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Midwives, Mothers and Good Oral Health Care

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Written by Kirsty Andermahr

Education Officer, ACM Education Unit

When I first started at the ACM, Ruth ran me through all the exciting e-learning courses that we had on our roadmap for development: Antenatal Refresher, Labour & Birth Refresher, Postnatal Refresher, Domestic Violence, the list goes on. For the most part, I could understand how each of these courses and topics related to midwifery and why they would be fundamental CPD opportunities for midwives. But, when she said “Midwifery Initiated Oral Health Program”, I stopped in my tracks. Wait, what? Did she just say oral health?

  1. That is an incredibly long title… I’ll just fondly call it ‘the teeth course’.
  2. What does a midwife have to do with teeth? Isn’t that what dentists are for?

Fast forward 18 months, I can confidently tell you that this topic does, in fact, directly relate to midwives. I can also tell you that I have learnt that midwives play a crucial role in reducing the side effects of poor oral health in women across the world, as well as children.  Having said that, I don’t want it to take you over 2,000 hours of course development and research to discover these facts. Instead, I’ve teamed up with my friends at Western Sydney University and Dental Health Services Victoria to provide you with our top 5 reasons that the Midwifery Initiated Oral Health Program can make a difference…

Poor oral health during pregnancy can have a significant impact on the health of the mother and the child.

Have you ever heard of periodontal disease? Well, in case you haven’t it is worth noting that it has been linked with cardiovascular disease, stroke and diabetes. It has also been associated with preterm birth and low birth weight.

Now, let me ask you this… Have you cared for a woman with one or more of the following?

  • Oestrogen level changes
  • Stress
  • Obesity
  • Poor dietary habits
  • High sugar intake

You’re probably thinking that this is a trick question, because what pregnant woman’s oestrogen levels haven’t changed. Well, risk factors for periodontal disease include each of the points listed above. That means that just being pregnant can increase a woman’s risk.

To add to this disease, high levels of cariogenic bacteria in mothers can lead to increased dental caries in the infant. What are dental caries, you ask? Come on, if I gave everything away there would be no need for you to complete the course.

The point that we are trying to make is that ‘pregnant women are prone to poor oral health, yet only a third of women access dental services in Australia.’  This is a statistic that midwives have the power to help shift in the other direction.

Although there is still debate on the effectiveness of dental treatment in improving pregnancy outcomes, the general consensus is that dental treatment is safe and all pregnant women should receive a dental check early in their pregnancy.

A two minute, non-invasive screening assessment could save a baby’s life.

If you’re worried that screening for poor oral health means sinking your fingers into someone’s mouth, or adding half an hour onto your antenatal visits, then the message from past users is that this is not actually the case.

“It’s not like a big assessment. It takes two minutes to touch on something that could ultimately affect their baby’s birth weight, their baby’s pre-maturity, and their child’s teeth.”

Screening women for poor oral health works similarly to many other antenatal assessments that you already complete, such as the AUDIT-C (an assessment tool for alcohol consumption during pregnancy).  The dental assessment involves reviewing the woman’s medical history, observing her during antenatal visits, and asking a series of simple questions, starting with:

  1. Do you have bleeding gums, swellings, sensitive teeth, loose teeth, holes in your teeth, broken teeth, toothache, or any other problems in your mouth?
  2. Have you seen a Dentist in the last twelve months?

The Midwifery Initiated Oral Health course contains easy to use checklists, pamphlets and referral templates to assist midwives with confidently answering a woman’s questions relating to poor oral health, as well as where and how they can seek further help/assistance.

To ensure that you’re not left in the lurch, we also walk you through a number of case studies, which assist you to practice the Seven Steps to Dental Care before applying them in the real world.

Oral health awareness building, from midwives, has been a contributing factor to the uptake of dental services.

Since MIOH began in Victoria in 2012, there has been an increase in pregnant women accessing public dental services in Victoria. This supports the findings of a randomised control trial conducted by Western Sydney University that strongly suggests that oral health awareness building from the midwives was a contributing factor to the uptake of dental services (George, A., Dahlen, H., Blinkhorn, A., Ajwani, S et al 2018).

   

Pictured above: First midwives to trial MIOH in Victoria with Dr Ajesh George and Dr Carole Gilmour former ACM Vic Branch member.

Undertaking an oral health assessment during pregnancy provides the opportunity to raise women’s awareness of the need to consider their own oral health not only for their own well-being, but that of their baby.

Midwives across Australia are already finding this course instrumental to their practice.

“As midwives, we are already familiar with the impact of oestrogen and progesterone during pregnancy so it makes sense that we also consider the affects that these hormones can have on a woman’s teeth and mouth.”  - Ann Kinnear

The Midwifery Initiated Oral Health Program has been making waves amongst our community since 2008. ACM are just making the content widely available by transferring it into an accessible e-learning course. 638 midwives participated in the first MIOH trial across antenatal and oral health care services, and a further 250 Victorian-based midwives in antenatal care or midwifery education roles have been trained in MIOH.

Many of these midwives have commented that the course has been ‘important to pregnant women and their families’ and ‘valuable to their practice’.

Another user stated:

“This course has improved my knowledge about oral health in pregnancy, vastly. It was comprehensive, easily understood and is hugely important to pregnant women and their families. I immediately used this information when I booked women in to our clinic.”

But, in case you’re reading this and thinking we’re tooting our own horn, take a minute to hear about this course directly from past participants…


 

You could be eligible for sponsorship.

 

Yes, you read that correctly!

“Dental Health Services Victoria will continue to sponsor eligible Victoria midwives to undertake MIOH on the ACM E-Learning portal.” – Gillian Lang, Dental Health Services Victoria

If you’re a midwife based in Victoria, you could accrue up to 16 CPD hours, and gain valuable skills, without having to make the purchase personally. Check if you’re eligible using the DHSV checklist. 

In case you don’t meet these requirements, the good news is that this course is only $176.00 and we email you a receipt so you can add this training to your tax reimbursement claim.

We truly hope that midwives find this course to be as informative and resourceful as we have. Sink your teeth into it from the 7th of August 2018, by purchasing access at www.midwives.org.au/shop/midwifery-initiated-oral-health.

Writer's note: I’ve learnt to call this program by its correct title, Midwifery Initiated Oral Health, but ‘the teeth course’ still pops up from time to time. After all, it does have a good ring to it!


On behalf of the ACM, I would like to thank the exceptional organisations that developed this program and entrusted it into our hands:

Western Sydney University (special mention to Associate Professor Ajesh George),

Centre for Oral Health Outcomes & Research Translation,

Centre for Applied Nursing Research,

Sydney & South Western Sydney Local Health Districts,

Sydney Dental Hospital,

Ingham Institute, and

Dental Health Services Victoria.