Carolyn Hastie

Publications

• Reflections on the practice of facilitating group-based antenatal education: should a midwife wear a uniform in the hospital setting?

  Peeranan Wisanskoonwong, Kathleen Fahy, Carolyn Hastie

  International journal of nursing practice. 12/2011; 17(6):628-35.

  The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group-based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife-led group-based antenatal education sessions in the hosp... [more] The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group-based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife-led group-based antenatal education sessions in the hospital setting? This paper reports on a single example of reflection in and on midwifery practice that aimed to answer the guiding question. The practice and reflection occurred over a number of months at the beginning of the feminist action research project. The midwife should wear normal clothes when facilitating group-based antenatal education as a symbol of equality in power relationships within the group. When power relationships between women and the midwife are equalized, women are more able to take responsibility for their health as they are less likely to defer to the 'expert'. Reflection in and on practice is a powerful tool to allow the midwife to understand and change her own practice as required to meet those goals. Self-change is a critical first step because there can be no change in the way maternity care is provided without each midwife being willing to be self-aware and open to appropriate self-change.

• The effectiveness of medical interventions aimed at preventing preterm birth: a literature review.

  Peeranan Wisanskoonwong, Kathleen Fahy, Carolyn Hastie

  Women and birth : journal of the Australian College of Midwives. 01/2011; 24(4):141-7.

  Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth? A systematic search was carried out in CINA... [more] Preterm birth is a significant global health problem with serious short and long term consequences. This paper reviews the research literature to answer the question how effective are the medical interventions that aim to reduce the rates of preterm birth? A systematic search was carried out in CINAHL, Cochrane, Medline and Embase in relation to following medical treatments aimed at preventing preterm births: anti-infective medications, tocolytics, progesterone and cervical cerclage. The research underpinning each type of intervention is critically analysed in order to establish the validity of knowledge claims that are made for each type of intervention. In relation to reducing the rates of preterm births, anti-infectives are only effective in the presence of known infection. Screening for infections during pregnancy is ineffective. Tocolytic agents are not effective in decreasing the preterm birth rates. Progesterone seems to be effective in a select group of pregnant women at higher risk of preterm birth. Cervical cerclage plays a small and an occasional role in preventing some preterm births. This literature review demonstrates that medical interventions aimed at preventing, not just delaying, preterm birth, are not effective at a population level. Providing holistic, antenatal midwifery care for women living in socio-economic disadvantage and/or with an increased risk of preterm birth seems to be a promising strategy to address the negative effects of the social determinants of disease and thus to reduce the rate of preterm births at an individual and a population level.

• Inter-professional collaboration in delivery suite: a qualitative study.

  Carolyn Hastie, Kathleen Fahy

  Women and birth : journal of the Australian College of Midwives. 11/2010; 24(2):72-9.

  Communication problems between clinicians are the most common cause of preventable adverse events in hospitals. In spite of these known risks the 'turf wars' between midwives and doctors continue unabated. What factors affect inter-professional interactions in birthing units? 9 doctors and 1... [more] Communication problems between clinicians are the most common cause of preventable adverse events in hospitals. In spite of these known risks the 'turf wars' between midwives and doctors continue unabated. What factors affect inter-professional interactions in birthing units? 9 doctors and 10 midwives from 10 Australian maternity units. Interpretive Interactionism was the research design. Probing in-depth interviews were conducted to elicit stories of inter-professional interactions and their perceived effects on birthing outcomes. Analysis resulted in two theoretical models of inter-professional interaction: one positive and the other negative. Midwives and doctors agree that positive interactions are collaborative, include the woman and her partner and are associated with the best possible outcomes and experiences possible. In contrast, they agree that negative interactions involve power struggles between the professionals and these are associated with adverse outcomes. All participants are able to demonstrate emotional and social competence when interacting and applied those skills sometimes. Factors related to the organisational culture within the 'birth territory' of a particular maternity unit seem to be predictive of the type of interactions that are likely to occur there. Interventions to enhance inter-professional collaboration should be directed first at changing organisational structures and policies to promote easy opportunities for natural dialogue between doctors and midwives.

• Holistic physiological care compared with active management of the third stage of labour for women at low risk of postpartum haemorrhage: a cohort study.

  Kathleen Fahy, Carolyn Hastie, Andrew Bisits, Christine Marsh, Lurena Smith, Anne Saxton

  Women and birth : journal of the Australian College of Midwives. 03/2010; 23(4):146-52.

  Is 'holistic psychophysiological care' in the third stage of labour safe for women at low risk of postpartum haemorrhage? Although there have been four randomised trials and a Cochrane Review on the safety and effectiveness of care during the third stage labour, no previous study has focusse... [more] Is 'holistic psychophysiological care' in the third stage of labour safe for women at low risk of postpartum haemorrhage? Although there have been four randomised trials and a Cochrane Review on the safety and effectiveness of care during the third stage labour, no previous study has focussed only on women at low risk of postpartum haemorrhage and no previous study has tested a form of physiological third stage care that is provided by skilled midwives in an appropriate setting. Retrospective cohort study involving a maternity unit at a tertiary referral hospital and a freestanding, midwifery-led birthing unit. All low risk women who gave birth at either unit in the period July 2005-August 2008. 'Active management' of the third stage of labour compared with 'holistic psychophysiological third stage care'. At the tertiary unit, 344 of 3075 low risk women (11.2%) experienced postpartum haemorrhages (PPH). At the midwifery-led unit, PPH occurred for 10 of 361 women (2.8%), OR=4.4, 95% CI [2.3, 8.4]. Treatment received analysis showed that active management (n=3016) was associated with 347 postpartum haemorrhages (11.5%) compared with receiving holistic psychophysiological care (n=420) which was associated with 7 (1.7%) PPH OR=7.7, 95% CI [3.6, 16.3]. This study suggests that 'holistic psychophysiological care' in the third stage labour is safe for women at low risk of postpartum haemorrhage. 'Active management' was associated with a seven to eight fold increase in postpartum haemorrhage rates for this group of women. Further prospective observational evaluation would be helpful in testing this association.

• Optimising psychophysiology in third stage of labour: Theory applied to practice.

  Carolyn Hastie, Kathleen M Fahy

  Women and birth : journal of the Australian College of Midwives. 05/2009;

  BACKGROUND: Active management of the third stage of labour is routine in delivery suites. New South Wales (NSW) Health has a policy which prescribes active management because medically designed randomised controlled trials have claimed a reduced blood loss in third stage with active, compared with &... [more] BACKGROUND: Active management of the third stage of labour is routine in delivery suites. New South Wales (NSW) Health has a policy which prescribes active management because medically designed randomised controlled trials have claimed a reduced blood loss in third stage with active, compared with 'physiological', management. In home and birth centre settings however, physiological third stage is common as women who access these settings prefer to labour without medical intervention and midwives who work in these settings adopt a holistic approach to working with women. The holistic approach is psychophysiological as the midwife engages with and supports integration of the woman's spirit, mind and body in her childbearing process. PURPOSE: To present midwifery theory that describes, explains and predicts how women and midwives work together to enable selected women to safely experience an optimal psychophysiological third stage of labour. METHOD: Key terms are defined. The literature relevant to psychophysiology and management of the third stage of labour is reviewed. An expanded understanding of risk factors for postpartum haemorrhage is presented and justified. A theoretical framework of Midwifery Guardianship is presented and discussed and applied to third stage care. CONCLUSIONS: A psychophysiological third stage is quite different from what has been defined as 'physiological management' in the medically designed randomised trials comparing active versus physiological care. The conditions for deciding if a particular woman, in a particular context with a particular midwife is a good candidate for a psychophysiological third stage are presented and discussed. Only if all these conditions are met it is safe to proceed with a psychophysiological third stage. Research about the effectiveness of midwifery care in a psychophysiological third stage of labour urgently needs to be conducted.

• Putting women first: interprofessional integrative power

  Carolyn Hastie

  01/2008

  Degree: Master of Philosophy (Midwifery_

  Supervisor: Dr Kathleen Fahy

  Download Paper

• Birth Territory and Midwifery Guardianship: Theory for practice, education and research

  Kathleen Fahy, Maralyn Foureur, Carolyn Hastie

  01/2008;