Papers by helen stapleton
Women and birth : journal of the Australian College of Midwives, Jan 8, 2016
Ethical and professional guidance for midwives and obstetricians emphasises informed consent and ... more Ethical and professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy; the right to refuse care is well established. However, the existing literature is largely silent on the appropriate clinical responses when pregnant women refuse recommended care, and accounts of disrespectful interactions and conflict are numerous. Policies and processes to support women and maternity care providers are rare and unstudied. To document the perspectives of women, midwives and obstetricians following the introduction of a structured process (Maternity Care Plan; MCP) to document refusal of recommended maternity care in a large tertiary maternity unit. A qualitative, interpretive study involved thematic analysis of in-depth semi-structured interviews with women (n=9), midwives (n=12) and obstetricians (n=9). Four major themes were identified including: 'Reassuring and supporting clinicians'; 'Keeping the door open'; 'Varied ...
Australian and New Zealand Journal of Obstetrics and Gynaecology, Dec 1, 2012
Background: Statewide (Queensland) Clinical Guidelines reflecting current best practice have rece... more Background: Statewide (Queensland) Clinical Guidelines reflecting current best practice have recently become available for the management of pregnancy-related obesity. However, dissemination of guidelines alone do not change practice. Aim: To systematically assess evidence-practice gap in the multidisciplinary management of overweight and obesity (ow/ob) in pregnancy to inform an intervention to facilitate translating obesity guidelines into practice in a tertiary maternity service. Materials and Methods: An online survey, available over a three-week period (May-June 2011), was disseminated to obstetric, midwifery and allied health staff. Outcomes of interest included a 15-point guideline adherence score, knowledge of guideline content, advice given, knowledge of obesity-pregnancy-related complications, previous training and referral patterns. Results: Eighty-four staff completed surveys (57% response rate). Widespread discordance with the guideline was noted. The majority (88.1%) reported overweight/obesity (ow/ob) as an important/very important general obstetric issue, most correctly identified associated complications. However, only 32.1% were aware of existing guidelines, with only half correctly identifying BMI categories for ow/ob. Compliance with referral recommendations varied; 20% of staff considered referral 'was not their job'. Conclusions: Staff are aware of negative outcomes associated with maternal ow/ob, although few are fully compliant with referral guidelines or provide advice in line with recommendations. These findings will be categorised using implementation of science methodological frameworks, and effective behaviour change interventions will be constructed to facilitate translation of this important guideline into practice.
British Journal of Midwifery, Sep 27, 2013
Developmental Psychobiology, 2016
The current study examined the effects of a natural disaster (a sudden onset flood) as a stressor... more The current study examined the effects of a natural disaster (a sudden onset flood) as a stressor in pregnancy on infant fine and gross motor development at 2, 6, and 16 months of age. Whether the timing of the stressor in pregnancy or sex of the infant moderated the impact of the prenatal maternal stress on motor development was also explored. Mothers' objective experiences of the flood, emotional reactions and distress, and their cognitive appraisal of the event were assessed retrospectively. Infants' fine and gross motor skills were assessed with the Ages and Stages Questionnaire, and results showed age-related changes in the effects of prenatal maternal stress on these domains. At 2 months, higher levels of prenatal maternal stress was positively related to infant motor development, yet at 6 and 16 months of age there was a negative association, particularly if flood exposure occurred later in pregnancy and if mothers had negative cognitive appraisals of the event. Results also showed differential effects of the maternal stress responses to the floods on infants' fine and gross motor development at each age and that infant sex did not buffer these effects. © 2016 Wiley Periodicals, Inc. Dev Psychobiol 58: 640-659, 2016.
British Journal of Midwifery, Sep 27, 2013
ABSTRACT The material in this series of papers is derived from a Department of Health funded eval... more ABSTRACT The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). The focus of these papers is on the role of the midwife in disseminating information to, and facilitating informed decision-making with, women in her care. Although health professionals generally expressed positive sentiments out the MIDIRS leaflets and their potential to assist women in making informed choices, competing demands within the clinical environment limited their effective use. This paper illustrates behavioural and organisational impediments, such as midwives’ conversational styles and pressures on their time, which reduced the opportunities for pregnant women to access the evidenced-based information they needed to participate more effectively in decision-making processes.The material in this series of papers is derived from a Department of Health funded evaluation of the MIDIRS Informed Choice leaflets (Kirkham and Stapleton, 2001). The focus of these papers is on the role of the midwife in disseminating information to, and facilitating informed decision-making with, women in her care. Although health professionals generally expressed positive sentiments out the MIDIRS leaflets and their potential to assist women in making informed choices, competing demands within the clinical environment limited their effective use. This paper illustrates behavioural and organisational impediments, such as midwives’ conversational styles and pressures on their time, which reduced the opportunities for pregnant women to access the evidenced-based information they needed to participate more effectively in decision-making processes.
Maternal & child nutrition, Jan 21, 2016
The aim of health guidelines is to ensure consistency in the delivery of care to minimise health-... more The aim of health guidelines is to ensure consistency in the delivery of care to minimise health-related complications. However, even when good evidence is available, professionals do not necessarily implement it. Following a 2011 survey (Time 1) of staff in a tertiary maternity hospital, a number of service changes were implemented to facilitate best practice delivery of care to pregnant women regarding gestational weight gain (GWG). A (second) staff survey was then undertaken to re-assess staff knowledge, attitudes and behaviours around the management of GWG in our hospital. This cross-sectional, prospective online survey was distributed to staff in antenatal clinic. The survey assessed staff awareness of pregnancy-related weight complications, knowledge and application of specific guidelines, and a guideline adherence score was calculated. Sixty-nine staff (44.8% response rate) completed the 2014 (Time 2) survey. Just over half (51.9%) stated they were familiar with clinical guid...
Http Dx Doi Org 10 1080 13698571003792926, Jul 5, 2010
... Lee, E. 2007. Health, morality and infant feeding: British mothers' experience of formul... more ... Lee, E. 2007. Health, morality and infant feeding: British mothers' experience of formula use in the early weeks. ... Keenan, J. and Stapleton, H. 2009. 'It depends what you mean by feeding on-demand': Mothers' accounts of babies' agency in infant feeding relationships. ...
Faculty of Health Institute of Health and Biomedical Innovation School of Public Health Social Work, Jan 12, 2013
In response to an identified need, a specialist antenatal clinic for women from refugee backgroun... more In response to an identified need, a specialist antenatal clinic for women from refugee backgrounds was introduced in 2008, with an evaluation planned and completed in 2010. Can maternity care experiences for women from refugee backgrounds, attending a specialist antenatal clinic in a tertiary Australian public hospital, be improved? The evaluation employed mixed methods, generating qualitative and quantitative data from two hospital databases, a chart audit, surveys and interviews with service users, providers and stakeholders. Contributions were received from 202 participants. The clinic was highly regarded by all participants. Continuity of care throughout the antenatal period was particularly valued by newly arrived women as it afforded them security and support to negotiate an unfamiliar Western maternity system. Positive experiences decreased however; as women transitioned from the clinic to labour and postnatal wards where they reported that their traditional birthing and recuperative practices were often interrupted by the imposition of Western biomedical notions of appropriate care. The centrally located clinic was problematic, frequently requiring complex travel arrangements. Appointment schedules often impacted negatively on traditional spousal and family obligations. Providing comprehensive and culturally responsive maternity care for women from refugee backgrounds is achievable, however it is also resource intensive. The production of translated information which is high quality in terms of production and content, whilst also taking account of languages which are only rarely encountered, is problematic. Cultural competency programmes for staff, ideally online, require regular updating in light of new knowledge and changing political sensitivities.
Midwifery, 2015
to explore back pain in labour from the perspectives of women and midwives. a qualitative study, ... more to explore back pain in labour from the perspectives of women and midwives. a qualitative study, which generated data through individual semi-structured interviews with postnatal women and focus groups with midwives. Data were analysed thematically. two metropolitan maternity units in Queensland, Australia. nine postnatal women and 11 midwives, all of whom had participated in a randomized controlled trial investigating the use of sterile water injections for back pain in labour. two major themes were identified, including back pain in labour: accounts, rationalisations and coping strategies, and fetal position: destabilising the Occipito Posterior-back pain discourse. back pain may be severe in labour, may impact negatively upon women׳s labour and birth experiences, and interfere with their ability to cope as planned. The assumed relationship between fetal position and back pain in labour is a dominant discourse, albeit one which is lacking in empirical credibility. Nonetheless, the information provided to women by maternity professionals tended to reiterate customary practices and beliefs rather than factual knowledge. Increasingly, women refer to other sources, which may challenge the information provided by health professionals. Back pain in labour is an under-researched area and the lack of solid evidence underpinning the advice provided to women has implications for labour management, and possibly for maternal and fetal outcomes. Care providers might usefully consider back pain as multifactorial, not always associated with OP position, and continue to seek evidence-based management strategies which address women׳s needs.
Women and Birth, 2015
All competent adults have the right to refuse medical treatment. When pregnant women do so, ethic... more All competent adults have the right to refuse medical treatment. When pregnant women do so, ethical and medico-legal concerns arise and women may face difficulties accessing care. Policies guiding the provision of maternity care in these circumstances are rare and unstudied. One tertiary hospital in Australia has a process for clinicians to plan non-standard maternity care via a Maternity Care Plan (MCP). To review processes and outcomes associated with MCPs from the first three and a half years of the policy's implementation. Retrospective cohort study comprising chart audit, review of demographic data and clinical outcomes, and content analysis of MCPs. MCPs (n=52) were most commonly created when women declined recommended caesareans, preferring vaginal birth after two caesareans (VBAC2, n=23; 44.2%) or vaginal breech birth (n=7, 13.5%) or when women declined continuous intrapartum monitoring for vaginal birth after one caesarean (n=8, 15.4%). Intrapartum care deviated from MCPs in 50% of cases, due to new or worsening clinical indications or changed maternal preferences. Clinical outcomes were reassuring. Most VBAC2 or VBAC>2 (69%) and vaginal breech births (96.3%) were attempted without MCPs, but women with MCPs appeared more likely to birth vaginally (VBAC2 success rate 66.7% with MCP, 17.5% without; vaginal breech birth success rate, 50% with MCP, 32.5% without). MCPs enabled clinicians to provide care outside of hospital policies but were utilised for a narrow range of situations, with significant variation in their application. Further research is needed to understand the experiences of women and clinicians.
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Papers by helen stapleton