Written By
Rachelle McCabe
College/Division
College of Healthcare Sciences
Publish Date
2 September 2022
Related Study Areas
Doing better for women, birth and beyond
JCU Professor Cate Nagle has spent her long and impressive career focused on pregnant women and improving health outcomes for mothers and babies.
Midwifery, particularly prenatal care, is a complex area of study with many facets, and Professor Nagle has been on the frontline. She’s an experienced nurse and midwife and is currently a Professor of Nursing and Midwifery at James Cook University and the Townsville Hospital and Health Service.
A desire to do better for pregnant women, particularly those identified as being at risk of having a baby with a fetal abnormality, inspired the academic to team up with other health experts to create the YourChoice app, which will soon be available Australia-wide. The app aims to make decision making easier for pregnant women by providing information about pregnancy and birth.
Developing this app has been a literal labour of love for Professor Nagle. She first created the decision-making aid as a printed document as part of her PhD project over a decade ago. She has been involved in refining and evolving it ever since, with the latest version of the app a joint initiative between Murdoch Children’s Research Institute and James Cook University.
A drive to improve women's education and care
As Professor Nagle explains, a pregnant woman is offered a series of scans and tests early in pregnancy. Medical experts supervising and providing these screening tests are checking for fetal abnormalities at this time, but the pregnant woman may not fully appreciate this and is often unprepared should a potential issue arise.
“A lot of the important decisions that pregnant women need to make about their health care are value-based. This app aims to educate women so that they know what information is relevant to them, and they can make informed decisions about which tests to have.”
“Working clinically, I knew we could do a better job in helping patients’ informed decision making. Particularly helping them understand some really complex screening information at a time when they were very happy with the news of pregnancy.
“You can imagine the shock when a woman goes for a blood test and ultrasound thinking they are going to have a picture of the baby but instead they are confronted with something not quite right on ultrasound, or where the risk of an abnormality has been picked up.”
Having an app that women can easily access early in their pregnancy for education will help prepare them for unexpected moments in the doctor’s office. Of course, the app is not a stand-alone tool but can be used to access correct information.
“It needs to be adjuvant to clinical care,” Professor Nagle says. “It's not meant to take the place of the clinician. But when pregnancy visits with your GP or your obstetrician are so quick, it doesn't always allow in-depth discussion, even though screening information is generally quite complex.
“It is meant to allow the woman and her partner to read as much information as they need. Some women just want the summary version. The app provides the summary as well as extra information and resources so every woman can find what she’s looking for.” Professor Nagle says.
Professor Nagle worked with a team that included maternal and fetal medicine obstetricians, epidemiologists and genetic counsellors to bring the project to fruition.
“It's really exciting. Oftentimes, you might have an idea for research but there may not be funding or resources to disseminate it. So, this is a ‘good news’ story in that so many people were involved to develop the app.”
Women's health in the region: a work in progress
As for how our health system supports women in the local area and beyond? Professor Nagle says that although the Australian health system looks after women well overall, there are significant areas that need attention, such as improving health outcomes for Aboriginal and Torres Strait Islander women.
“These areas include the health outcomes of Aboriginal and Torres Strait Islander women, preventable lifestyle diseases such as smoking and obesity, domestic violence and sexual assault, and supporting people with mental health issues or chronic diseases. And I’d say another area that gets a bit lost is the care of older women as well.”
A further research focus for Professor Nagle is the rate of induction of labour and caesarean section delivery, the latter of which Professor Nagle indicates currently sits at about 35 per cent of all births in Townsville.
“Caesarean section is a really valuable operation — lifesaving for mothers and babies when it's done for clinically based reasons,” she says. “But when it's not, there's the risk of the surgery, the risk of the anaesthetic, and then the risks related to clotting and sepsis that can come after that."
Patients will also have a scar on the uterus after a caesarean, so there is increased risk next pregnancy. “I think there's a lot of room for education, and also for promotion of models of care that give better outcomes," Professor Nagle says.
Midwifery Model — A Townsville University Hospital success story
One such model of care that Professor Nagle has seen rolled out with huge success is the midwifery-led model currently being offered at the Townsville University Hospital.
This model has seen improvements in pre-term birth rates, a reduction in pregnancy loss, an increase in breastfed babies at six weeks and six months, improved culturally responsive care for Aboriginal and Torres Strait Islander women and greater satisfaction for women overall.
“Here in Townsville, we now have a quarter of the women using this model, so a quarter of our women have continuity of care, and there are plans to increase that to 50 per cent, so that's really great,” Professor Nagle says.
“Basically, a woman books in with a midwife and has care by that midwife for the duration of her pregnancy and postnatal care. This method eliminates the issue of reinventing yourself at every visit with a different doctor or midwife because they’re going off the previous visit’s notes, which may not have captured the full picture of your pregnancy. There's a real relationship of trust; a partnership. And they are understood as a person rather than as a pregnant person.”
A time to reflect, celebrate and push for progress
Professor Nagle says she welcomes any opportunity to spotlight women and their health.
“It is a chance to meaningfully highlight where the gaps are as well as the successes that we've had. And I think your local successes are important to celebrate,” she says.
She values her role, where she works across JCU and the Townsville Hospital and Health Service. “I do think that positions like mine, that do everything they can to build the links between the hospital and the university, are ideal.
“My research feeds into the midwifery students’ education and I also have all these clever clinicians, midwives and nurses walking through my door to trade ideas. We build up the research capabilities of our students and then they can enrol in JCU’s higher research degrees and benefit the entire region.
“I think JCU, with its tropical setting, performs at a very high level in a lot of areas and there are great collaborations between different disciplines as well. Queensland is such a big state and the whole issue of distance can’t be underestimated. Using technology well — such as apps that assist the healthcare system — certainly helps us address provide the best care we can.”