Maralyn Jean Foureur

University of Technology Sydney | UTS · Centre for Midwifery, Child and Family Health

Objective In many high-income countries, approximately half of all births are now planned regarding timing, either by elective Caesarean Section (CS) or induction of labour (IOL). To what degree this is explained by women's birth beliefs and preferences, and in turn, factors such as parity and ethnicity that may influence them, is contentious. With...

Background Unexplained clinical variation is a major issue in planned birth i.e. induction of labour and planned caesarean section. Aim To map attitudes and knowledge of maternity care professionals regarding indications for planned birth, and assess inter-professional (midwifery versus medical) and intra-professional variation. Methods A custom-...

Objectives: to examine the factors that motivate women who have had a previous caesarean section to consider planning a vaginal birth. Design: a qualitative descriptive study with thematic analysis, drawing on interviews with women participating in a two arm, un-blinded randomised controlled trial (RCT) of midwifery continuity of care for increasin...

Introduction An increased metabolic demand during pregnancy is fulfilled by gaining sufficient gestational weight. Women who gain inadequate-weight are at a high-risk of premature birth or having a baby with low-birth weight. However, women who gain excessive-weight are at a high-risk of having a baby with macrosomia. The aim of this review was to...

Background Rates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women’s...

Background: In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in...

Objective: The psychological and emotional impact of a traumatic birth experience on clinicians is well-established. It is also known that emotions can generally influence decisions. However, it is not clear whether experiencing a birth trauma can affect the professional behaviour and decision-making of clinicians. This study explores the impact o...

Passion for Complementary Alternative Medicine/Therapies: Midwives’ education and training Despite the proliferation of research exploring Complementary and Alternative Medicine/Therapies (CAM) use in the perinatal period and midwifery practice, studies investigating midwives’ CAM training is sparse. This study investigated Australian midwives’ ed...

Background: Intermittent auscultation (IA) is the technique of listening to and counting the fetal heart rate (FHR) for short periods during active labour and continuous cardiotocography (CTC) implies FHR monitoring for longer periods. Although the evidence suggests that IA is the best way to monitor healthy women at low risk of complications, the...

Background: There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may stem from variability in clinical guidelines. This review aimed to identify to what extent induction of labour guidelines provide consistent recommendations in relation to reasons for, and timing of, induction...

Background: Inadequate or excessive gestational weight gain is associated with both short and long-term adverse maternal and infant health outcomes. The practice of routine maternal weight monitoring has been suggested as an effective health promotion intervention, both as a screening tool for adverse maternal and infant outcomes and as a weight m...

Background: Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings. Aim: Th...

Background: There has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in re...

Aim To describe the epidemiology of EOS including blood culture utilisation, across a large and geographically diverse Australian health district. Background Sepsis in the first three days of life remains a leading cause of death and morbidity. In high-income countries, group B Streptococcus (GBS) and Escherichia coli (E. coli) have dominated as c...

Background Intrapartum antibiotic prophylaxis (IAP) to reduce the likelihood of neonatal early-onset group B streptococcal infection (EOGBS) has coincided with major reductions in incidence. While the decline has been largely ascribed to IAP following either universal screening or a risk-based approach to identify mothers whose babies may most bene...

Introduction In the last decade, there has been an increased interest in exploring the impact of the physical birth environment on birth outcomes. The birth environment might have an important role in facilitating the production of the hormone oxytocin that causes contractions during labour. Oxytocin is released in a safe, secure and confidence-ind...

Complementary and Alternative Medicine/Therapies (CAM) options have increasingly been used by pregnant women, however literature describing midwives’ views and beliefs towards CAM is sparse. This study aimed to investigate Australian midwives’ views and beliefs about CAM. Methods: A national survey of Australian College of Midwives midwife members...

Background: Approximately 50% of women gain excessive weight in pregnancy. Optimizing gestational weight gain is important for the short- and long-term health of the childbearing woman and her baby. Despite this, there is no recommendation for routine weighing in pregnancy, and weight is a topic that many maternity care providers avoid. Resource-i...

Background: In some countries, up to 30% of women are exposed to intrapartum antibiotic prophylaxis for prevention of early-onset group B Streptococcal infection. Intrapartum antibiotic prophylaxis aims to reduce the risk of neonatal morbidity and mortality from this infection. The intervention may adversely affect non-pathogenic bacteria which ar...

Background: Australia experiences high breastfeeding initiation but low duration rates. UNICEF introduced the global breastfeeding strategy, the Baby-Friendly Hospital Initiative, to Australia in 1992, transferring governance to the Australian College of Midwives (ACM) in 1995. In 2017 23% of facilities were registered as 'baby-friendly' accredite...

Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Literature describing CAM and self-help options midwives recommend to women experiencing a post-date pregnancy is sparse. This study aimed to investigate if Australian midwives’ personal CAM use impacts on discussio...

This chapter focuses on one relatively small aspect of design thinking and practice that concerns the building of just one room, the space and place for birth. The argument we present is that much of current design thinking in this area falls far short of what is needed to support the ongoing health and wellbeing of the population this space is mea...

Background: Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of serious perinatal outcomes for these women is comparable to similarly low risk women, who choose to birth in hospital. New Zealand women have a choice of Lead Maternity Carer (LMC) and birt...

Objective In longitudinal studies, women gain significant amounts of weight during young adulthood, pointing to pregnancy as an important trigger for weight gain. Studies examining the effect of parity vary in their findings and are complicated by multiple potential confounders. This study examines the association between parity and long‐term weigh...

Objective: to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. Design: this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews a...

Background: the viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, require transfer. Aim: to compare the maternal and neonatal birth outcomes of women who planned, to give birth at freestanding midwifery units and subsequently, transferred to a tertiary...

Background It is accepted that healthcare’s physical environment influences patients and staff’s perceptions and experiences. Research has explored how birth unit design influences women and midwives’ experiences during childbirth. However, although there is evidence that cooperative supporters are beneficial to laboring women, and that women desir...

Objective To investigate the level of burnout among midwives working in caseloading practices compared to other models of midwifery care. Study design and setting In this survey the Copenhagen Burnout Inventory was used to measure burnout among midwives working in a tertiary maternity unit Denmark. Main outcome measures Mean burnout scores and the...

Objective: The objective of this paper was to inform the development of a mobile phone-optimised, SMS-based, informative and interactive telephone-linked support system for new fathers. Methods: The SMS4dads intervention was designed to support fathers with helpful and encouraging text messages, links to relevant web resources, mood monitoring and...

Background: limited efforts have been made to understand the complex relationships between women's experiences of birth and the influence of the design and environment of a birth space. Domestic aesthetics in a birth space are believed to be an important aspect of optimal birth unit design. Aim: to explore the concept of domesticity within the b...

Background: Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century. The World Health Organization launched a global health promotion strategy to help create a 'breastfeeding culture'. Research on the programme has revealed multiple barriers since implementation. Aim: To a...

Unlabelled: Feasibility randomised controlled trials of complementary medicine are important to evaluate acceptability and practicality. This study examined participants' and health professionals' perceptions of CAM and participation in a feasibility RCT of acupressure for labour onset. Methods: A qualitative study incorporated within an RCT. Da...

Problem: One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. Background: Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section...

Objective: To explore inhibiting and facilitating design factors influencing childbirth supporters’ experiences. Background: Birthing women benefit from the continuous, cooperative presence of supporters. However, little research has investigated how birth room design facilitates or inhibits supporters’ role navigation. Methods: We conducted an e...

Objective: this Australian feasibility study aimed to determine; the willingness of women experiencing a post-date pregnancy to participate in a randomised controlled trial (RCT) of acupressure and compliance with the study protocol. The study also aimed to determine the effect size of the primary outcome in order to calculate a sample size for a...

Objective: the aim of this study is to advance knowledge about the working and living conditions of midwives in caseload midwifery and how this model of care is embedded in a standard maternity unit. This led to two research questions: 1) What constitutes caseload midwifery from the perspectives of the midwives? 2) How do midwives experience worki...

Objective: this study examined images of birth rooms in developed countries to analyse the messages and visual discourse being communicated through images. Design: a small qualitative study using Kress and van Leeuwen's (2006) social semiotic theoretical framework for image analysis, a form of discourse analysis. Setting/participants: forty im...

Aim: To explore the use and application of case study research in midwifery. Background: Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified. Design: A methodological review of midwifery case study research...

Background: Caseload midwifery is expanding in Denmark. There is a need for elaborating in-depth, how caseload midwifery influences the partner and the woman during childbirth and how this model of care influences the early phases of labour. Aim: To follow, explore and elaborate women's and their partner's experiences of caseload midwifery. Met...

Introducion: In the developed world, 97-99% of women give birth in a hospital labour room. Burgeoning research has shown the highly technological birth environment is associated with increasing rates of medical intervention and caesarean section births. Few studies have examined the objects of the hospital birth space (furniture, medical equipment,...

Background: Fetal monitoring guidelines recommend intermittent auscultation for the monitoring of fetal wellbeing during labour for low-risk women. However, these guidelines are not being translated into practice and low-risk women birthing in institutional maternity units are increasingly exposed to continuous cardiotocographic monitoring, both o...

Background: There is a growing body of evidence to show that the birth environment can influence women's experiences of labour and birth as well as midwifery practice. A common feature of the modern birth space is the bed. Knowledge about how the use of the bed shapes clinicians' perceptions and attitudes is limited. Aim: The aim of this paper i...

Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers. This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits. The Birth Unit Design project was...

In N. Fernando & G. Allen Barker (Eds.), Proceedings of the 46th Annual Conference of the Environmental Design Research Association. The 46th Annual Conference of the Environmental Design Research Association: BrainSTORM: Dynamic Interactions of Environment-Behavior and Neuroscience, Los Angeles, CA, (p. 249). Madison, WI: The Environmental Design...

There is worldwide concern with increasing rates of pharmacologically induced labour and operative birth. Many women would like to avoid medical or surgical interventions in childbirth; a desire that may contribute towards the popularity of complementary and alternative medicine/therapies. This systematic review examines the effects of acupressure...

Background Women at low risk of pregnancy complications benefi t from continuity of midwifery care, but no trial evidence exists for women with identifi ed risk factors. We aimed to assess the clinical and cost outcomes of caseload midwifery care for women irrespective of risk factors.

Objective To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia. Design Prospective cohort study. Participants 494 women who intended to give birth at freestanding midwifery units and 3157 wo...

Objective: To explore the relationship between the birth environment and the practice of midwifery using the theoretical approach of critical realism. Background: The practice of midwifery has significant influence on the experiences and health outcomes of childbearing women. In the developed world most midwifery takes place in hospitals. The de...

Background The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labou...

Background The Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Healt...

Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one s...

IntroductionThe prevalence of obesity in Australia among women of childbearing age has doubled over the past 2 decades. Obesity is associated with complications for women and their newborns during pregnancy and birth. Limiting gestational weight gain can reduce perinatal complications and postnatal weight retention, but evidence supporting interven...

Little is known about how the physical design of a birthing unit can influence the experiences of labour and birth for women, their supporters and midwives. We proposed that an interdisciplinary approach (disciplines of midwifery, architecture, design, communication and public health) was likely to be the most effective way to better understand the...

The emotional and hormonal pathways of labour and birth: integrating mind, body and behaviour ABSTRACT Background: Women have described normal labour and birth in terms of their emotions. Major advances in knowledge have occurred within the sciences resulting in an understanding of emotions as prime directors of human behaviour which is orchestrate...

Research indicates that midwives and their practice are influenced by space and place and that midwives practice differently in different places. It is possible that one mechanism through which space and place influence midwifery practice is via neurobiological responses such as the production and release of oxytocin, which can be triggered by expe...