BACKGROUND:There is limited understanding of the pain experiences of young nulliparous people undergoing intrauterine device (IUD) insertion without sedation and how this influences the acceptability of the procedure. Although quantitative studies have measured pain intensity during insertion, little research has explored how young people perceive, experience, and contextualise this. We therefore conducted a mixed-methods study to better understand pain experiences and how this affects acceptability. METHODS:Patients aged 16-30 years getting an IUD at a family planning clinic were recruited. They completed pre- and post-insertion surveys to rate anticipated and actual pain associated with the insertion. Interviews were conducted post-insertion to discuss expectations, pain, and acceptability. We used a convergent mixed-methods design with merged integration of qualitative and quantitative data for analysis. RESULTS:Altogether, 30 young people participated. Most used simple oral analgesia and local anaesthetic spray to the cervix. On average, participants rated anticipated pain as 6.63/10 and actual pain as 5.88/10. Despite describing the procedure as very painful, most felt the pain was short-lived and therefore tolerable, and that their analgesia was sufficient. Overall, participants reported the procedure as acceptable. Higher acceptability was significantly associated with feeling that their pain relief was sufficient, that the insertion went as they expected, and that they perceived the benefits of the IUD outweighed the discomfort. CONCLUSIONS:Although the IUD insertion was very painful for young nulliparous patients, it was not the only determinant of insertion acceptability. Findings emphasise the importance of clinicians providing sufficient education and information about IUD insertions to support preparation and manage expectations, in addition to providing effective pain management.

Access to postpartum contraception is critical for the health of the mother and subsequent pregnancies. However, the differential roles and responsibilities of maternity care providers in contraception discussions and provision are often unclear. Our study, part of a larger study on midwifery provision of contraceptive implants, presents the perspectives of hospital-based maternity clinicians. Participants suggested that contraception discussions and provision are a shared responsibility of maternity care providers but identified inconsistencies and issues with current approaches. Access to contraception could be improved through more routine discussions antenatally and postnatally and greater collaboration between maternity care providers in hospital, community and primary care settings.

Discussing contraception is considered part of midwives’ scope of practice in Australia, yet most midwives receive minimal training in conducting these discussions. There is a lack of guidance available in Australia on how and when midwives should discuss contraception with women, and little is known regarding midwives’ experiences. As part of a larger study of midwife-led provision of contraceptive implants, we conducted semi-structured interviews with 13 hospital-based midwives and discussed their experiences of providing contraception information. Midwives perceived that most women found discussing contraception with a midwife to be highly acceptable, including those from cultural or religious backgrounds that may be stereotyped as being uninterested in contraception. Despite this, several midwives stated that due to the busy clinical environment, they tended to prioritise speaking to women they viewed to be most interested in postpartum contraception, including those of high parity, who had an unintended pregnancy, or were experiencing financial disadvantage or psychosocial stressors. Midwives’ approaches to initiating contraception discussions varied widely. Most favoured introducing contraception into wider conversations about pregnancy spacing and women’s plans for the future, in order to establish rapport and provide context to the discussion. Midwives felt that more than one conversation was necessary to allow women to consider the information before making a decision. Our findings suggest that most women are open to discussing contraception with a midwife, and that midwives are able to use different strategies to integrate these conversations into their practice. However, many women may still miss out on contraceptive information due to time pressures faced by midwives and cultural stereotypes that inform which women they prioritise for these discussions. National guidelines are needed that incorporate provision of contraception information as part of core midwifery practice, as well as provision of training and strategies to initiate and tailor contraception discussions to meet women’s individual needs.

Many pregnancies in the first year after a birth are not intended. Access to postpartum contraception is critical for the health of the mother and subsequent pregnancies. In many maternity settings in Australia, the roles and responsibilities of maternity care providers (including midwives, obstetricians and general practitioners) in providing postpartum contraception information and services is not always clear, and there is no consistent system or process to ensure timely access. We undertook an analysis of interview data conducted with hospital-based maternity clinicians as part of a larger study on midwifery provision of contraceptive implants in New South Wales, Australia, to document their views regarding access to postpartum contraception and clinician responsibilities. Interviews were conducted with maternity hospital clinicians (midwives, doctors, midwifery managers and clinical midwifery specialists) in two hospitals. Reflexive thematic analysis was used for the analysis of interview data. Themes relating to postpartum contraception access, timing of contraceptive discussions and the role of clinicians were identified. Interviews were conducted with 21 hospital-based maternity clinicians. Participants suggested contraception discussions and provision are a shared responsibility by maternity care providers but identified inconsistencies and issues with current approaches. Ensuring postpartum contraception was accessible in hospital, primary care and community settings was raised. Postpartum contraception discussions and provision are regarded as a shared responsibility by maternity care providers. This would ideally be led by the primary provider. These services are not routinely available or always easily accessible in Australian maternity care settings, however, and there is a lack of consistency in how postpartum contraception is managed. Access to postpartum contraception could be improved through routine inclusion of contraception discussions during antenatal and postpartum care, and greater collaboration between maternity care providers in hospital, community and primary care settings to support continuity of care through the postpartum period.

BACKGROUND:Repeat pregnancy in the first year after a birth is common. Many of these conceptions are unintended and may be prevented by providing access to contraception in the immediate postpartum period. Midwives in the hospital setting could potentially play a greater role in improving postnatal contraception information and provision.AIM:We sought to implement and examine the success of a program training hospital-based midwives in immediate postpartum implant insertion.METHODS:This mixed methods study in two hospitals in New South Wales sought to explore the feasibility, acceptability and sustainability of a program that provided competency-based implant insertion training for midwives. The study documented training completion, implant insertion numbers and experience, and conducted end of study interviews with midwives and stakeholders.FINDINGS:Twenty-seven midwives undertook training and inserted 265 implants during the study period. Interviews with 13 midwives and 11 stakeholders concluded the program to be feasible and acceptable with midwives reporting high satisfaction from their involvement. All interviewees felt that midwives were well placed to insert implants, and reported that challenges around workload and opportunities for practice were generally manageable. It was recognised that sustainability of the program would require supportive policy and regular insertion opportunities.CONCLUSIONS:Midwives successfully upskilled in implant insertions and there was widespread support for the program with expectations it would be sustained. Provision of contraceptive information and implant insertion by midwives in the immediate postpartum period is likely to increase contraceptive choice and access for women and contribute to reducing rapid repeat pregnancies.

BACKGROUND:Women are susceptible to unintended pregnancies in the first year after giving birth, particularly as consideration of contraception may be a low priority during this time. Discussing and providing contraception before women leave hospital after giving birth may prevent rapid repeat pregnancy and its associated risks. Midwives are well placed to assist with contraceptive decision-making and provision; however, this is not routinely undertaken by midwives in the Australian hospital setting and little is known regarding their views and experiences in relation to contraception. METHODS:An anonymous survey was conducted with midwives at two urban hospitals in New South Wales to better understand their contraceptive knowledge, views and practices regarding midwifery-led contraception provision in the postpartum period. FINDINGS:The survey was completed by 128 midwives. Most agreed that information about contraception provided in the postpartum period is valuable to women, although their knowledge about different methods was variable. The majority (88%) believed that midwives have a role in providing contraceptive information, and 79% reported currently providing contraceptive counselling. However, only 14% had received formal training in this area. CONCLUSION:Findings demonstrate that most midwives provide some contraception information and believe this is an important part of a midwife's role. Yet most have not undertaken formal training in contraception. Additional research is needed to explore the content and quality of midwives' contraception discussions with women. Training midwives in contraceptive counselling would ensure women receive accurate information about available options. Upskilling midwives in contraception provision may increase postpartum uptake and reduce rapid repeat pregnancies.

Background: The contraceptive implant is a long-acting, effective method of contraception. Low uptake in Australia may be partially due to limited clinicians trained in implant procedures. Internationally, nurse-led implant procedures are accepted practice; however, this is not common in Australia. Aim: An evaluation was undertaken to determine the effectiveness of implant training for nurses and consider the implications for clinical service delivery. Methods: Participating nurses (n = 5) completed pre- and post-training surveys, and three were subsequently interviewed. Supervising doctors and nurses (n = 5) were also interviewed. A file audit was conducted to review implant procedures undertaken post-training. Findings: Nurses undertook implant training to acquire new skills and meet patient demand. After the training, all nurses self-reported feeling 'very confident' in inserting the implant and at least 'a little confident' in removing the implant; the latter had minimal impact on removal success, as indicated in the file audit. Overall, nurses and supervising doctors and nurses felt that nurses could play a greater role in the provision of contraceptive implant procedures in Australia. Discussion: Nurse-led procedures would increase access to the contraceptive implant for women, and have a positive impact on service delivery in different healthcare settings; however, funding constraints for nurses remain a significant barrier. Conclusion: Nurses are well placed to undertake contraceptive implant procedures. This would increase access to this method of contraception for women. These findings may inform models of care that promote nurse-led contraceptive procedures in Australia. (C) 2020 Australian College of Nursing Ltd. Published by Elsevier Ltd.

One of the great challenges facing humankind in the 21st century is preserving healthy brain function in our aging population. Individuals over 60 are the fastest growing age group in the world, and by 2050, it is estimated that the number of people over the age of 60 will triple. The typical aging process involves cognitive decline related to brain atrophy, especially in frontal brain areas and regions that subserve declarative memory, loss of synaptic connections, and the emergence of neuropathological symptoms associated with dementia. The disease-state of this age-related cognitive decline is Alzheimer’s disease and other dementias, which may cause older adults to lose their independence and rely on others to live safely, burdening family members and health care systems in the process. However, there are two lines of research that offer hope to those seeking to promote healthy cognitive aging. First, it has been observed that lifestyle variables such as cognitive leisure activities can moderate the risk of Alzheimer’s disease, which has led to the development of plasticity-based interventions for older adults designed to protect against the adverse effects of cognitive decline. Second, there is evidence that lifelong bilingualism acts as a safeguard in preserving healthy brain function, possibly delaying the incidence of dementia by several years. In previous work, we have suggested that foreign language learning programs aimed at older populations are an optimal solution for building cognitive reserve because language learning engages an extensive brain network that is known to overlap with the regions negatively affected by the aging process. Here, we will outline potential future lines of research that may uncover the mechanism responsible for the emergence of language learning related brain advantages, such as language typology, bi- vs. multi-lingualism, age of acquisition, and the elements that are likely to result in the largest gains.