Midwives' Role in Preconception Care

Preconception Care (PCC) and interconception care (ICC) are important types of healthcare that focus on women's Health before and between pregnancies. These care strategies aim to improve the health of women and their future children by promoting healthy behaviors, managing existing health conditions, and providing valuable health Education. Every woman deserves access to healthcare that supports her well-being, including preconception care, which can help reduce social issues such as gender-based violence and economic inequality in society.

#The Importance of PCC and ICC

PCC and ICC play a crucial role in ensuring that women achieve better health outcomes during their reproductive years. Research demonstrates that good health before pregnancy is linked to fewer complications during pregnancy. For example, women who are physically active before becoming pregnant have a lower risk of developing conditions like preeclampsia. Moreover, following a healthy diet, such as a Mediterranean-style diet, in the three years prior to pregnancy can reduce the chances of developing gestational diabetes.

The time before pregnancy and between pregnancies is also vital for addressing health issues that could lead to long-term problems. Conditions like polycystic ovary syndrome can increase the risk of heart disease later in life. Women with a history of gestational diabetes are also at a higher risk for developing type 2 diabetes after giving birth. Additionally, some groups, such as First Nations women and those facing social disadvantages, are more likely to develop gestational diabetes, which in turn increases their risk for type 2 diabetes shortly after childbirth.

There is growing evidence that preconception health can impact the health of future infants and children. Initiatives like the First 1000 Days and First 2000 Days emphasize how crucial the health of parents is during and after pregnancy for children's development. Accessible preconception care should be a priority for everyone of reproductive age.

#Role of Midwives in Providing PCC and ICC

Midwives have a significant opportunity to provide preconception and interconception care. They have the skills and knowledge to offer a wide range of sexual and reproductive health services. However, in Australia, many midwives focus mainly on providing care during pregnancy and shortly after childbirth. By enabling midwives to expand their role into preconception care, the health of women, infants, and communities can improve significantly.

Recent research in Australia has looked at how primary health care nurses can provide PCC, but not much has focused on midwives' roles in this area. A 2006 study in the Netherlands indicated that midwives often miss out on supporting women before pregnancy due to how antenatal care is structured. More recent research suggests that midwives want to be involved in providing sexual and reproductive health care, but they feel they need additional training, especially in preconception care.

#Goals of This Research

This research aims to explore midwives' knowledge, attitudes, learning needs, and the challenges they face when delivering preconception care. Gathering this information is essential for helping midwives provide better care and support for women throughout their reproductive years, which may also be applicable in other countries.

#Research Methodology

To gather valuable data, a cross-sectional study design was used. This method allows researchers to collect information at one point in time, making it suitable for exploring midwives' knowledge and attitudes concerning preconception care. Ethical approval for the study was obtained, and all participants gave their consent to take part in the survey.

#Study Context

There are over 26,000 midwives working in Australia, with the majority serving in clinical roles. Most of these midwives work in public hospitals and assist women during pregnancy and postnatal care. To practice fully, midwives typically must complete specific education programs, and some can even prescribe medication and order tests after further study.

#Survey Design and Implementation

Given that there were no existing tools to assess midwives' knowledge of preconception care, the research team created a new survey. The survey consisted of several sections, including demographic information, knowledge ratings, education preferences, attitudes towards providing preconception care, and barriers to service delivery. There was also a section for open-ended comments.

The survey was distributed through various channels, such as midwifery association newsletters and social media. Data were collected anonymously, and participants could complete the survey at their convenience.

#Data Analysis

The survey results were analyzed in multiple ways, including looking at demographic information and participants' self-rated knowledge of preconception care. Univariate analysis was performed to identify any significant associations with knowledge. Open-ended responses were categorized to understand better the participants' views and experiences.

#Survey Results: Participant Demographics

A total of 355 midwives began the survey, but some exited before completing it, resulting in 338 valid responses for analysis. The majority of participants were female and had extensive experience in midwifery, with many holding nursing qualifications as well. Around half worked in metropolitan areas, while others served in regional and rural locations. Most midwives reported that their highest level of education was a graduate diploma or a master's degree.

#Participants' Knowledge of Preconception and Interconception Care

Most midwives rated their overall knowledge of preconception health for women positively, with a large percentage confidently reporting good to excellent knowledge. However, knowledge regarding preconception health for men was less satisfactory, with many participants acknowledging that they had limited knowledge in this area.

When looking at specific topics related to preconception care, some areas showed more significant gaps in knowledge, such as screening for certain health disorders and management of pre-existing conditions. Many midwives expressed a desire for further education in these areas, particularly in managing pre-existing health conditions and optimizing reproductive health.

#Preferred Education Formats

Midwives indicated a strong preference for various educational formats to improve their knowledge of preconception care. Online courses were the most popular choice, followed by face-to-face training sessions and online webinars. This preference highlights the need for flexible learning options that can fit into busy work schedules.

#Attitudes Toward Providing Preconception Care

The survey revealed that most midwives believe preconception care should be available to everyone of reproductive age. They agreed that providing this care falls within their professional scope and that they often encounter health issues that could be addressed before pregnancy. This shows a positive attitude towards integrating preconception care into their practice.

#Barriers to Providing Preconception Care

Participants identified several barriers that hindered their ability to offer preconception care. A lack of prioritization in funding and service planning was the most frequently cited issue. Other barriers included time constraints, insufficient staffing, and a lack of recognition from other healthcare professionals regarding the importance of preconception care.

Midwives also felt that they often do not see women until they are already pregnant, limiting their ability to provide necessary preconception health support. Many participants expressed a willingness to incorporate regular preconception care into their roles but noted that systemic issues and lack of resources made this challenging.

#Factors Affecting Knowledge of Preconception Care

The survey found that years of experience significantly influenced midwives' knowledge of preconception health for women. Those with more than 11 years of experience were more likely to report above-average or excellent knowledge. However, experience did not have a strong effect on knowledge concerning preconception health for partners.

#Midwives’ Qualitative Insights on Providing Care

Analysis of open-ended responses from midwives highlighted three main themes:

1. Providing Preconception Care: Midwives expressed confidence in their ability to provide preconception care and recognized that their training equips them to offer holistic support to women. Many believe that their professional philosophy and emphasis on supportive relationships make them well-suited for this role.

2. Challenges in Provision: Midwives discussed various challenges they faced in delivering preconception care, including high demands on the workforce, systemic barriers, and issues with funding. They acknowledged that even with a desire to help, the current health care structure often limits their ability to do so effectively.

3. Education Needs: Midwives emphasized the need for more education on preconception care, both during their training and as continuing professional development. Many suggested that preconception topics should be integrated into nursing and midwifery curricula to better prepare future practitioners.

#Conclusion and Recommendations

This research highlights the importance of preconception and interconception care and the role midwives can play in enhancing women's health before and between pregnancies. While many midwives feel prepared to offer this care, significant gaps in knowledge remain, particularly concerning health for male partners.

To address these gaps and improve access to preconception care across Australia, several recommendations emerge:

• Ensure that midwifery education programs incorporate relevant topics related to preconception and interconception care.
• Offer diverse and flexible learning opportunities, such as online courses and workplace training.
• Advocate for systemic changes in healthcare funding and service planning to prioritize preconception care as part of routine health services.
• Encourage midwives to focus on providing care to all individuals of reproductive age, including their partners, to enhance community health outcomes.

By fostering an environment that supports midwives in delivering comprehensive preconception care, we can improve health outcomes for women, children, and communities as a whole.