Showing papers in "Birth-issues in Perinatal Care in 1987"
TL;DR: A review of all postpartum early discharge program outcomes in the United States published between 1960 and 1985 indicates that discharge under 48 hours after delivery has generally been safe for mothers and infants.
Abstract: A review of all postpartum early discharge program outcomes in the United States published between 1960 and 1985 indicates that discharge under 48 hours after delivery has generally been safe for mothers and infants. The levels and types of morbidities did not appear to differ from those experienced with longer hospital stays. Infant readmissions and overall morbidity rates were consistently higher than the number of maternal readmissions and morbidity. The major infant morbidity was hyperbilirubinemia. Differences in identification and treatment of this single problem accounted for much of the variation in infant readmission rates among programs.
Expansion of postpartum early discharge based on these favorable results must proceed with caution. Nearly all reported outcomes were for programs with extensive prenatal preparation and postpartum follow-up, serving relatively advantaged middle-class populations. It is not clear that equally good outcomes would result from less intensive programs or those serving disadvantaged populations. More research is needed on the effectiveness of early discharge procedures, cost savings, and patient satisfaction.
73 citations
TL;DR: Findings are consistent with studies of other settings in which the place of birth was shown to have an impact on childbirth experience, thus demonstrating that birth centers can oversee childbirth as safely and with less intervention than do hospitals.
Abstract: Two retrospectively matched groups of low-risk women were studied, one that chose to give birth in an out-of-hospital birth center staffed and run by nurse-midwives, and another that labored and delivered in a tertiary care teaching hospital. The groups were matched for low risk status at 37 weeks. Although outcomes for both groups were similar, the use of almost all interventions during labor and delivery was significantly more frequent in the hospital group. These findings are consistent with studies of other settings in which the place of birth was shown to have an impact on childbirth experience, thus demonstrating that birth centers can oversee childbirth as safely and with less intervention than do hospitals. Larger comparative studies are needed to explore the impact and safety of hospital and out-of-hospital birth settings.
64 citations
TL;DR: Interviews with 290 healthy pregnant women revealed that of the sample of black, Latino, and white pregnant women, 23 percent had been battered before or during the current pregnancy and 63.8 percent were unaware of resources available for battered women.
Abstract: Battering during pregnancy is a major health problem affecting not only the pregnant woman but the unborn child. Battering frequently begins or escalates during pregnancy or the postpartum period. Interviews with 290 healthy pregnant women revealed that of the sample of black (22.4%), Latino (43.1%), and white (32.1%) pregnant women, 23 percent had been battered before or during the current pregnancy. Of these, 63.8 percent were unaware of resources available for battered women. Of those who were aware, the predominant resource cited was family. Perinatal caregivers can be instrumental in primary, secondary, and tertiary prevention of battering.
60 citations
TL;DR: Differences of as little as 10 percent in the scores of different groups of women on the LADSI represent clinically important differences in levels of satisfaction with labor and delivery.
Abstract: Recognizing the need to assess the caring aspects of childbirth care, we developed a Labor and Delivery Satisfaction Index (LADSI) for use in clinical trials of options for delivery. Thirty-eight items were constructed after extensive consultation with recent mothers and clinicians, and each was worded as a statement for ratings of agreement or disagreement on a six-point scale. Fifty-nine unselected women completed the index two days postpartum, and 35 of them completed it again at four to six weeks postpartum. Analysis of these data showed the LADSI to have stability over time with a correlation of 0.67 between test and retest, face validity to mothers and clinicians, construct validity by showing significantly different satisfaction scores among groups expected a priori to differ significantly, and enough internal consistency to use total scores (average item-total correlations of 0.5), but not enough to use subcomponent scores (Cronbach's alpha = 0.35). On the basis of this study, differences of as little as 10 percent in the scores of different groups of women on the LADSI represent clinically important differences in levels of satisfaction with labor and delivery.
56 citations
TL;DR: Unfulfilled expectations of pain relief were a prominent theme among the 978 responses categorized and implications for clinical practice are discussed.
Abstract: In an interview administered 24 to 72 hours postpartum, 70 women were asked to rate how similar their birth experience was to their expectations and to describe how the event was similar to, or different from, their expectations. Only 27 percent of the subjects described their overall experience as “about like” expected. Unfulfilled expectations of pain relief were a prominent theme among the 978 responses categorized. Implications for clinical practice are discussed.
46 citations
43 citations
TL;DR: To determine those factors that predict the duration of breastfeeding in low income women 47 participants in the Women Infants and Children Program (WIC) who had breastfed an infant were interviewed.
Abstract: From 1971 to 1979 the number of women who breastfed doubled whereas the incidence of long-term breastfeeding (over 6 months) quadrupled. To determine those factors that predict the duration of breastfeeding in low income women 47 participants in the Women Infants and Children Program (WIC) who had breastfed an infant were interviewed. Data were analyzed using descriptive statistics and stepwise multiple regression. A combination of 4 variables--age of the infant in weeks at the time of introduction of solid foods maternal report of perceived success the mothers years of education and age of the infant in weeks at the time of introduction of the formula--explained 52% of the variance in the duration of breastfeeding. The best predictor the age of the infant at the time of introduction of solid foods accounted for 32% of the variance in the duration of breastfeeding. (Authors modified)
37 citations
37 citations
TL;DR: Significant changes occur in the ability to give physical support to women during labor and in who owns the tools and the information they provide, as high-technology procedures and artifacts are more easily transported than are the household artifacts of birth, which are embedded in the matrix of daily life.
Abstract: As the tools of birth change from familiar household objects, such as hammocks and beds, to high-technology objects, such as delivery tables and fetal monitors, significant changes occur in the ability to give physical support to women during labor and in who owns the tools and the information they provide. Data derived from the laboring woman herself are less sought after and less valued.
Ironically, high-technology procedures and artifacts are more easily transported than are the household artifacts of birth, which are embedded in the matrix of daily life. When different levels of technology are available, the solution to a problem during childbirth is usually sought on the next higher level of technology–i.e., medication or surgery, even when a simpler approach, such as human comforting or ambulation, might work more quickly and effectively.
29 citations
TL;DR: Type and prevalence of policies established by large companies to support breastfeeding among their employees and the types of support available in companies contacted because they were known to take an affirmative position are examined.
Abstract: This survey examined types and prevalence of policies established by large companies to support breastfeeding among their employees. Twelve firms with known breastfeeding support programs were surveyed by telephone. In addition, a survey was mailed to 100 of the most profitable Fortune 500 companies; 29 percent responded. All repondents had maternity leave policies including guaranteed return to the same or a similar position; 32 percent had flex time and part-time policies; and less than 5 percent had job sharing or day care available. Only 14 percent of responding companies allowed breastfeeding in the workplace; 5 percent had an electric breast pump and 48 percent had refrigeration facilities on site. Fourteen percent of the respondent companies reported having available health care and educational materials related to parenting. The types of support available in companies contacted because they were known to take an affirmative position are described.
27 citations
TL;DR: In this article, descriptive, correlational, and quasi-experimental research on support and breastfeeding is reviewed to identify what knowledge has been gained over the past decade, and new ideas for more effective professional support are suggested.
Abstract: Support from professionals and members of a social network has been found to be associated with the initial decision to breastfeed and with breastfeeding duration. In this paper, descriptive, correlational, and quasi-experimental research on support and breastfeeding is reviewed to identify what knowledge has been gained over the past decade. New ideas for more effective professional support are suggested.
TL;DR: Comparison of the two cohorts suggests that the operation itself may have contributed to some of the problems and the decision to perform a cesarean section may have to take into account sequelae in a subsequent pregnancy.
Abstract: Two cohorts of healthy Swedish primiparae having a healthy child by cesarean section in 1973 (index women, N = 2592) and in 1976 (N = 3867) and matched vaginal delivery controls were identified from the Swedish Birth Register. The second births to these women occurring in the following five years were studied. The mean lengths of gestation were somewhat shorter and there were more problems during pregnancy, labor, and delivery among those with previous cesarean births (index women). Children born to the index women had a higher perinatal mortality and were smaller and less healthy. Comparison of the two cohorts suggests that the operation itself may have contributed to some of the problems. The decision to perform a cesarean section may have to take into account sequelae in a subsequent pregnancy.
TL;DR: A passenger safety curriculum was developed and implemented for expectant mothers and coaches attending Lamaze childbirth classes at a prepaid health plan and women in the minimal and moderate intervention groups increased their safety belt use.
Abstract: A passenger safety curriculum was developed and implemented for expectant mothers and coaches attending Lamaze childbirth classes at a prepaid health plan. Women in the minimal and moderate intervention groups increased their safety belt use from 19.4 to 28.6% and 13.5 to 24.2%, respectively. Women in the control group and all the husbands or coaches did not show an increase. As adult mandatory safety belt legislation is enacted, additional efforts to promote safety belt use in adult family members are needed.
TL;DR: The evolution of the original Newton hypothesis of a psychoactive, neurohormonal fetus ejection Reflex is discussed with reference to similarities to the milk ejection reflex, and the ecologic importance of the ability of environment to regulate labor and lactation is emphasized.
Abstract: In this comment on the preceding paper by Michel Odent on the fetus ejection reflex, the evolution of the original Newton hypothesis of a psychoactive, neurohormonal fetus ejection reflex is discussed with reference to similarities to the milk ejection reflex. The ecologic importance of the ability of environment to regulate labor and lactation is emphasized. Four types of fetus-expulsion mechanisms discussed by Ferguson are reviewed, with the emphasis on the need for more research. The work of Newton and her collaborators, who first experimentally demonstrated the environmental regulation of labor in an infrahuman mammal, is discussed in connection with current data on the effect of environment on human labor.
TL;DR: It is argued that infant formula is unable to be “humanized”; that it is intrinsically hazardous; and that damage to Western children has occurred and is probably still occurring on a frightening scale.
Abstract: Widespread recognition of the immunologic value of human milk has left untouched an equally widespread belief in the nutritional adequacy of infant formula and its equivalence to human milk. Thus many believe that while “breast is best” in conditions of poor sanitation, there is little difference between formula and human milk where good hygiene is possible. Many also believe that women must be free to choose breast or bottle feeding, and that any critique of formula (though not of breastfeeding) is an intrusion upon that choice. But to be free, choice must be informed. This paper looks at the claims of nutritional adequacy and equivalence and argues that infant formula is unable to be “humanized”; that it is intrinsically hazardous; and that damage to Western children has occurred and is probably still occurring on a frightening scale. Once the risks of formula feeding are exposed, social and political change becomes necessary.
TL;DR: The value of advising women to assume the knee-chest position for 15 minutes three times a day in reducing the incidence of breech presentation at delivery in women with a persistent singleton breech presented at 37 weeks’ or more gestation is tested.
Abstract: A randomized clinical trial of 76 women with a persistent singleton breech presentation at 37 weeks’ or more gestation tested the value of advising women to assume the knee-chest position for 15 minutes three times a day in reducing the incidence of breech presentation at delivery. In the 39 women advised to perform the procedure, 16 (41.0%) fetuses underwent rotation and remained cephalic at delivery compared to 12 (32.4%) of the 37 women in the control group in whom spontaneous version to cephalic occurred. The procedure warrants further evaluation in other obstetric populations, at or in the thirty-seventh week of gestation, and in a larger study group.
TL;DR: It is concluded that rapid milk maturation is desirable from associations with an increased rate in infant weight gain at 28 days, lower transcutaneous bilimeter readings at 14 days and increased weeks of breastfeeding for those who weaned by 20 weeks.
Abstract: Milk maturation from colostrum to mature milk occurs at rates that vary from mother to mother. The clinical significance of milk maturation rate is discussed here. Milk samples of 98 mothers were monitored in an observational study using the Maturation Index of Colostrum and Milk (MICAM). Samples were collected with each feeding during hospitalization, twice daily at home through day 7, and on days 14 and 28. Frequency and duration of early feeding were positively associated with milk maturation rates. An increased milk maturation rate was associated with an increased rate in infant weight gain at 28 days, lower transcutaneous bilimeter readings at 14 days and increased weeks of breastfeeding for those who weaned by 20 weeks. It is concluded from these associations that rapid milk maturation is desirable.
TL;DR: Urea-plasma urealyticum, group B streptococcus, Chlamydia trachomatis, and anaerobic vaginosis are discussed, along with other data regarding intrauterine infection as a cause of prematurity.
Abstract: This is a review of four vaginal and cervical infections that may be associated with prematurity, premature rupture of the membranes, or low birthweight. Urea-plasma urealyticum, group B streptococcus, Chlamydia trachomatis, and anaerobic vaginosis are discussed, along with other data regarding intrauterine infection as a cause of prematurity.
TL;DR: Infants with inadequate suckling, such as prematures, small multiples, “happy to starve” nondemanding babies, or infants with oral defects may adversely affect breastmilk supply as a result of ineffective suckling.
Abstract: Numerous maternal factors may be associated with impaired lactation, including breast surgery that damages lactiferous ducts and nipple innervation, inadequate mammary glandular tissue, superimposed pregnancy, and severe maternal illness. Infants with inadequate suckling, such as prematures, small multiples, “happy to starve” nondemanding babies, or infants with oral defects may adversely affect breastmilk supply as a result of ineffective suckling. The overenthusiastic promotion of unsupplemented breastfeeding in the presence of these conditions can lead to critical failure to thrive in the infant. Case examples are cited to guide the clinician in distinguishing primary or nonremediable etiologies of insufficient lactation from common errors in the management of breastfeeding. When full lactation is not possible, the nursing relationship can still be preserved despite the need for supplement with infant formula.
TL;DR: An independent survey of family-centered maternity care policies in the hospitals of a large Australian city was used to identify two groups of hospitals at the extreme ends of the range with respect to their use of induction of labor, oxytocin, and operative delivery.
Abstract: An independent survey of family-centered maternity care policies in the hospitals of a large Australian city was used to identify two groups of hospitals at the extreme ends of the range. A comparison of the two groups with respect to their use of induction of labor, oxytocin, and operative delivery could detect no differences between them.
TL;DR: Nurses reported more job satisfaction overall, but that their workloads had increased as a result of these changes, with more “traffic managing” and patient teaching required.
Abstract: A descriptive study was conducted to determine what changes nurses report in maternity care and how these changes affect them and their practice. The stratified random sample was composed of six female, full-time registered nurses with a minimum of three years’ maternity experience from each of 10 hospitals in central Oklahoma and southeastern Kansas. Fifty-nine interviews, using a semistructured format, were completed, transcribed, and coded. Changes related to family-centered maternity care, short postpartum hospitalization, and patient characteristics are reported here. Patients know more about what to expect than they did only a few years ago, but also seem to expect the ideal; they are both older and younger than before, and many are sick or at high risk. Nurses reported more job satisfaction overall, but that their workloads had increased as a result of these changes, with more “traffic managing” and patient teaching required. Conflicts arise from lack of postpartum teaching time, lower patient census causing job insecurity, and from the need to care for all the members of the family instead of only mothers or babies. Some interdisciplinary conflict was also reported.
TL;DR: Nurses’ responses to changes in obstetric technology, the legal climate, and economic pressures in maternity care were collected by means of a five-question, open-ended interview from 59 nurses practicing in 10 hospitals in Oklahoma and Kansas.
Abstract: Nurses’ responses to changes in obstetric technology, the legal climate, and economic pressures in maternity care were collected by means of a five-question, open-ended interview from 59 nurses practicing in 10 hospitals in Oklahoma and Kansas. The method and sample are described in Part I of this article. Forty-eight of the nurses said that technologic advances have reduced job stress, raised professional status, increased interdisciplinary contacts, and either raised or lowered workloads. Defensive use of procedures in obstetrics has increased the need for charting and many other nursing duties not related to caring for patients. At the same time, anxiety and anger at the idea of being vulnerable to lawsuit for years after each birth did negatively affect some nurses’ attitudes toward their jobs and their patients. Despite the need for greater vigilance and more procedures, nurse-patient staffing ratios are dropping in some hospital maternity units, while nurses are expected to market hospital services and help develop innovative programs.
TL;DR: It is concluded that in the first two years candidates scored unusually high in this examination and that in future years fewer candidates will have the experience of these initial groups.
Abstract: To identify factors of professional experience, education, and socioeconomic background that might predict high scores on the examination given by the International Board of Lactation Consultant Examiners, 135 (52.2%) of those tested in 1985, and 209 (94%) of those tested in 1986 completed a questionnaire after the six-hour test. The percentage of candidates who passed the examination was 94.6 in 1985 and 93.2 in 1986. The candidates’ mean years of experience in counseling breastfeeding mothers was 10. Nearly all had had one year of college; half had baccalaureate or master's degrees in nursing. Three-quarters in 1985 stated that their primary affiliation was with La Leche League International, whereas only 41 percent claimed this affiliation in 1986. We conclude that in the first two years candidates scored unusually high in this examination and that in future years fewer candidates will have the experience of these initial groups.