General Practice and Primary Care - Research Publications
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ItemEnding preventable stillbirths among migrant and refugee populations(WILEY, 2019-06)
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ItemResumption of sex after a second birth: An Australian prospective cohort(WILEY, 2019-03)BACKGROUND: Few longitudinal studies have examined women's experiences of sex after childbirth. Much of the advice given to couples about what to expect in relation to sex after childbirth is based on cross-sectional studies. OBJECTIVE: To investigate timing of resumption of sex after a second birth and assess associations with obstetric factors (method of birth and perineal trauma) and time interval between first and second births. METHOD: Prospective cohort of 1507 nulliparous women recruited before 25 weeks' gestation in Melbourne, Australia followed up at 3, 6, 9, and 12 months after first births, and 6 and 12 months after second births. Measures include: obstetric factors and resumption of vaginal sex after first and second births. RESULTS: By 8 weeks after their second birth, 56% of women had resumed vaginal sex, compared with 65% after their first birth. Women were more likely to resume sex later than 8 weeks postpartum if they had a spontaneous vaginal birth with episiotomy or sutured perineal tear (aOR: 2.21, 95% CI: 1.5-3.2), operative vaginal birth (aOR: 2.60, 95% CI: 1.3-5.3) or cesarean delivery (aOR: 2.15, 95% CI: 1.4-3.3) compared with a vaginal birth with minimal or no perineal trauma. There was no association between timing of resumption of sex and the time interval between births. CONCLUSION: For almost half of the cohort, sex was not resumed until at least 8 weeks after the second birth. Timing of resumption of sex was influenced by obstetric factors, but not the time interval between births.
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ItemCommon maternal health problems among Australian-born and migrant women: A prospective cohort study(PUBLIC LIBRARY SCIENCE, 2019-02-11)BACKGROUND: Migrant women of non-English speaking background make up an increasing proportion of women giving birth in high income countries, such as Australia, Canada and the United Kingdom. The aim of this study was to assess the prevalence of common physical and psychosocial health problems during pregnancy and up to 18 months postpartum among migrant women of non-English speaking background compared to Australian-born women. METHODS: Prospective pregnancy cohort study of 1507 nulliparous women. Women completed self-administered questionnaires or telephone interviews in early and late pregnancy and at 3, 6, 9, 12 and 18 months postpartum. Standardised instruments were used to assess incontinence, depressive symptoms and intimate partner violence. FINDINGS: Migrant women of non-English speaking background (n = 243) and Australian-born mothers (n = 1115) reported a similar pattern of physical health problems during pregnancy and postpartum. The most common physical health problems were: exhaustion, back pain, constipation and urinary incontinence. Around one in six Australian-born women (16.9%) and more than one in four migrant women (22.5%) experienced intimate partner abuse in the first 12 months postpartum. Compared to Australian-born women, migrant women were more likely to report depressive symptoms at 12 and 18 months postpartum. CONCLUSION: Physical and mental health problems are common among women of non-English speaking background and Australian-born women, and frequently persist up to 18 months postpartum. Migrant women experience a higher burden of postpartum depressive symptoms and intimate partner violence, and may face additional challenges accessing appropriate care and support.
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ItemWhat factors are associated with resilient outcomes in children exposed to social adversity? A systematic review(BMJ PUBLISHING GROUP, 2019-06)OBJECTIVES: Children exposed to social adversity-hardship as a result of social circumstances such as poverty or intergenerational trauma-are at increased risk of poor outcomes across the life course. Understanding what promotes resilient outcomes is essential for the development of evidence informed intervention strategies. We conducted a systematic review to identify how child resilience is measured and what factors are associated with resilient outcomes. DESIGN: Systematic search conducted in CINAHL, MEDLINE and PsychInfo from January 2004 to October 2018 using the keywords 'resilien* and child* in the title or abstract. Eligible studies: (1) described children aged 5-12 years; (2) identified exposure to social adversity; (3) identified resilience; and (4) investigated factors associated with resilience. OUTCOME MEASURES: (1) approaches to identifying resilience and (2) factors associated with resilient outcomes. RESULTS: From 1979 studies retrieved, 30 studies met the inclusion criteria. Most studies were moderate to high quality, with low cultural competency. Social adversity exposures included poverty, parent loss, maltreatment and war. Only two studies used a measure of child resilience; neither was psychometrically validated. Remaining studies classified children as resilient if they showed positive outcomes (eg, mental health or academic achievement) despite adversity. A range of child, family, school and community factors were associated with resilient outcomes, with individual factors most commonly investigated. The best available evidence was for cognitive skills, emotion regulation, relationships with caregivers and academic engagement. CONCLUSIONS: While there is huge variation in the type and severity of adversity that children experience, there is some evidence that specific individual, relational and school factors are associated with resilient outcomes across a range of contexts. Such factors provide an important starting point for effective public health interventions to promote resilience and to prevent or ameliorate the immediate and long-term impacts of social adversity on children.
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ItemHealing The Past By Nurturing The Future: A qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment(PUBLIC LIBRARY SCIENCE, 2019-12-13)BACKGROUND: Child maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to 'intergenerational trauma'. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood. METHODS: A protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches. FINDINGS: The search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future. CONCLUSIONS: Pregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent's experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.
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ItemHealing the Past by Nurturing the Future-co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study(BMJ PUBLISHING GROUP, 2019-06)INTRODUCTION: Child maltreatment and other traumatic events can have serious long-term physical, social and emotional effects, including a cluster of distress symptoms recognised as 'complex trauma'. Aboriginal and Torres Strait Islander (Aboriginal) people are also affected by legacies of historical trauma and loss. Trauma responses may be triggered during the transition to parenting in the perinatal period. Conversely, becoming a parent offers a unique life-course opportunity for healing and prevention of intergenerational transmission of trauma. This paper outlines a conceptual framework and protocol for an Aboriginal-led, community-based participatory action research (action research) project which aims to co-design safe, acceptable and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal parents experiencing complex trauma. METHODS AND ANALYSIS: This formative research project is being conducted in three Australian jurisdictions (Northern Territory, South Australia and Victoria) with key stakeholders from all national jurisdictions. Four action research cycles incorporate mixed methods research activities including evidence reviews, parent and service provider discussion groups, development and psychometric evaluation of a recognition and assessment process and drafting proposals for pilot, implementation and evaluation. Reflection and planning stages of four action research cycles will be undertaken in four key stakeholder workshops aligned with the first four Intervention Mapping steps to prepare programme plans. ETHICS AND DISSEMINATION: Ethics and dissemination protocols are consistent with the National Health and Medical Research Council Indigenous Research Excellence criteria of engagement, benefit, transferability and capacity-building. A conceptual framework has been developed to promote the application of core values of safety, trustworthiness, empowerment, collaboration, culture, holism, compassion and reciprocity. These include related principles and accompanying reflective questions to guide research decisions.
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ItemIntergenerational Impacts of Family Violence - Mothers and Children in a Large Prospective Pregnancy Cohort Study(ELSEVIER, 2019-10)BACKGROUND: Violence and other adversities commonly co-occur, yet are usually investigated individually. The primary objectives of this paper are to investigate: (i) the relationship between maternal exposure to violence (including childhood abuse and intimate partner violence) and postpartum mental and physical health; and (ii) the extent to which exposure to violence and poor maternal mental and physical health are associated with children's emotional-behavioral difficulties. METHODS: Prospective pregnancy cohort (n = 1507) followed up to 4 year postpartum. Validated measures used: Composite Abuse Scale; Edinburgh Postnatal Depression Scale, SF-36, Child Maltreatment History Self Report; Strengths and Difficulties Questionnaire. Logistic regression was used to investigate associations between maternal childhood abuse, intimate partner violence (IPV), maternal health and child emotional and behavioral difficulties at age 4. OUTCOMES: Two out of five women (41%) reported abuse in childhood, and almost one in three (29%) reported IPV during the first four years of motherhood. Women reporting both physical and sexual childhood abuse had markedly raised odds of IPV and poor physical and mental health at all time points (pregnancy, first year postpartum and four year postpartum). For the index child, violence exposures (maternal childhood abuse or IPV) and poor maternal physical or mental health were associated with higher odds of emotional/behavioral difficulties at age four. In multivariable models (adjusted for child gender and maternal age), cumulative exposures (multiple violence exposures or poor maternal mental or physical health at multiple time points) each independently added to increased odds of emotional-behavioral difficulties. Children of mothers who reported a history of childhood abuse but were not exposed to IPV had odds of difficulties similar to children of mothers not reporting any violence exposure, suggesting resilient outcomes where violence experiences are not repeated in the next generation. INTERPRETATION: The clustering of risk (child and adult violence experiences) and the accumulation of risk within families (IPV, poor maternal health, child difficulties) highlight the need for effective early intervention to limit or ameliorate the impact of violence across the lifespan, and to break the intergenerational cycle of disadvantage.