Stuart Watson

Background
Growing evidence highlights maternal risk factors that can increase the likelihood of traumatic childbirth experience. Yet little is known about the availability of primary antenatal intervention for childbirth trauma to facilitate optimal maternal and infant outcomes. The aim of this study was to conduct a systematic review of the literature and empirical evidence to identify antenatal interventions and their effectiveness for treatment of childbirth trauma, post-traumatic stress disorder (PTSD), subthreshold PTSD, or post-traumatic stress (PTS) from childbirth.

Methods
Four databases were accessed: PUBMED, CINAHL, ProQuest, and EBSCOHOST. PRISMA guidelines were followed for screening and reporting. Inclusion criteria were as follows: (1) peer reviewed articles; (2) samples of pregnant women; (3) published in English; (4) measure of PTSD, PTSD symptoms, PTS or fear of childbirth; (5) variable of childbirth trauma or childbirth experience; (6) antenatal intervention; and (7) human studies.

Results
We identified 2034 articles, with 12 articles in the final sample. The most common antenatal intervention in four studies was childbirth plans, which were associated with an increase in positive childbirth experience, childbirth control, mastery, and participation, as well as increased self-efficacy and reduced PTSD symptoms (p < 0.01). Other interventions included antenatal counseling and psychoeducation; eye movement desensitization and reprocessing; counseling; haptotherapy; trauma-informed care; cognitive behavioral therapy; and hypnosis for childbirth trauma.

Conclusions
Methodological limitations as well as a lack of inclusion of women with perinatal mental health difficulties represent gaps in knowledge. Findings suggest promising evidence for the implementation of antenatal interventions in clinical and hospital contexts to treat childbirth trauma.

Problem
Retention is a known challenge in international and Australian midwifery workforce.

Background
Identification of drivers of workforce retention is essential to enable strategic planning for service delivery, consistent with workforce trends. Limited contemporary, midwifery-specific workforce data within Western Australia (WA) exists.

Aim
To explore midwives’ perspectives of factors contributing to retention, and views on their working environment.

Methods
An anonymous cross-sectional survey was conducted with midwives within the largest maternity service in WA. Quantitative data were analysed using descriptive statistics and structural equation modelling. Qualitative data underwent content analysis.

Findings
A total 193 midwives participated. Modelling demonstrated that perceptions of workplace culture was positively associated with the probability of midwives feeling acknowledged by the organisation for their work (OR=6.61, p < .001), and with better midwifery retention (b=3.34, p < .001). Acknowledgement was not a significant direct predictor of retention (b=1.12, p = .150), thus, was not a significant mediator of the association between workplace culture and retention. Top three reasons influencing midwives’ intention to stay were pay (89.6 %), patient ratios reflecting acuity (82.4 %) increasing the profile of the midwifery profession (80.8 %). Content analysis of midwives’ perspectives on retention factors exposed three categories: Intraprofessional relationships; Valuing the workforce; Career satisfaction.

Discussion
Midwives’ perspectives on retention emphasise the need for transformational leadership, professional recognition, and workplace empowerment as key strategies for sustaining the midwifery workforce.

Conclusion
Findings provide novel insight into indicators of WA midwifery workforce retention. Recommendations for midwife-driven solutions provide direction to enable midwifery leadership to support sustainable midwifery workforce retention into the future.

Coercive control (CC) involves an ongoing pattern of behaviour that can occur within intimate partner violence with the aim of controlling, containing, or compelling a person, with deleterious long‐term effects. This study addresses an evidence gap using Lagdon, Jordan, Devine, Tully, Armour and Shannon (2023: Journal of Family Violence 38, no. 1: 39–50) methodological approach to assess the Australian public awareness about CC. Participants reviewed two gendered CC scenarios, one more obvious and one less obvious, rated their agreement towards ten opinion statements, and answered if they had heard of the term ‘coercive control’. Binary logistic regression assessed predictors of CC awareness and split‐plot analysis of covariance models assessed agreement to opinion statements by CC obviousness and victim gender. Findings indicated that reporting low awareness of CC (42%; n = 152) was more likely among respondents aged 18–24 years ( p < 0.001) and among those who did not complete high school ( p < 0.001), and less likely among those living in non‐metropolitan locations ( p < 0.001) and among those earning a low income ( p = 0.009). There was stronger agreement ( p < 0.001) with statements for obvious CC, indicating respondents' difficulty identifying subtle behavioural patterns and male victim‐survivor experiences. Findings highlight the need for education campaigns that increase CC awareness, to facilitate early identification of less obvious CC and mitigate adverse long‐term effects.

Adjusting to motherhood can be a difficult period, with significant changes to routines, lifestyle, and relationships. For some new mothers, individual circumstances can be associated with difficulty adjusting to the changes a new baby brings, and these experiences can lead to poorer mental health and mother-infant relationship difficulties. Early identification and intervention for mothers who are experiencing difficulties in adjusting to a new baby can reduce distress and protect against further deterioration of the mother's mental health, thereby supporting positive experiences with their baby and overall wellbeing. Community-based group-based interventions for new mothers have demonstrated efficacy to improve mental health symptoms and prevent common postpartum psychological disorders and support the quality of the mother-infant relationship.

The term co-design is considered in research to describe working with consumers from the creation of an idea through to the implementation of an intervention. To determine local relevance to mothers in Western Australia, a contemporary, innovative, and participatory approach of consumer co-design guided the ongoing development of a perinatal mental health intervention: New Beginnings. Incorporating the lived experience from mothers as knowledge experts, in tandem with guidance from mental health clinicians ensured the Australian Commission on Safety and Quality in Health Care (ASCQHC) standard 2 was addressed effectively. “Patients are partners in their own care” demands collaboration between stakeholders to deliver high-quality health care. Internationally, consumer co-design has been established as imperative across the perinatal period due to association with improved intervention efficacy.

This engaging presentation will showcase the translation of empirical research findings alongside our application of the recommendations offered within a national strategy for working with consumers in women's health research applied to the perinatal mental health setting. The results of lived experience captured within a statewide survey and facilitation of a focus group with members of the New Beginnings program offers perinatal mental health personnel attending the presentation an opportunity to gain knowledge and confidence around engaging consumer and community involvement to inform innovative service delivery design.

Introduction
Abortion care experiences encompass various aspects, including women’s decision-making capability, physical and emotional experiences, service provision, and post-abortion experiences. The lack of woman-centred and respectful abortion services, influenced by stigma and restrictive abortion laws in certain contexts, poses a public health concern. These challenges may lead to variations in women’s experiences and care outcomes, potentially resulting in adverse physical, psychological, and emotional outcomes for individuals seeking abortions. Therefore, this systematic review aims to synthesise the available evidence on women’s abortion care experiences and outcomes in sub–Saharan Africa published from 2010 onwards.

Methods
Eight databases including Medline, Embase, Scopus, CINAHL, Cochrane Library, Psych-Info, Web of Science, and Global Health will be searched using subject headings and specific keywords related to women’s abortion care experiences, abortion care outcomes, and its measurement. Predetermined criteria will be used to select studies that meet the review’s inclusion criteria. These include all original studies published in English languages that focussed on induced abortion care and assessed women’s abortion care experiences and outcomes. After screening for title and abstract and full text, included studies will undergo data extraction, where information relevant to the methodological quality of each study will be collected. This review will integrate qualitative and quantitative data through a narrative synthesis approach.

Discussion
By synthesising abortion care experiences and outcomes across studies and analysing the commonalities and differences of the multifactorial challenges women face in health facilities, this study will improve the understanding of abortion care experiences and outcomes and inform evidence-based recommendations and future research directions. In addition, this systematic review will also discover and locate an existing measurement tool for abortion care experiences and outcomes for women while receiving the services in the facility.
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Background: Midwifery students require essential midwifery assessment skills like vaginal examination (VE) and abdominal palpation (AP). Teaching and learning these skills are challenging due to the inability to visualize internal landmarks. Evidence on teaching these skills is scarce. ePortfolios (ePs) are used to collate evidence required for education standards. Students use platforms embedded with learning-analytics capabilities, providing a unique opportunity to investigate the process of learning. The aim of this study was to explore the role of eP-learning-analytics in supporting midwifery students' development of clinical skills, from student and clinical facilitator (CF) perspectives.

Method: We used a two-phased mixed-method research approach, quantitative data were collected first, followed by qualitative. Metadata contained within completed student ePs were analysed using descriptive statistics and baseline trajectory models. Semi-structured interviews were completed with seven midwifery students and seven CFs. Inductive thematic analysis was used to identify themes and subthemes.

Findings: A total 9,235 AP and 1,417 VE entries were analysed. Findings showed increased student confidence in AP and VE with practice, plateauing around 100 AP and 20 VE entries. Students with higher confidence ratings were less likely to document follow-up learning and documentation of follow-up learning reduced as students progressed.

Qualitative data emphasized the value of reflective conversations post-skill completion. CFs mainly viewed ePs as records, not reflective tools, contrasting students who found ePs conducive to reflection. CFs preferred assessing skills through observation and discussion, finding AP easier to teach and learn than VE. Learning was influenced by care models and clinical situations, with systematic approaches aiding learning and post-graduation practice.

Conclusions/Implications for Practice: Study findings showcase a world-first example of innovative eP-based learning-analytics for students, demonstrating confidence and competence development in clinical settings. Findings offer insights into teaching and learning of essential skills, beneficial for all midwives. The research underscores the eP's potential beyond data storage, as a novel teaching and learning tool.

Background
The interconnected effects of maternal perinatal depression and the early mother-infant relational quality on children's executive function development are crucial yet understudied. This study addresses this gap, focusing on how perinatal depressive symptoms and emotional availability at 6 months predict child executive function performance at age four, with an emphasis on the moderating role of emotional availability.

Method
This study included 282 mother-infant pairs recruited from the Mercy Pregnancy and Emotional Wellbeing Study, utilising repeated Edinburgh Postnatal Depression Scale measurement over the perinatal period, Emotional Availability Scales, and child executive function assessments (Shape School, NEPSY-II, Preschool Age Psychiatric Assessment, Attention Deficit Hyperactivity scale, inattentive subscale). Latent growth curve analysis incorporated controls for socioeconomic status and maternal cognitive abilities, and moderation effects were examined through multiplicative interaction terms.

Results
We found that emotional availability influences children's executive function, specifically switching, motor inhibition, and inattentive symptoms, irrespective of maternal depressive symptom changes. This effect is further nuanced by emotional availability's moderating role in the association between depressive symptom change and switching.

Limitations
The study's limitations include a relatively small sample size for moderation analysis and the exclusion of paternal influences.

Conclusion
This study is a significant step in understanding the profound influence of maternal emotional availability in infancy on child executive function development, offering new avenues for research and, if replicated, a foundation for innovative intervention approaches.

Background
Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression.

Methods
The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale.

Results
Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression.

Limitations
Intergenerational conflicts and quality of grandparenting were not assessed.

Conclusions
Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.

Emphasis on continuous infant sleep overnight may be driven by parental concern of risk to child mental health outcomes. The Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) examined whether infant sleep at 6 and 12 months postpartum predicts anxiety disorders at 2–4 years, and whether this is moderated by maternal depression, active physical comforting (APC) or maternal cognitions about infant sleep. Data included 349 women and infants. Infant sleep was measured using the Brief Infant Sleep Questionnaire and child anxiety disorders by the Preschool Age Psychiatric Assessment. The risk of developing generalised anxiety or social phobia disorders at 3–4 years was reduced by 42% (p = 0.001) and 31% (p = 0.001), respectively, for a one standard deviation increase in total sleep at 12 months. No other infant sleep outcomes were associated. Maternal depression, APC and cognitions about infant sleep did not significantly moderate these relationships. Focus may need to be on total infant sleep, rather than when sleep is achieved.