Promoting oral health in pregnancy. Exploring the needs of lead maternity care midwives
Aims: To identify the educational needs of practising lead maternity care (LMC) midwives to facilitate their provision of evidence-based oral health advice and promotion to their clients during pregnancy. To identify the enablers and barriers LMC midwives face in providing evidence-based oral health advice and promotion to their clients during pregnancy. Additionally, to inform future development of resources to support the provision of evidence-based oral health advice and promotion by LMC midwives to New Zealand women Methods: LMC midwives in New Zealand were invited to participate in a mixed- methods study comprising a web-based survey and semi-structured interviews. Results: One hundred and eleven LMC midwives returned completed surveys, six participated in a semi-structured interview. There was no evidence to suggest the demographic characteristics of our survey sample were significantly different to the New Zealand midwifery workforce. More than three quarters (76.6%, 95% CI 67.6-84.1) provided oral health advice and promotion to clients, despite four fifths (81.1%, 95% CI 72.6-87.4) having no exposure to education regarding oral health in pregnancy. Nearly all (99%, 95% CI 93.8-99.9) LMC midwives believe oral health care is safe during pregnancy, and almost two thirds (65.8%, 95% CI 56.4- 74.1) believe maintaining good oral health is ‘very important’ to pregnancy wellbeing. Eighty percent identified two or more barriers to the provision of oral health advice and promotion. Crucial barriers identified by interviewees include burdening of midwives and women with respect to antenatal information volume, and accessing oral health care in the context of systemic barriers to oral health services in New Zealand. Crucial facilitators include enhancing internal motivation; holistic care; partnership; and driving change from within the midwifery workforce. Four out of five LMC midwives surveyed (81.1%, 95%CI 72.6-87.4) would like more education regarding oral health in pregnancy, with over half (58.6%, 95% CI 49.1-67.4) believing this should be included in undergraduate midwifery training. The belief that good oral health is ‘very important’ to pregnancy wellbeing was associated with a significantly increased likelihood of providing oral health promotion, OR 3.68 (95% CI 1.47-9.16). Midwives with 11 or more years of practising experience were significantly more likely to provide oral health advice and promotion to their clients, OR 6.16 (95% CI 2.31-16.44) than those with less experience. Conclusions: LMC midwives recognised the importance of oral health to pregnancy wellbeing, were receptive to oral health education, and promoting oral health as part of maternity care. LMC midwives require support through evidence- based midwifery-led education; development of culturally appropriate, fit-for- purpose resources; and interprofessional collaboration to address the systemic barriers to oral health services access for New Zealand women during pregnancy.
Advisor: Ting, Graeme; Bradford, Billie; Samaranayaka, Ari
Degree Name: Doctor of Clinical Dentistry
Degree Discipline: Oral Diagnostic and Surgical Sciences
Publisher: University of Otago
Keywords: New Zealand; oral health; dentistry; midwifery; health promotion; maternal oral health; midwifery education; pregnancy
Research Type: Thesis