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This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.

This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.

This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.

A study of women's views of maternity services in the Northern Sydney Area Health Service was conducted as a result of the changing patterns of use of the Area's 7 obstetric hospitals. 340 primiparous women living in the Northern Sydney Area who had given birth in the previous six months were approached in Early Childhood Health Centres and asked to complete a survey exploring the factors influencing their choice of obstetric hospital, postnatal length of stay in hospital, and overall satisfaction with their choice of hospital. Of the 315 eligible women, 312 (99%) consented to participate and 297 (94%) completed the survey. Overall, reputation of the hospital and quality of nursing care were the most frequent reasons given for choice of hospital and there was some evidence that women selected different hospitals for distinct reasons. Women's postnatal length of stay ranged from less than 1 day to 11 days with an average of 5.3 days. Private patients stayed an average of 1 day longer than public patients, after adjusting for delivery type and pregnancy induced hypertension. There was little evidence that women in the Northern Sydney Area Health Service desire a shorter postnatal stay with the majority of women reporting they were satisfied with their length of stay. Overall, women displayed high levels of satisfaction with their choice of hospital; at least 90% of women attending all hospitals except one reported that they would choose the same hospital for the birth of another baby. This study provides valuable information, based on the experiences of the service users, to help guide the Northern Sydney Area Health Service in the provision of its maternity services to ensure they meet the changing needs of women and their families.

Research Doctorate - Doctor of Philosophy (PhD) / The thesis involves a re-examination of feminist views of the childbearing body from a post-structuralist perspective and applies these theoretical ideas to an empirical investigation into contemporary childbirth and midwifery. Critiques of medicalised childbirth developed in Australia, Britain and the USA in the 1970s are related to debates within feminism about appropriate ways to theorise motherhood and the female body as well as to understand the role played by midwives and doctors in childbirth. It is argued these critiques were the product of three strands of feminism that differed in their analysis of gender politics, their philosophy of knowledge and their understanding of power. The three critiques are also related to differences between the USA, Britain and Australia in respect of their medical system, ways in which the history of childbirth practices are viewed and differences between the professional roles of midwives. It is argued that these critiques need to be modified by more recent post-structuralist feminist approaches, particularly the way in which bodies are shaped by language and power is related to the distribution of knowledge The empirical study concentrates on a maternity unit in a regional town in New South Wales. The unit was studied through repeat interviews with mothers attending the hospital for the birth of their second or a later child, interviews with the midwives and doctors working in the unit and observations over several months. Childbirth is re-imagined as a drama and found to be an intense embodied experience shaped in turn by the practices of the hospital and the changing boundaries between medicine and midwifery, relationships of the women with the staff and the women’s own diversity. This approach to the analysis of the interview data demonstrates the limitations of the liberal feminist critique that there is insufficient rational and ‘scientific’ evaluation of childbirth practices, the radical feminist critique that the key issue is men’s domination of women’s bodies and the materialist feminist critique of the lack of fairness and support given to childbearing women, while showing how these discourses continue to circulate in debates over the management of childbirth.

Research Doctorate - Doctor of Philosophy (PhD) / The thesis involves a re-examination of feminist views of the childbearing body from a post-structuralist perspective and applies these theoretical ideas to an empirical investigation into contemporary childbirth and midwifery. Critiques of medicalised childbirth developed in Australia, Britain and the USA in the 1970s are related to debates within feminism about appropriate ways to theorise motherhood and the female body as well as to understand the role played by midwives and doctors in childbirth. It is argued these critiques were the product of three strands of feminism that differed in their analysis of gender politics, their philosophy of knowledge and their understanding of power. The three critiques are also related to differences between the USA, Britain and Australia in respect of their medical system, ways in which the history of childbirth practices are viewed and differences between the professional roles of midwives. It is argued that these critiques need to be modified by more recent post-structuralist feminist approaches, particularly the way in which bodies are shaped by language and power is related to the distribution of knowledge The empirical study concentrates on a maternity unit in a regional town in New South Wales. The unit was studied through repeat interviews with mothers attending the hospital for the birth of their second or a later child, interviews with the midwives and doctors working in the unit and observations over several months. Childbirth is re-imagined as a drama and found to be an intense embodied experience shaped in turn by the practices of the hospital and the changing boundaries between medicine and midwifery, relationships of the women with the staff and the women’s own diversity. This approach to the analysis of the interview data demonstrates the limitations of the liberal feminist critique that there is insufficient rational and ‘scientific’ evaluation of childbirth practices, the radical feminist critique that the key issue is men’s domination of women’s bodies and the materialist feminist critique of the lack of fairness and support given to childbearing women, while showing how these discourses continue to circulate in debates over the management of childbirth.

A study of women's views of maternity services in the Northern Sydney Area Health Service was conducted as a result of the changing patterns of use of the Area's 7 obstetric hospitals. 340 primiparous women living in the Northern Sydney Area who had given birth in the previous six months were approached in Early Childhood Health Centres and asked to complete a survey exploring the factors influencing their choice of obstetric hospital, postnatal length of stay in hospital, and overall satisfaction with their choice of hospital. Of the 315 eligible women, 312 (99%) consented to participate and 297 (94%) completed the survey. Overall, reputation of the hospital and quality of nursing care were the most frequent reasons given for choice of hospital and there was some evidence that women selected different hospitals for distinct reasons. Women's postnatal length of stay ranged from less than 1 day to 11 days with an average of 5.3 days. Private patients stayed an average of 1 day longer than public patients, after adjusting for delivery type and pregnancy induced hypertension. There was little evidence that women in the Northern Sydney Area Health Service desire a shorter postnatal stay with the majority of women reporting they were satisfied with their length of stay. Overall, women displayed high levels of satisfaction with their choice of hospital; at least 90% of women attending all hospitals except one reported that they would choose the same hospital for the birth of another baby. This study provides valuable information, based on the experiences of the service users, to help guide the Northern Sydney Area Health Service in the provision of its maternity services to ensure they meet the changing needs of women and their families.