We aimed to directly compare women’s pregnancy to postpartum outcomes and experiences across the major maternity models of care offered in Queensland, Australia. We conducted secondary analyses of self-reported data collected in 2012 from a state-wide sample of women who had recently given birth in Queensland (response rate = 30.4%). Logistic regression was used to estimate the odds of outcomes and experiences associated with three models (GP Shared Care, Public Midwifery Continuity Care, Private Obstetric Care) compared with Standard Public Care, adjusting for relevant maternal characteristics and clinical covariates. Of 2,802 women, 18.2% received Standard Public Care, 21.7% received GP Shared Care, 12.9% received Public Midwifery Continuity Care, and 47.1% received Private Obstetric Care. There were minimal differences for women in GP Shared Care. Women in Public Midwifery Continuity Care were less likely to have a scheduled caesarean and more likely to have an unassisted vaginal birth, experience freedom of mobility during labour and informed consent processes for inducing labour, vaginal examinations, fetal monitoring and receiving Syntocinon to birth their placenta, and report highest quality interpersonal care. They had fewer vaginal examinations, lower odds of perineal trauma requiring sutures and anxiety after birth, shorter postpartum hospital stays, and higher odds of a home postpartum care visit. Women in Private Obstetric Care were more likely to have their labour induced, a scheduled caesarean birth, experience informed consent processes for caesarean, and report highest quality interpersonal care, but less likely to experience unassisted vaginal birth and informed consent for Syntocinon to birth their placenta. There is an urgent need to communicate variations between maternity models across the range of outcome and experiential measures that are important to women; build more rigorous comparative evidence for Private Midwifery Care; and prioritise experiential and out-of-pocket cost comparisons in further research to enable woman-centred informed decision-making.
Background Currently, there is limited empirical validation of feminist-informed or individualised interventions for the treatment of eating disorders. The aim of this study was to examine the effectiveness of a feminist-informed, individually delivered counselling intervention for the treatment of eating disorders at a community-based eating disorder treatment service. Methods Eighty individuals aged between 17 and 64 years presenting to an outpatient eating disorder service were examined in a case series design at baseline, session 10, session 20 and end of treatment (session 30). Changes in eating disorder symptomology, depression, anxiety, stress, and mental health recovery over the course of treatment were examined in linear mixed model analyses. Results The treatment intervention was effective in reducing eating disorder symptomology and stress and improving mental health recovery after 10 sessions in a sample of 80 eating disorder participants engaged with the treatment service. Reductions in eating disorder symptomology and stress and improvements to mental health recovery were maintained at session 20 and session 30. Conclusions The findings of this study provide preliminary support for feminist-informed and individualised interventions for the treatment of eating disorders in community-based settings.
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