Elsevier

Women and Birth

Volume 29, Issue 3, June 2016, Pages 208-213
Women and Birth

ORIGINAL RESEARCH – QUANTITATIVE
The evaluation of an oral health education program for midwives in Australia

https://doi.org/10.1016/j.wombi.2015.10.004Get rights and content

Abstract

Background

Antenatal care providers are now recommended to promote oral health during pregnancy and provide dental referrals. However, midwives in Australia are not trained to undertake this role. To address this shortcoming, an online evidence based midwifery initiated oral health (MIOH) education program was systematically developed as a professional development activity.

Aim

This study aimed to evaluate the effectiveness of the program in improving the oral health knowledge of midwives and assess their confidence to promote maternal oral health post training.

Methods

The program was evaluated using a pre–post test design involving 50 midwives purposively recruited from two states in Australia. The pre–post questionnaire contained 24 knowledge items previously pilot tested as well as items exploring confidence in promoting oral health and perceptions of the program.

Findings

The results showed a significant improvement in the oral health knowledge (↑21.5%, p < 0.001) of midwives after completion of the program. The greatest improvement in knowledge occurred in key areas vital in promoting maternal oral health namely the high prevalence of dental problems and its impact on birth and infant outcomes. The majority also reported being confident in introducing oral health into antenatal care (82%) and referring women to dental services (77.6%) after undertaking the education program.

Conclusion

The MIOH education program is a useful resource to equip midwives with the necessary knowledge and skills to promote oral health during pregnancy. The program is accessible and acceptable to midwives and can potentially be transferable to other antenatal care providers.

Introduction

In recent year's considerable emphasis has been placed on oral health promotion during pregnancy and its potential benefits to maternal, infant and pregnancy outcomes.1, 2, 3 Although there is still debate surrounding the efficacy of periodontal treatment in reducing low birth weight and preterm birth4 the consensus is that dental treatment is safe and all pregnant women should receive a dental check early in their pregnancy.5 Good maternal oral health can protect a woman's general health and quality of life, plus it will minimise the risk of their infants developing early dental caries through reduced transmission of maternal cariogenic bacteria.6, 7

There has also been considerable discussion about the role of antenatal care providers in promoting maternal oral health.8, 9, 10 The close relationship between antenatal care providers and pregnant women provides a unique opportunity to motivate and change women's oral health practices. As such it is now recommended internationally5, 11, 12 that all antenatal care providers offer oral health education, assessment and referrals to women early in their pregnancy.

Similar policy directions are emerging in Australia. Although in the past there has been limited focus on maternal oral health in Australia2 recently new antenatal care guidelines have been developed that advocate all health professionals promote oral health and provide dental referrals for pregnant women.13 Midwives are the main providers of antenatal care for Australian women and are in an excellent position to promote oral health. Unfortunately, midwives in Australia face significant barriers in promoting oral health during pregnancy the most relevant being their lack of knowledge and skills in this area.14 There is also evidence of misconceptions among pregnant women such as believing that poor oral health is a normal and accepted part of pregnancy and that dental treatment can harm the fetus.2 These misconceptions and general lack of oral health awareness have contributed to the low rate of dental service utilisation during pregnancy in Australia with only a third of pregnant women consulting a dentist even if they had a problem.15, 16, 17 To address these issues and adhere to current practice guidelines, an online Midwifery Initiated Oral Health (MIOH) education program was developed to provide midwives with the necessary theoretical and practical knowledge to provide oral health education, screening and referral to pregnant women at their first antenatal appointment.14 To aid in the screening, the program also showed how to undertake a visual inspection of the oral cavity if required – this component was included in the program as earlier research showed that midwives were open to this idea.8 As part of the development process the dental education program along with a screening tool was pilot tested18, 19 and then further refined and subsequently endorsed by the Australian College of Midwives. The aim of this study is to evaluate the effectiveness of the MIOH education program.

The key research questions are:

  • How effective is the MIOH education program in improving the oral health knowledge of midwives?

  • How confident are midwives in promoting maternal oral health after completing the education program?

Section snippets

Methods

A pre–post test design was used to evaluate the MIOH education program.

Demographics

A total of 50 midwives were recruited for the study. The participants from NSW (n = 17) worked in metropolitan hospitals while those from VIC (n = 33) worked across metropolitan (n = 22), regional (n = 5) and rural (n = 6) hospitals and community health services. Table 1 shows that on average the midwives were 44 years old, had 15 years’ experience and the majority had undertaken postgraduate education. There were no statistically significant differences between the NSW and Victorian sample in terms of

Discussion

Oral health education for midwives is only now coming to light within education programs throughout the world.14 Undergraduate nursing courses contain little education on oral health and the content of this educational experience goes well beyond an understanding of a healthy oral cavity.18 Leading professional organisations have noted that currently midwives do not receive any education or training in maternal oral health at the undergraduate level nor is there any relevant information

Conclusion

Oral health promotion during pregnancy is increasingly being recognised as important in Australia as well as internationally. Antenatal care providers, such as midwives require specific oral health knowledge and skills to address this aspect in their practice. This study has shown that the MIOH education program, which is evidence based and systematically developed, is a potential professional development activity that can assist midwives in incorporating oral health promotion into their

Conflict of interest

All authors declare that there are no competing interests in relation to this manuscript.

Acknowledgements

This work was supported by the National Health and Medical Research Council (project grant APP1022007) and the State Government of Victoria for the Dental Health Services Victoria, Health Families Healthy Smiles Initiative. We would like to thank the midwives from NSW (Campbelltown, Fairfield and Nepean Hospitals) and Victoria for participating in this study and completing the Midwifery Initiated Oral Health Education program.

References (32)

  • M. Sanz et al.

    Periodontitis and adverse pregnancy outcomes: consensus report of the joint EFP/AAP workshop on periodontitis and systemic diseases

    J Clin Periodontol

    (2013)
  • National Health Service Health Scotland. Maternal and early years for early years workers: how can i help address oral...
  • Council AHMA

    Clinical practice guidelines: antenatal care – module 1

    (2012)
  • A. George et al.

    The development of an education program for midwives in Australia to improve perinatal oral health

    J Perinat Educ

    (2012)
  • A. George et al.

    Views of pregnant women in South Western Sydney towards dental care and midwives promoting oral health

    Health Promot J Aust

    (2013)
  • M.J.N.C. Keirse et al.

    Women's attitudes to and perceptions of oral health and dental care during pregnancy

    J Perinat Med

    (2010)
  • Cited by (0)

    View full text