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Department of Communities acknowledged MOSAIC mentor mother co-ordinator, and MOSAIC MOSAIC’s strong community partnership Jan Wiebe, MOSAIC research officer. They with maternal and child health nurse teams, are pictured here, together with Chief divisions of general practice, and women’s Investigators Angela Taft, Rhonda Small implementation health services in the north-west region of and Judith Lumley, and Kim Hoang, our Melbourne. research and project officer with the – funded The Hon Mary Delahunty MLA, Minister for Vietnamese community. Women's Affairs, will launch MOSAIC on Project update: MOSAIC has now at last! Angela Taft 12 December at Richmond Town Hall. completed training with six maternal and The launch will provide a wonderful child health nurse teams and 21 GPs from MCHR NEWS We have been outlining the gradual opportunity to celebrate the project with 17 general practices. These nurse teams development of the MOSAIC (Mothers’ our community partners and the mentor and practices have been randomised to Advocates In the Community) cluster mothers who have all supported MOSAIC comparison and intervention arms of the randomised trial over previous centre with such enthusiasm and commitment trial and referrals to the study have now newsletters. Readers will know that during our quest for funding. commenced. Further GP recruitment and Della Forster’s thesis Breastfeeding – Jane Yelland’s studies culminated in her MOSAIC aims to evaluate the role of making a difference: predictors, women’s thesis Changing maternity care: an evaluation MOSAIC has also recently welcomed two training will continue early in 2006. Celebrating supportive mentor mother advocates in views and results from a randomised trial of mainstream maternity enhancement new staff – Vivianne Woska, the new reducing partner abuse and depression, described a study that aimed to determine initiatives at four Melbourne hospitals. and strengthening mother-child bonds for three PhD whether mid-pregnancy breastfeeding In the late 1990s a Melbourne health women pregnant or with children under MOSAIC team education, with a focus on either attitudes network introduced a range of initiatives five, identified as at risk by their primary graduations to breastfeeding or on technical aspects of with the aim of improving mainstream care providers. breastfeeding, had an effect on rates of In a first for MCHR, three students recently maternity care. These innovations included breastfeeding initiation and duration. We were delighted in November that the graduated together with the award, Doctor the development of approaches that Victorian Government announced a grant of of Philosophy. Vice-Chancellor of La Trobe In Australia, as in many high income provided greater continuity of care, an $471,982 through its Community Support University, Professor Michael Osborne, countries, it has proven difficult to reach emphasis on improving postnatal Fund for full implementation of the project. conferred the awards on 7 October 2005. World Health Organization (WHO) outcomes and strategies to foster the MOSAIC already has NHMRC funding for recommendations that infants be uptake of evidence in clinical practice. Lisa Amir’s research focussed on the the study’s evaluation. The Victorian exclusively breastfed from birth to six Prevalence and prevention of mastitis in Jane’s doctoral work reports on the four-year months of age, yet there is limited lactating women. Mastitis is an important multifaceted evaluation of these maternity knowledge about interventions that are public health issue because it affects a enhancement initiatives. The findings focus effective in increasing breastfeeding large number of women and has physical on the outcomes of postal surveys of over initiation and duration. What is particularly and emotional consequences. 2,000 women who had given birth within lacking is evidence about how to maintain Complications of mastitis include the the network at two time-points. Seventy-five • Jane Yelland, Della Forster, Helen breastfeeding rates past the first six weeks Vietnamese women who had recently given development of a breast abscess and/or McLachlan and Jo Rayner received in countries which already have a high birth were also interviewed at home about Staff news Grants premature cessation of breastfeeding. $9,517 for a project titled ’The feasibility initiation of breastfeeding. their experiences of care. Process MOSAIC welcomes two new staff to the Angela Taft, Rhonda Small, Judith The Breastfeeding Survey of Frances Perry and development of a patient preference Neither intervention tested in the trial made evaluation, involving interviews with team. Jan Wiebe is working as a research Lumley and Associate Professor House and the Royal Women’s Hospital package of postnatal care’. a difference to the proportion of women managers, clinicians and recent mothers, officer and Vivianne Woska as mentor Kelsey Hegarty were awarded a (RWH) Family Birth Centre was an addition • Ann Krastev and Stephanie Brown initiating (96%) or continuing (53%) was conducted to assess the process and mother co-ordinator for the project. Community Support Grant of $472,891 to a concurrent large breastfeeding trial, received $4,946 for a project titled ‘Medical breastfeeding. progress of change. Emergency for the MOSAIC project. Attachment to the Breast and Family Vicki Wyatt graduated in October with a records versus self-report questionnaires: department attendances and readmissions An NHMRC enabling grant of $1,040,000 Attitudes to Breastfeeding (ABFAB), which Recommendations for further research are La Trobe University Diploma of University assessing discrepancies, inconsistencies of mothers and infants were monitored. over five years for the WOMBAT recruited public patients at the RWH. Of the based on the findings of this study in Administration. and missing data for exposure and The evaluation demonstrated that it is possible collaboration on perinatal trials was 1,189 women who were interviewed at six combination with meta-analyses following Dianne Beck has commenced a four outcome measures in a prospective cohort to re-orient mainstream maternity care in awarded to Professor Caroline months postpartum, 205 women (17%) had a systematic review of the literature. Given month placement at MCHR, her final study investigating women’s health during complex hospital environments, resulting in Crowther, Dr Steve Cole, Dr Jodie experienced mastitis. Fifty percent of the complex issues related to measuring placement as part of the Victorian Public pregnancy and after childbirth’. significant improvements. The study also Dodd, Professor Lex Doyle, Ms Vicki episodes occurred in the first four weeks breastfeeding outcomes and the relative Health Training Scheme. Dianne will be illustrated the strengths and limitations of a Flenady, Professor David Henderson- • Helen McLachlan, Della Forster, Jane postpartum and 83% in the first three lack of efficacy of many breastfeeding working with Lyn Watson and Judith Lumley quasi-experimental approach to evaluation Smart, Judith Lumley, Ms Philippa Yelland and Jo Rayner received $4,934 for months postpartum. Five women interventions, it is important that future on the association of prior pregnancy loss and the benefits of systematically Middleton, Dr Christine Roberts, their project, ‘Supporting women after developed a breast abscess, which is 3% studies include adequate sample size; and preterm birth and how smoking examining the context and process of a new Professor Jeffrey Robinson, Professor childbirth: adapting and piloting an educational of the women who experienced mastitis. follow-up to at least six months; economic influences this association. program aimed at enhancing the knowledge evaluation; clear breastfeeding definitions; approach to public maternity care. Many Karen Simmer and Professor William A separate case-control study investigated Congratulations to Ann Krastev and Ellie and skills of midwives and nurses to identify and importantly, input from women about of the findings from the evaluation have Tarnow-Mordi. the possible association between mastitis McDonald on their recent marriages and and support women with psychosocial issues intervention design. applicability for the organisation and Five Faculty of Health Sciences and nasal carriage of Staphylococcus Liesje Toomey on her engagement. We during the postnatal period’. provision of care at other maternity facilities. Research Grant applications were aureus. There was no difference in the Della’s studies were supervised by wish them every happiness for the future. Jane’s studies were supervised by recently successful. Sue Armstrong received a Faculty of proportion of women with mastitis and Judith Lumley. Congratulations also to Fiona Bruinsma Health Sciences Postgraduate Support Stephanie Brown. • Della Forster, Jo Rayner, Helen without mastitis who were nasal carriers. on the birth of a baby girl, Naomi Elise. Grant of $425 to support her attendance at McLachlan and Jane Yelland received However, the infants of mothers with the recent annual $9,930 for ‘A state-wide review of postnatal mastitis were more likely to be nasal Jane Yelland, Lisa Amir Public Health & Della Forster care in private hospitals in Victoria’. Mother & Child carriers (82%) than the infants of other Awards Association of Health Research women (56%). The presence of a cracked • , , Mary-Ann Davey Della Forster Helen Australia La Trobe University nipple was associated with a high odds for Congratulations to Lisa Amir on winning , , and McLachlan Lisa Amir Lisa Gold Jo Conference to 251 Faraday Street mastitis after adjusting for mother’s age, the prize for the best poster at the received $9,884 for a project titled Rayner present her Carlton Victoria 3053 income, maternal tiredness and Academy of Breastfeeding Medicine annual ‘Exploring the acceptability of peer support research findings. Australia breastfeeding difficulty. meeting in Denver, Colorado, USA in for breastfeeding from the perspective of Telephone October. Her poster is titled ‘The breastfeeding women and potential peer Lisa’s studies were supervised by +61 3 8341 8500 relationship between maternal smoking and supporters in Melbourne’. Judith Lumley. breastfeeding duration after adjustment for Facsimile maternal infant feeding intention’. +61 3 8341 8555 Email [email protected] EDITORIAL TEAM: Maggie Flood, Jo Rayner, Rhonda Small, Vicki Wyatt, Jane Yelland 4 1 DECEMBER 2005 #24 062160 MCHR NEWS #24 FA 25/11/05 4:00 PM Page 2

one visit to the next. SRM was an the pregnancy and a number of specific Exploring the anonymous, population-based postal survey, aspects of antenatal care, women who felt sent at six months postpartum to women who that the caregivers got to know and importance of gave birth in a 14-day period in September remember them remained much more likely 1999. Sixty-seven percent of those who gave to rate their care highly (ORadj=3.18, 95%CI birth in Victoria during the study period 2.0, 5.1), whereas seeing the same continuity of responded to the survey (n=1,616). caregiver was no longer associated with the opening plenary session about the smokefree” was used throughout the rating of care (ORadj=0.65, 95%CI 0.3, 1.2). The majority of women saw the same Women and WHO Framework Convention on Tobacco meeting. The context was the high antenatal caregiver at each antenatal visit (77%), and As measured by overall rating of their Control. Women and men attended from prevalence of smoking and the serious felt that caregivers got to know them antenatal care, women were more almost every country in the world and in effects of smoking on women and babies 1 smoking: caregiver (65%). However, the proportions varied concerned that their antenatal caregivers every country harms from tobacco and both in pregnancy and afterwards, with the widely between different models of took the time to get to know them, and approaches to tobacco control were major aim of increasing awareness at all levels. Mary-Ann Davey maternity care. Women who saw caregivers remember them and their progress from from Toledo problems. The notion of “becoming smokefree” and in private rooms (private care, shared care, one visit to the next, than that they always Toledo was a great place to hold this “staying smokefree” provided a much Continuity of care and of caregiver are combined care) reported much higher saw the same caregiver at each visit. to Auckland international meeting and not just because needed alternative to the usual language in thought to be important influences on levels of both aspects of continuity than 1. Davey M-A, Brown S, Bruinsma F. What is it about of its beauty. Reminders of the three which such discussions are phrased. I am women’s experience of maternity care. We those who saw caregivers at a hospital antenatal continuity of caregiver that matters to Judith Lumley cultures (Jewish, Muslim and Christian) looking forward to the final report and to a asked women about a number of aspects of (regular antenatal clinic care, midwives women? Birth. In press. which have all long had a place there new approach in a very invisible area of their antenatal care in the 2000 Survey of clinic care, birth centre care, and the In late October I took part in the first contributed to that, as did the age of the public health. Recent Mothers (SRM), and were interested hospital component of shared care). International Symposium on Women and city and its hilltop location. The unexpected to explore the contribution of two aspects of Mary-Ann Davey Tobacco (ISOWAT) within the amazing Women were much more likely to describe factor, to me at least, was the ubiquity of continuity of caregiver in the antenatal period setting of the city of Toledo, in Spain. As I their antenatal care as ‘very good’ if they people’s smoking, apparent everywhere to women’s overall rating of antenatal care: had not seen a program for the symposium ‘always’ or ‘mostly’ felt the caregiver got to outside the building where the symposium the extent to which women saw the same I had no idea until it started just how know them (OR=5.86, 95%CI 4.3, 7.9), and was held. I had totally forgotten how caregiver throughout pregnancy; and the diverse this meeting was going to be. if they ‘always’ or ‘mostly’ saw the same unpleasant it is. The worst experience was extent to which women felt that their Examples of this diversity were that while I caregiver at each visit (OR=2.91, 95%CI a late afternoon drink and sandwich in the caregiver/s got to know them and was asked to present the updated 2.0, 4.3). However, after adjusting for socio- main city square with people at two remembered them and their progress from Cochrane Review on interventions to assist demographic factors, parity, risk status of adjacent tables smoking cigars and a high women in stopping smoking during prevalence of smoking all around. pregnancy, another speaker from Australia – Mary Assunta – discussed the information Shortly after the Toledo symposium I from tobacco companies on their activities travelled to a forum in Auckland where the and plans for Asia and Australia which had topic was also smoking. The title shows expressed satisfaction with the decision to irregular periods, mood swings, been brought into the light of day by how different this experience was to be. undertake treatment to reduce their height. depression, increased nipple pigmentation, Are women activists in the last few years. The third The title was The Smokefree Pregnancy While there was no clear association and increased vaginal secretions. Each speaker from Australia, Kathy Esson, gave Forum and the language of “becoming between satisfaction with the treatment was independently associated with satisfied with decision and women’s adult height, those dissatisfaction and those women who treated women who were satisfied reported experiencing three or more side the decision expressed this in terms of being glad they effects were significantly less satisfied with were not as tall as predicted. the treatment decision (x2 for trend 45.865, to treat tall Dissatisfaction among treated women was p<0.001). One in four dissatisfied women research supported policy changes and family balance reflects widespread significantly related to: whether or not they provided comments about side effects Women’s and advocated by second-wave feminists community concern that present social stature? had an active say in the decision; negative during treatment. Perceived long term side including accessible, affordable childcare arrangements are failing families.1 experiences of assessment and treatment; effects of treatment were also associated men’s and paid maternity and paternity leave. The I have spent Semester 2, 2005 at Mother Jo-Anne Rayner side effects whilst on the treatment; and with dissatisfaction with the treatment most pressing need identified by the and Child Health Research, working on my any side effects in later years that they decision. Women who had tried mothers of young children was some own research and participating in the life of The Tall Girls study was a retrospective associated with the treatment. unsuccessfully to get pregnant for 12 incomes after arrangement that would allow them to take the Centre in order to learn more about cohort study of girls treated and/or Women who felt they had not had an active months or more were significantly more time off from looking after their children carrying out large research projects, assessed for tall stature between 1959 and say in the treatment decision, were likely to be dissatisfied with the treatment childbearing when they were sick themselves. designing randomised controlled trials, 1993. Synthetic oestrogens have been significantly more likely to be dissatisfied decision (p=0.001). Comments included Recent research I have conducted into writing grant applications, and the available since the 1950s to reduce the (p=0.001) when compared with women issues about the untested nature of the Marty Grace women’s and men’s incomes following functioning of a successful research predicted adult height of tall girls. Therapy who did have an active say. Comments treatment and a lack of explanation of childbearing, was funded by a Victoria culture. was undertaken in adolescence for possible long term consequences. My interest in mothering research came included expressions of anger and University Discovery Grant, and utilised 1. Goward P, Mihailuk T, Moyle S, O’Connell K, de perceived psychosocial reasons including: from my own experiences of bearing and resentment toward parents and treating 1. Pyett P, Rayner J, Venn A, Bruinsma F, Werther G, Australian Bureau of Statistics 2001 Census Silva N, Squire S, Tilly J. Striking the balance: the potential for teasing; girls feeling raising children. My first two children were doctors. Others suggested their young age Lumley J. Using hormone treatment to reduce the data. I found that couple-family fathers are women, men, work and family. Sydney: Human born at the height of second-wave different from their peers; an inability to find at the time precluded them from adult height of tall girls: Are women satisfied with the only parents with any reasonable Rights and Equal Opportunity Commission, 2005. feminism in the early 1970s, and the third in a male partner; and exclusion from careers. challenging such a decision. A summary of the decision in later years? Soc Sci Med 2005; likelihood of achieving high incomes. 60:1629-39. 1991 at a time when we were hoping to In a postal questionnaire we asked 844 experiences to describe assessment and Couple mothers, single mothers and single reap the benefits of second-wave activism. Marty Grace participating women (396 treated and 448 treatment procedures, revealed that women fathers all had particularly low incomes Jo-Anne Rayner My disappointment over the continuing untreated) to evaluate and comment on a who reported their experiences in negative while their children were very young, near impossibility of both caring for a number of issues, including how they felt terms were significantly less likely to be gradually increasing with children’s age, young child and being economically self- about the decision around treatment. satisfied with the decision (p<0.0001) when but never reaching the high average supporting, led to a long-term research Comments analysed qualitatively clearly compared to women who reported no incomes of couple fathers. Responsibility interest in the material conditions of illustrated women’s satisfaction and negative experiences. Comments included for children clearly has a significant impact 1 mothers’ lives. dissatisfaction with the treatment decision. strong feelings about the inappropriateness on income: caring for young children Untreated women were overwhelmingly of the assessment process. Women also My PhD explored ideas for change in the restricts parents’ ability to earn labour happy that they were not treated (99.1%) reported a range of side effects social arrangements for caring for young market income. The recent inquiry into work no matter what adult height they reached. experienced during treatment including: children in Australia. Participants in the However, only 57.9% of the treated women problematic weight gain, heavy periods,

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