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these findings are important to practitioners, policy makers, governing bodies and researchers, providing insight into the motivations for Complementary and Alternative Medicine use by women in pregnancy.

Background Childbearing women have been using various herbs to assist with pregnancy, labour and birth for centuries. One of the most common is raspberry leaf. The evidence base for the use of raspberry leaf is however under-developed. It is incumbent on midwives and other maternity care providers to provide women with evidence-based information so they can make informed choices. The aim of this study was to review the research literature to identify the evidence base on the biophysical effects, safety and efficacy of raspberry leaf in pregnancy. Methods A systematic, integrative review was undertaken. Six databases were searched to identify empirical research papers published in peer reviewed journals including in vitro, in vivo, human and animal studies. The search included the databases CINAHL, MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection and AMED. Identified studies were appraised independently by two reviewers using the MMAT appraisal instrument. An integrative approach was taken to analysis. Results Thirteen studies were included. Five were laboratory studies using animal and human tissue, two were experiments using animals, and six were human studies. Included studies were published between 1941 and 2016. Raspberry leaf has been shown to have biophysical effects on animal and human smooth muscle including the uterus. Toxity was demonstrated when high doses were administered intravenously or intaperitoneally in animal studies. Human studies have not shown any harm or benefit though one study demonstrated a clinically meaningful (though non-statistically significant) reduction in length of second stage and augmentation of labour in women taking raspberry leaf. Conclusions Many women use raspberry leaf in pregnancy to facilitate labour and birth. The evidence base supporting the use of raspeberry leaf in pregnancy is weak and further research is needed to address the question of raspberry leaf’s effectiveness.

Increasing the number of infants exclusively breastfeeding on discharge from the hospital after birth is a key goal of breastfeeding policy in New South Wales (NSW), Australia. Despite consistent efforts, exclusive breastfeeding on discharge rates have declined over the past decade. Using pooled data from the New South Wales Perinatal Data Collection from 2011 to 2020, we examined the association between antenatal care (ANC) and exclusive breastfeeding at discharge from birth admission outcomes for mother–baby dyads in Southern New South Wales Local Health District (SNSWLHD). Our study confirmed that exclusive breastfeeding rates in SNSWLHD have declined over the past decade, providing local evidence to support action. Late entry to ANC and a failure to attend the recommended number of ANC visits were important predictors of a lower rate of exclusive breastfeeding on discharge. Improving accessibility to ANC visits for rural and regional mothers has potential to positively impact breastfeeding rates in SNSWLHD. We suggest that wider implementation of caseload midwifery models may have a positive impact on breastfeeding outcomes in the region for all mother–baby dyads, but particularly for Aboriginal mothers and infants, younger mothers and mothers experiencing disadvantage.

Low birth weight (LBW) and preterm birth are adverse perinatal outcomes that pose a significant risk to a child’s healthy beginning. While antenatal care (ANC) is an established intervention for pregnancy care, little is understood about how the number and timing of ANC visits can impact these adverse health outcomes. This study aimed to examine the impact of the number and timing of ANC visits on LBW and preterm birth in a regional setting. A decade-long perinatal dataset related to singleton live births that took place in the Southern New South Wales Local Health District (SNSWLHD) was utilized. The outcomes of interest were LBW and preterm birth, and the exposure variables were based on the Australian pregnancy guidelines on the number and timing of ANC visits. A multivariable logistic regression was performed to measure the association between outcome and exposure while adjusting for potential confounders. A greater level of protection against LBW and preterm birth was observed among mothers who had an adequate number of visits, with early entry (first trimester) into ANC. The protective effect of an adequate number of ANC visits against LBW and preterm birth among mothers with late entry into ANC (third trimester) was found to be statistically non-significant.