Antenatal asthma management by midwives in Australia: self-reported knowledge, confidence and guideline use

Background: Asthma affects approximately 12.7% of pregnant women in Australia. Increased maternal and infant morbidity is closely associated with poorly controlled asthma during pregnancy. Midwives are well placed to provide antenatal asthma management but data on current asthma management during pregnancy is not available, nor is the use of guidelines for clinical practice by this health professional group.
Aim: To explore self-reported antenatal asthma management provided by midwives across Australia and how this reflects guideline recommendations.
Method: An online survey was developed and distributed throughout Australia via the Australian College of Midwives, social media and healthcare facilities.
Results: Responses from 371 midwives were obtained. Ten percent of midwives rated their knowledge as ‘good’ and 1% as ‘very good’, with 39% ‘poor’ or ‘very poor’. Being ‘somewhat’ or ‘not at all’ confident to provide antenatal asthma management was noted by 87% of midwives. Clinical guidelines were referred to by 50% of midwives and 40% stated that their main role was to refer women to other healthcare professionals. Only 54% reported that a clear referral pathway existed. Most respondents (>90%) recognised key recommendations for asthma management such as smoking cessation, appropriate vaccinations, and the continuation of prescribed asthma medications.
Conclusion: Although midwives appear aware of key clinical recommendations for optimal antenatal asthma management, low referral to clinical practice guidelines and lack of knowledge and confidence was evident. Further research is required to determine what care pregnant women with asthma are actually receiving and identify strategies to improve antenatal asthma management by midwives.