian state.Methods: A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study.Results: Women who planned to give birth in a birth centre or at home were significantly more likely to have a normal labour and birth compared with women in the labour ward group. There were no statistically significant differences in stillbirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences.Conclusion: This study provides information to assist the development and evaluation of different places of birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of birth in a low risk population, especially in countries like Australia where homebirth rates are low. © 2014 Homer et al.; licensee BioMed Central Ltd.
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2013 |
Catling-Paull C, Coddington RL, Foureur MJ, Homer CSE, 'Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years', MEDICAL JOURNAL OF AUSTRALIA, 198 616-620 (2013)
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2013 |
Catling-Paull C, Coddington RL, Foureur MJ, Homer CSE, 'Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years REPLY', MEDICAL JOURNAL OF AUSTRALIA, 199 743-743 (2013)
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2013 |
Dixon L, Skinner J, Foureur M, 'Women's perspectives of the stages and phases of labour', MIDWIFERY, 29 10-17 (2013)
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2013 |
Stenglin M, Foureur M, 'Designing out the Fear Cascade to increase the likelihood of normal birth', MIDWIFERY, 29 819-825 (2013)
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2013 |
Monk AR, Tracy SK, Foureur M, Tracy M, 'Evaluating midwifery units (EMU): Lessons from the pilot study', MIDWIFERY, 29 845-851 (2013)
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2013 |
Dahlen HG, Kennedy HP, Anderson CM, Bell AF, Clark A, Foureur M, et al., 'The EPIIC hypothesis: Intrapartum effects on the neonatal epigenome and consequent health outcomes', MEDICAL HYPOTHESES, 80 656-662 (2013)
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2013 |
Atchan M, Davis D, Foureur M, 'The impact of the Baby Friendly health Initiative in the Australian health care system: A critical narrative review of the evidence', Breastfeeding Review, 21 15-22 (2013) Studies have identified that the practices of maternity facilities and health professionals are crucial to women's experience of support and breastfeeding 'success'... [more] Studies have identified that the practices of maternity facilities and health professionals are crucial to women's experience of support and breastfeeding 'success'. The Baby Friendly Hospital Initiative (BFHI) was launched globally in 1991 to protect, promote and support breastfeeding. While a direct causal effect has not been established and critics suggest the rhetoric conflicts with women's lived experiences as new mothers, a positive association between the Initiative and breastfeeding prevalence is apparent. Internationally, impact studies have demonstrated that where the Initiative is well integrated, there is an increase in rates of breastfeeding initiation and, to a lesser extent, duration. In consideration of the known health risks associated with the use of artificial baby milks this would suggest that BFHI implementation and accreditation should be a desirable strategy for committed health facilities. However, a variation in both BFHI uptake and breastfeeding prevalence between nations has been reported. This narrative review critically discusses a variety of issues relevant to the uptake and support of breastfeeding and the BFHI, utilising Australia as a case study. Whilst it enjoys 'in principle' policy support, Australia also suffers from a lack of uniformity in uptake and perception of the benefits of BFHI at all levels of the health system. Australian and international studies have identified similar enablers and barriers to implementation.
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2013 |
Foureur M, Besley K, Burton G, Yu N, Crisp J, 'Enhancing the resilience of nurses and midwives: Pilot of a mindfulness-based program for increased health, sense of coherence and decreased depression, anxiety and stress', CONTEMPORARY NURSE, 45 114-125 (2013)
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2013 |
Homer CSE, Besley K, Bell J, Davis D, Adams J, Porteous A, Foureur M, 'Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? a randomised controlled trial', BMC PREGNANCY AND CHILDBIRTH, 13 (2013)
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2013 |
Monk AR, Tracy S, Foureur M, Barclay L, 'Australian primary maternity units: Past, present and future', WOMEN AND BIRTH, 26 213-218 (2013)
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2013 |
Hammond A, Foureur M, Homer CSE, Davis D, 'Space, place and the midwife: Exploring the relationship between the birth environment, neurobiology and midwifery practice', WOMEN AND BIRTH, 26 277-281 (2013)
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2013 |
Tracy SK, Hartz DL, Tracy MB, Allen J, Forti A, Hall B, et al., 'Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial', The Lancet, 382 1723-1732 (2013) [C1] Background Women at low risk of pregnancy complications benefit from continuity of midwifery care, but no trial evidence exists for women with identifi ed risk factors. We aimed t... [more] Background Women at low risk of pregnancy complications benefit from continuity of midwifery care, but no trial evidence exists for women with identifi ed risk factors. We aimed to assess the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors. Methods In this unblinded, randomised, controlled, parallel-group trial, pregnant women at two metropolitan teaching hospitals in Australia were randomly assigned to either caseload midwifery care or standard maternity care by a telephone-based computer randomisation service. Women aged 18 years and older were eligible if they were less than 24 weeks pregnant at the fi rst booking visit. Those who booked with another care provider, had a multiple pregnancy, or planned to have an elective caesarean section were excluded. Women allocated to caseload care received antenatal, intrapartum, and postnatal care from a named caseload midwife (or back-up caseload midwife). Controls received standard care with rostered midwives in discrete wards or clinics. The participant and the clinician were not masked to assignment. The main primary outcome was the proportion of women who had a caesarean section. The other primary maternal outcomes were the proportions who had an instrumental or unassisted vaginal birth, and the proportion who had epidural analgesia during labour. Primary neonatal outcomes were Apgar scores, preterm birth, and admission to neonatal intensive care. We analysed all outcomes by inten tion to treat. The trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000349246. Findings Publicly insured women were screened at the participating hospitals between Dec 8, 2008, and May 31, 2011. 1748 pregnant women were randomly assigned, 871 to caseload and 877 to standard care. The proportion of caesarean sections did not differ between the groups (183 [21%] in the caseload group vs 204 [23%] in the standard care group; odds ratio [OR] 0¿88, 95% CI 0¿70-1¿10; p=0¿26). The proportion of women who had elective caesarean sections (before onset of labour) diff ered signifi cantly between caseload and standard care (69 [8%] vs 94 [11%]; OR 0¿72, 95% CI 0¿52-0¿99; p=0¿05). Proportions of instrumental birth were similar (172 [20%] vs 171 [19%]; p=0¿90), as were the proportions of unassisted vaginal births (487 [56%] vs 454 [52%]; p=0¿08) and epidural use (314 [36%] vs 304 [35%]; p=0¿54). Neonatal outcomes did not diff er between the groups. Total cost of care per woman was AUS$566¿74 (95% 106¿17-1027¿30; p=0¿02) less for caseload midwifery than for standard maternity care. Interpretation Our results show that for women of any risk, caseload midwifery is safe and cost-effective.
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2013 |
Mollart L, Skinner VM, Newing C, Foureur M, 'Factors that may influence midwives work-related stress and burnout', WOMEN AND BIRTH, 26 26-32 (2013) [C1]
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Show 134 more journal articles |
Conference (19 outputs)
Year | Citation | Altmetrics | Link | |||||
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2019 |
Mclaughlin K, Foureur M, Jensen M, Gibson P, Murphy V, 'Stop, Start or Continue Asthma Medication in Pregnancy: Acceptability of a Biomarker-Based Approach to Antenatal Clinic Obstetricians and Midwives', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY (2019)
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2019 |
Mclaughlin K, Jensen M, Foureur M, Gibson P, Murphy V, 'Are pregnant women with asthma receiving guideline-recommended antenatal asthma management?- A survey of pregnant women in Australia', WOMEN AND BIRTH (2019)
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2019 |
Mollart L, Stulz V, Foureur M, 'Passion for complementary alternative medicine/therapies: Midwives' education and training', WOMEN AND BIRTH (2019)
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2017 |
Braye K, Xu F, Ferguson J, Foureur M, 'Is exposing around a third of our birthing population to Intrapartum Antibiotic Prophylaxis (IAP) for prevention of Early Onset Group B Streptococcal infection (EOGBSI) doing more harm than good?', WOMEN AND BIRTH (2017)
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2015 |
Braye K, Foureur M, 'Group B streptococcus: Are we doing more harm than good?', WOMEN AND BIRTH (2015)
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2013 |
Mollart L, Foureur M, Skinner V, Shah M, Albert G, 'PREPARE (PRimigravidas Experiencing Postdates Acupressure REsearch', WOMEN AND BIRTH (2013)
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Show 16 more conferences |
Grants and Funding
Summary
Number of grants | 12 |
---|---|
Total funding | $6,780,542 |
Click on a grant title below to expand the full details for that specific grant.
20202 grants / $190,000
A practice change intervention to increase the routine provision of care addressing gestational weight gain: a stepped-wedge trial$180,000
Funding body: Hunter New England Local Health District
Funding body | Hunter New England Local Health District |
---|---|
Project Team | Professor John Wiggers, Professor John Attia, Professor Karen Campbell, Professor Maralyn Foureur, Doctor Jenna Hollis, Doctor Melanie Kingsland, Professor Francesco Paolucci, Professor Craig Pennell, Professor Chris Rissel, Professor Luke Wolfenden |
Scheme | Partnership Projects Partner Funding |
Role | Investigator |
Funding Start | 2020 |
Funding Finish | 2022 |
GNo | G2000238 |
Type Of Funding | C2220 - Aust StateTerritoryLocal - Other |
Category | 2220 |
UON | Y |
Investigating the health effects of bushfire smoke exposure, specifically on people with asthma, including pregnant women with asthma, and their children$10,000
Funding body: Hunter Medical Research Institute
Funding body | Hunter Medical Research Institute |
---|---|
Project Team | Conjoint Professor Peter Gibson, Doctor Vanessa Murphy, Professor Vanessa McDonald, Doctor Adam Collison, Conjoint Associate Professor Anne Vertigan, Doctor Megan Jensen, Doctor Dennis Thomas, Associate Professor Jay Horvat, Professor Maralyn Foureur, Professor Leigh Kinsman, Associate Professor Liz Holliday, Doctor Erin Harvey, Ms Alycia Jacob, Professor Joerg Mattes, Graeme Zosky, Wilfried Karmaus, Michele Goldman, Dr Craig Dalton |
Scheme | Research Grant |
Role | Investigator |
Funding Start | 2020 |
Funding Finish | 2020 |
GNo | G2000414 |
Type Of Funding | C3120 - Aust Philanthropy |
Category | 3120 |
UON | Y |
20191 grants / $750,000
Partnerships in Aged-Care Emergency Services using Interactive Telehealth (PACE-IT) incorporating telehealth visual assessment information sharing and decision making for people living in residential aged care facilties$750,000
Funding body: NSW Health Transalational Research Grants Scheme
Funding body | NSW Health Transalational Research Grants Scheme |
---|---|
Project Team | Giles, M., Sumner, C., Foureur, M., et al |
Scheme | NSW Health Translational Research Grants Scheme |
Role | Investigator |
Funding Start | 2019 |
Funding Finish | 2021 |
GNo | |
Type Of Funding | C1600 - Aust Competitive - StateTerritory Govt |
Category | 1600 |
UON | N |
20171 grants / $350,000
Maternal, Newborn and Women's Health, Clinical Academic Group$350,000
Funding body: Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
Funding body | Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) |
---|---|
Project Team | Homer, CSE., Henry, A., Foureur, M., et al |
Scheme | Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) |
Role | Investigator |
Funding Start | 2017 |
Funding Finish | 2019 |
GNo | |
Type Of Funding | C1700 - Aust Competitive - Other |
Category | 1700 |
UON | N |
20122 grants / $1,047,550
Birthplace in Australia: A prospective cohort study$790,000
Funding body: NHMRC (National Health & Medical Research Council)
Funding body | NHMRC (National Health & Medical Research Council) |
---|---|
Project Team | Homer, CSE., Ellwood, D., Oats, G., Foureur, MJ., Sibbritt, D., McLachlan, H., Forster, D., Dahlen, H. |
Scheme | Project Grant |
Role | Investigator |
Funding Start | 2012 |
Funding Finish | 2017 |
GNo | |
Type Of Funding | C1100 - Aust Competitive - NHMRC |
Category | 1100 |
UON | N |
Does Continuity of Midwifery Care Increase Vaginal Birth After Caesarean (VBAC): A Randomised Controlled Trial$257,550
Funding body: NHMRC (National Health & Medical Research Council)
Funding body | NHMRC (National Health & Medical Research Council) |
---|---|
Project Team | Homer, CSE., Foureur, MJ., Davis, D., Adams, J., Porteous, A. |
Scheme | Project Grant |
Role | Investigator |
Funding Start | 2012 |
Funding Finish | 2015 |
GNo | |
Type Of Funding | C1100 - Aust Competitive - NHMRC |
Category | 1100 |
UON | N |
20111 grants / $277,992
Theorising the relationship between birth unit design and the communication patterns of labouring women and their maternity care providers$277,992
Funding body: ARC (Australian Research Council)
Funding body | ARC (Australian Research Council) |
---|---|
Project Team | Foureur, M., Homer CSE, Fenwick, J,m Davis, D., Sorensen, R., Forbes, I. |
Scheme | Discovery Project |
Role | Lead |
Funding Start | 2011 |
Funding Finish | 2015 |
GNo | |
Type Of Funding | C1200 - Aust Competitive - ARC |
Category | 1200 |
UON | N |
20102 grants / $715,000
Evaluation of Midwifery Units$670,000
Funding body: NHMRC (National Health & Medical Research Council)
Funding body | NHMRC (National Health & Medical Research Council) |
---|---|
Project Team | Tracy, S., Foureur, M., Barclay, L., Tracy, M., Welsh, A. |
Scheme | Project Grant |
Role | Investigator |
Funding Start | 2010 |
Funding Finish | 2013 |
GNo | |
Type Of Funding | C1100 - Aust Competitive - NHMRC |
Category | 1100 |
UON | N |
Developing Cutting Edge Birth Unit Design: A Feasibility Study$45,000
Funding body: University of Technology Sydney
Funding body | University of Technology Sydney |
---|---|
Project Team | Foureur, M., Fenwick, J., Iedema, R., Homer, C., Verghese, G., Davis, D., Pandolfo, B., Leap, N., Forbes, I. |
Scheme | Seed Grant |
Role | Lead |
Funding Start | 2010 |
Funding Finish | 2011 |
GNo | |
Type Of Funding | Internal |
Category | INTE |
UON | N |
20093 grants / $3,450,000
Australian Placental Transfusion Study$2,700,000
Funding body: NHMRC (National Health & Medical Research Council)
Funding body | NHMRC (National Health & Medical Research Council) |
---|---|
Project Team | Tarnow-Mordi W., Foureur, M., et al |
Scheme | Project Grant |
Role | Investigator |
Funding Start | 2009 |
Funding Finish | 2014 |
GNo | |
Type Of Funding | C1100 - Aust Competitive - NHMRC |
Category | 1100 |
UON | N |
Multi centre randomised controlled trial of caseload midwifery (M@NGO trial)$550,000
Funding body: NHMRC (National Health & Medical Research Council)
Funding body | NHMRC (National Health & Medical Research Council) |
---|---|
Project Team | Tracy, S., Homer, C., Tracy, M., Kildea, S., Foureur, M. |
Scheme | Project Grant |
Role | Investigator |
Funding Start | 2009 |
Funding Finish | 2012 |
GNo | |
Type Of Funding | C1100 - Aust Competitive - NHMRC |
Category | 1100 |
UON | N |
Introduction and evaluation of a new antenatal maternity service model focusing on weight management for women with a BMI>30 in Northern Sydney Central Coast and South Eastern Sydney Illawarra Area Health Services$200,000
Funding body: NSW Health, Targeted Initiative Grant
Funding body | NSW Health, Targeted Initiative Grant |
---|---|
Project Team | Davis, D., Foureur, M., Adams, C., Clements, V., Mollart, L., Raymond, J., Teate, A., Zuschman, A |
Scheme | Targeted Initiative Grant NSW Health |
Role | Investigator |
Funding Start | 2009 |
Funding Finish | 2010 |
GNo | |
Type Of Funding | C1600 - Aust Competitive - StateTerritory Govt |
Category | 1600 |
UON | N |
Research Supervision
Number of supervisions
Current Supervision
Commenced | Level of Study | Research Title | Program | Supervisor Type |
---|---|---|---|---|
2021 | Masters | Working with Rural Aboriginal Women to Increase Breastfeeding Rates | M Philosophy (Nursing), College of Health, Medicine and Wellbeing, The University of Newcastle | Principal Supervisor |
2020 | PhD | Women's Knowledge and Awareness of the Risk of Venous Thromboembolism During Pregnancy and the Postpartum Period in Al-Jouf City, Kingdom of Saudi Arabia | PhD (Midwifery), College of Health, Medicine and Wellbeing, The University of Newcastle | Principal Supervisor |
2020 | PhD | Partnerships in Aged-Care Emergency Services using Interactive Telehealth (PACE-IT) incorporating Telehealth Visual Assessment, Information Sharing and Decision Making for People Living in Residential Aged-care Facilities (RACF) | PhD (Nursing), College of Health, Medicine and Wellbeing, The University of Newcastle | Principal Supervisor |
2019 | PhD | Understanding the Pedagogy of Continuity of Care Experiences Within Pre-registration Midwifery Education: A Critical Feminist Approach | PhD (Midwifery), College of Health, Medicine and Wellbeing, The University of Newcastle | Co-Supervisor |
2019 | PhD | Evaluating a model of midwifery education based on continuity of antenatal and postnatal care | Midwifery, The University of Newcastle | Australia | Co-Supervisor |
2018 | PhD | Shoulder Dystocia and range of head-body delivery interval | Midwifery, University of Technology Sydney | Co-Supervisor |
2018 | PhD | Gestational Weight Gain in Eastern Ethiopia: Patterns, Determinants and Birth Outcomes and Postpartum weight retention | Public Health, University of Technology Sydney | Co-Supervisor |
2014 | PhD | Antenatal Weighing and Gestational Weight Gain | PhD (CommunityMed & ClinEpid), College of Health, Medicine and Wellbeing, The University of Newcastle | Co-Supervisor |
2014 | PhD | A study of the management of Group B streptococcal colonisation in pregnant women: Benefits and risks of preventative modalities | Midwifery, University of Technology Sydney | Principal Supervisor |
Past Supervision
Year | Level of Study | Research Title | Program | Supervisor Type |
---|---|---|---|---|
2020 | PhD | Usual Antenatal Asthma Management and the Clinical Translational Potential of a Fractional Exhaled Nitric Oxide (FeNO)-based Management Strategy | PhD (Medicine), College of Health, Medicine and Wellbeing, The University of Newcastle | Co-Supervisor |
2018 | PhD | Hisotry of the Baby Friendly Health Initiative (BFHI) in Australia | Midwifery, University of Technology Sydney | Principal Supervisor |
2018 | Masters | Midwives' perceptions of their role in caring for women with, or at risk of, Perinatal Depression | Midwifery, University of Technology Sydney | Principal Supervisor |
2018 | PhD | Randomised controlled trial of Acupressure for women who are post 41 weeks gestation | Midwifery, University of Technology Sydney | Principal Supervisor |
2017 | Professional Doctorate | Engaging the clinicians of a maternity health service-an exploration of neuro-leadership in action | Midwifery, University of Technology Sydney | Principal Supervisor |
2017 | PhD | Continuity of Midwifery Care in Denmark: A Cohort Study | Midwifery, University of Southern Denmark | Sole Supervisor |
2017 | PhD | How does the birth unit design impact on midwifery practice | Midwifery, University of Technology Sydney | Principal Supervisor |
2016 | PhD | Birth Unit Design and the Impact on the woman's supporters during labour | Midwifery, University of Technology Sydney | Principal Supervisor |
2016 | PhD | Evaluation of the NSW Health statewide FONT (Fetal Welfare and Obstetric and Neonatal Emergency Training) program | Midwifery, University of Technology Sydney | Principal Supervisor |
2016 | Masters | A new model of antenatal preparation for childbirth including Movement | Midwifery, University of Technology Sydney | Principal Supervisor |
2015 | PhD | Evaluation of Midwifery Units (EMU)-A Cohort Study in Australia | Midwifery, The University of Sydney | Co-Supervisor |
2015 | Masters | The Caseload Model of Midwifery Student Clinical Education | Midwifery, University of Technology Sydney | Principal Supervisor |
2014 | Honours | Exploring the non-verbal communication between labouring women and their maternity care providers and how the birth environment influences this communication | Midwifery, University of Technology Sydney | Co-Supervisor |
2014 | PhD | Humidification in Neonatal Intensive Care-is a randomised controlled trial possible? | Nursing, University of Technology Sydney | Co-Supervisor |
2013 | Honours | A comparison of oral handover and documented handover to determine the impact on health service funding from the perspective of the medical coder | Health Not Elswhere Classified, University of Technology Sydney | Principal Supervisor |
2013 | PhD | Multi centre randomised controlled trial of caseload midwifery (M@NGO trial) | Midwifery, The University of Sydney | Co-Supervisor |
2012 | Masters | Women's Expectations and Experiences of Induction of Labour | Midwifery, University of Technology Sydney | Principal Supervisor |
2012 | PhD | Development and Testing of a model of Intelligent Structured Intermittent Auscultation (ISIA) of the Fetal Heart | Midwifery, Victoria University of Wellington | Principal Supervisor |
2011 | PhD | An exploration of women's perspectives on labour progress | Midwifery, Victoria University of Wellington | Principal Supervisor |
2011 | Masters | Preceptorship in Midwifery- A qualitative study of the way tacit knowledge is transferred between preceptor and student midwife | Midwifery, University of Technology Sydney | Principal Supervisor |
2011 | PhD | A Randomised controlled trial of oral glucose for pain management prior to 2-month immunisation in healthy infants | General Nursing, University of Technology Sydney | Principal Supervisor |
2011 | PhD | A descriptive study of a new model of group mentorship for newly graduated midwives | Midwifery, Victoria University of Wellington | Principal Supervisor |
2010 | PhD | A study of rural midwifery practice and the decision to transfer: A multi method approach | Midwifery, Victoria University of Wellington | Principal Supervisor |
2010 | Masters | Interdisciplinary Education-a model for collaborative practice in maternity care | Midwifery, University of Technology Sydney | Principal Supervisor |
2010 | PhD | Segementation of the Maternity Care market from a healthcare marketing approach | Public Health, Victoria University of Wellington | Principal Supervisor |
2009 | Masters | Women's experience of intrapartum transfer from homebirth to hospital | Midwifery, Victoria University of Wellington | Principal Supervisor |
2007 | Honours | The development of a consensus statement for Neonatal Developmental Supportive Care in New Zealand | Nursing, Victoria University of Wellington | Principal Supervisor |
2007 | Masters | Exploring Birth Outcomes for pirmiparous women within the practice of the same midwife-according to their birth environment | Midwifery, Victoria University of Wellington | Co-Supervisor |
2006 | PhD | The personal mandate to practise midwifery prior to 1990: Domiciliary Midwives and the Domiciliary Midwives Society (Inc) of Aotearoa/New Zealand-An Historical Study | Midwifery, Victoria University of Wellington | Principal Supervisor |
2006 | PhD | Nursing Immersion Programs in Developing Countries: A Reflective Topical Autobiography | Midwifery, Victoria University of Wellington | Principal Supervisor |
2006 | Masters | Women Talk: narrative analysis of traumatic birth experience and post traumatic stress disorder (PTSD) | Midwifery, Victoria University of Wellington | Principal Supervisor |
2005 | PhD | Midwives' understanding of Risk in Maternity Care: A multimethod study | Midwifery, Victoria University of Wellington | Principal Supervisor |
2005 | PhD | Midwives' use of complementary therapies: A multimethod study | Midwifery, Victoria University of Wellington | Principal Supervisor |
2000 | Masters | Towards a sustainable model of midwifery practice in a continuity of care setting. The experience of New Zealand midwives | Midwifery, Victoria University of Wellington | Principal Supervisor |
1998 | Masters | A demographic profile of independent (self employed) midwives in New Zealand/Aotearoa | Midwifery, Victoria University of Wellington | Principal Supervisor |
1998 | Masters | The jewel in the crown: A case study of the New Zealand College of Midwives Standards Review Process in Wellington | Midwifery, Victoria University of Wellington | Principal Supervisor |
1998 | Masters | Knowledge levels and attitudes of student nurses regarding pain and pain management | Nursing, Victoria University of Wellington | Sole Supervisor |
1997 | Masters | Perceived level and sources of stress in beginning Bachelor of Nursing Students | Nursing, Victoria University of Wellington | Sole Supervisor |
Professor Maralyn Foureur
Position
Joint Chair and Professor
School of Nursing and Midwifery
College of Health, Medicine and Wellbeing
Contact Details
maralyn.foureur@newcastle.edu.au |