Skip to content

Research Programs

Centre for Applied Nursing Research, University of Western Sydney

Development of a Midwifery-Initiated Oral Health (MIOH) Service for Pregnant Women in South Western Sydney

Brief Description

It is becoming increasingly evident that poor oral health during pregnancy could have a significant impact on the health of the mother and the child. Poor maternal oral health may contribute to adverse pregnancy outcomes such as preterm low birth-weight babies and increase the chances of infants developing early childhood caries. Unfortunately, due to various reasons, women often do not access dental care during pregnancy. In Australia, the situation is more challenging for these women due to the lack of universal access to dental services. These constraints highlight the importance of having preventative oral health services involving screening, education and referral during the prenatal period. Midwives are in an excellent position to offer such preventative services. Unfortunately the role of midwives in maintaining the oral health of mothers during pregnancy has not been clearly defined in Australia.


The aim of this study is to develop an oral health service program that midwives can utilise to maintain the oral health of pregnant women in Southwest Sydney. This service will incorporate oral health guidelines into normal midwifery practice and provide appropriate care pathways where pregnant women can be referred to for prompt dental treatment.


The Centre for Applied Nursing Research (CANR), Liverpool Hospital (South Western Sydney Local Health District/University of Western Sydney), is working collaboratively with a team of researchers, dentists, clinical midwives, midwifery educators, academics and an epidemiologist to develop the new oral health service program.  The program is being developed over the following 6 phases

  1. Systematic review and development of program guidelines
  2. Perceptions of the proposed service from midwives and pregnant women
  3. Designing of the service and education program for midwives
  4. Education, training and assessment of midwives
  5. Piloting of the oral health service program
  6. Multicentre trial of the oral health service program


The first 4 phases of the program have been completed and have resulted in the following series of activities:

  • Development of an prenatal oral health brochure for pregnant women that has been endorsed by COHS and distributed across the state ( The pregnancy brochure has been well received with more than 5000 copies being distributed across the state in the last 1 year
  • Telephone interviews with 10 pregnant women from Southwest Sydney. The main findings from the interviews are as follows:
    • 6 out of the 10 pregnant women interviewed had oral health problems
    • None of the women had regular dental care
    • Barriers faced by pregnant women in maintaining oral health: lack of awareness, safety concerns, cost of treatment & access.
    • All pregnant women receptive to midwives providing oral health education, assessment and referrals.
  • A focus group with 15 midwives from Southwest Sydney. The main findings  from the focus group are as follows:
    • 1 in every 4 pregnant women seen by midwives have poor oral health
    • Lack of oral health awarenes (midwives)
    • Most midwives receptive to providing oral health education, assessment and referrals during antenatal check-ups.
    • Barriers for engaging in the proposed service: educational requirements, referral pathways, long waiting lists to access public dental services
  • Surveys of 241 pregnant women attending antenatal clinics in Southwest Sydney The main findings  from the surveys are as follows:
    • More than 50% (n=130) of the pregnant women had dental problems
    • Less than 30% (n=70) had seen a dentist in the last 6 months.
    • Less than 10% (n=23) received information about oral health & pregnancy
    • Pregnant women [92.5% (n=220)] were very receptive to midwives providing oral health education, assessment and referrals. 
  • Development of an on-line oral health education program for midwives consisting of pre-reading material, video and photographs of the assessment process and knowledge testing. ( The education program has been endorsed by the Australian College of Midwives and offers 16 Continuing Professional Development points to all midwives across Australia.
  • The education program was pilot tested at a large hospital in Southwestern Sydney (Campbelltown Hospital). Pilot results indicate that the program was well received by midwives with most achieving high competency (>80%) in the assessment examinations. Midwives showed an improvement in knowledge and are now more confident in promoting perinatal oral health.
  • The MIOH program is currently being piloted through a randomised control trial at Campbelltown Hospital.  After the pilot study, the MIOH service will be tested more extensively through a multicentre trial across Sydney in 2012.

Reports or Publications from Project

1. George, A. (2011- in press) "Response to 'Treatment of periodontal infection does not reduce the rates of poor pregnancy outcomes'". International Journal of Evidence-Based Healthcare.

2. George, A., Duff, M., Ajwani, S., Johnson, M., Dahlen, H., Blinkhorn, A., Ellis S. & Bhole, S.  (2011, in-press) The development of an online education program for midwives in Australia to improve perinatal oral health. Journal of Perinatal Education

3. George, A., Johnson, M., Duff, M., Ajwani, S., Bhole, S., Blinkhorn, A., & Ellis, S. (2011) Midwives and oral health care during pregnancy: Perceptions of pregnant women in South-Western Sydney, Australia.  Journal of Clinical Nursing. DOI: 10.1111/j.1365-2702.2011.03870.x

4. George, A., Shamin, S., Johnson, M., Ajwani, S., Bhole, S., Blinkhorn, A., Ellis S. & Andrews, K. (2011). Periodontal treatment during pregnancy and birth outcomes: A meta-analysis of randomised trials. International Journal of Evidence-Based Healthcare, 9, 122-147.

5. George, A., Johnson, M., Blinkhorn, A., Ellis, S., Bhole, S. & Ajwani, S. (2010) Promoting oral health during pregnancy: Current evidence and implications for Australian midwives. Journal of Clinical Nursing. 19, 3324-3333.

6. George, A., Johnson, M., Duff, M., Blinkhorn, A., Ajwani, S., Bhole, S. & Ellis, S. (2011) Maintaining oral health during pregnancy: Perceptions of midwives in Southwest Sydney. Collegian. 18, 71-79.

7. George, A. & Johnson, M. Ellis, S. Dahlen, H., Blinkhorn, A., Bhole, S. & Ajwani, S. (2010) Promoting dental health in pregnant women: A new role for midwives in Australia. Australian Nursing Journal, 18(1), 37." "Centre for Applied Nursing Research (CANR)

Involved Organisations

University of Western SydneyLink to external website

South Western Sydney Local health District (SWSLHD)

Sydney & South Western Sydney Local Health District Oral Health Services and Sydney Dental Hospital

Australian College of Midwives

The NSW Centre for Oral Health Strategy (funding body)

The Australian Dental Association (NSW) (funding body)

The National Health and Medical Research Council (funding body for multicentre trial-commencing 2012)

Contact Person for Further Information

Dr Ajesh George
Senior Research Fellow, CANR
Tel: 02 96120672


return to top
Oral Health Promotion Clearinghouse Unit

Adelaide Dental School 
Level 9, Adelaide Health and Medical Sciences building 
The University of Adelaide


T: +61 8 8313 3291