Showing papers in "Birth-issues in Perinatal Care in 1995"

Variables Related to Nausea and Vomiting During Pregnancy

Abstract: Seventy to 90 percent of all pregnant women experience nausea, and 50 percent have at least one episode of vomiting or retching. A continuous measure was used to quantify symptoms of nausea with or without vomiting or retching during pregnancy in 126 women. Relationships between symptoms and selected variables were evaluated. Nausea with or without vomiting or retching was associated with maternal age, occupation, parity, cigarette smoking, infant gender, and the personality trait of independence. Significant associations were entered into multiple regression equations. Fourteen percent of the variation in symptoms overall, 25.1 percent of the variation in nausea symptoms, and 16.6 percent of the variation in vomiting or retching symptoms were explained by a combination of these selected independent variables. Although this study found associations, independent variables contributed little to predicting or explaining the presence and severity of nausea and vomiting during pregnancy. More sensitive measures and evaluation are required to understand and treat this perplexing phenomenon.

Evaluation of Antenatal and Postnatal Support to Overcome Postnatal Depression: A Randomized, Controlled Trial

Abstract: This randomized, controlled trial tested the hypothesis that women identified as more vulnerable to developing postnatal depression who attended two specific antenatal groups and one postnatal group have a reduced frequency of postnatal depression from 37 to 15 percent at 6 weeks, 12 weeks, and 6 months postpartum. A modified antenatal screening questionnaire was completed, and women identified as more vulnerable to postnatal depression were stratified by parity and randomly allocated to receive extra support groups or to a control group. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect postnatal depression. Attendance at the support groups was low, 31 percent overall. At six weeks, in the intervention group, 8 (13%) of 64 women scored high (> 12) on the EPDS, compared with 11 (17%) controls. Similarly, at 12 weeks 7 (11%) of 63 versus 10 (15%) of 65 women scored higher than 12, and at 6 months, 9 (15%) of 60 versus 6 (10%) of 64 women scored higher than 12, indicating that the intervention did not reduce postnatal depression. It is possible that the method of applying the intervention, using groups separate from the standard antenatal classes, may have affected attendance. More research is required into ways of reaching and supporting women who may become depressed.

Effective Care in Pregnancy and Childbirth: A Synopsis

Abstract: Evidence about the effects of care practices is not a sufficient guide to the most appropriate care. Those who provide care, who receive care, who advocate care, or who pay for care must choose on the basis of many factors: personal experience, personal preference, personal values, availability of resources and facilities, and a myriad of other considerations, among which knowledge of the effects of care is certainly important. This knowledge is essential for choices to be properly informed. The most reliable evidence about the effects of care is provided by randomized controlled trials. Unfortunately, this evidence is not readily accessible. It is scattered through a large number of journals throughout the world, and is hidden among a mass of weak, inadequate, and sometimes frankly misleading studies. Those who wish to use all the valid evidence must rely on properly prepared, up-to-date, systematic reviews. The Cochrane Collaboration has taken on the task of preparing, maintaining, and disseminating reviews of randomized trials of health care, published electronically as the Cochrane Database of Systematic Reviews. The reviews are provided by a number of Collaborative Review Groups, and the Cochrane Pregnancy and Childbirth Database is the first specialty database to appear. It is regularly updated to incorporate data that have become available since the previous issue.

Denial of pregnancy: a review and case reports.

Abstract: This paper describes the characteristics of women who deny awareness of their pregnancies, the underlying causes and conflicts, and specific interventions required to address these issues. Case reports illustrate this complication of pregnancy. The absence of many physical symptoms of pregnancy, inexperience, general inattentiveness to bodily cues, intense psychological conflicts about the pregnancy, and external stresses can contribute to the denial in otherwise well-adjusted women. Assessment should include the possible contribution of painful reactivation of memories concerning childhood or adult trauma and the effect of dissociative states on the development of denial of pregnancy. Psychotherapy is recommended to resolve these conflicts, and to prevent future pregnancy denials and child abuse or neglect. Denial of pregnancy is easier to understand in women with psychosis or serious cognitive impairment than in those without such disorders. The underlying illness requires treatment by a psychiatrist. Psychological conflicts also exist in psychotic women, such as the intense wish to have a baby while fearing loss of the infant to child-protection services. Acknowledging the conflict and supporting the mother despite her puzzling behavior is an important task for health caregivers.

What Predicts Breastfeeding Intention in Mexican-American and Non-Hispanic White Women? Evidence from a National Survey

Abstract: We examined the effects of a series of predictors on the prepartum intention to breastfeed in both Mexican-American and non-Hispanic white women. A national sample included 430 Mexican-American women and 3659 non-Hispanic white women who had a pregnancy in 1988. Prenatal behavioral, sociodemographic, and biomedical information was obtained through the 1988 National Maternal and Infant Health Survey. Two dependent variables were constructed to identify significant predictors of breastfeeding intention: exclusive versus partial and bottle-feeding, and exclusive and partial versus bottle-feeding. Results from the multiple logistic regression models indicated that advice to breastfeed at prenatal care was the strongest predictor of intentions in both Mexican-American (OR = 2.15, OR = 1.86) and non-Hispanic white mothers (OR = 2.29, OR = 3.61). In Mexican-Americans the father's being Hispanic was negatively associated with breastfeeding intention (OR = 0.63). In non-Hispanic whites the advice to formula feed at the Women, Infants, and Children's nutrition program was a significant negative predictor of breastfeeding intention (OR = 0.33, for exclusive and partial breastfeeding vs exclusive bottle-feeding). These results have important implications for public health policy and practice.

Changes in cesarean delivery in the United States, 1988 and 1993.

Abstract: The rate of cesarean delivery in the United States (22.8% in 1993) has remained stable since the mid-1980s after dramatic increases during the 1970s and early 1980s. The primary cesarean rate (16.3 cesareans in 1993 per 100 women with no history of previous cesarean delivery) was also stable from 1988 to 1993. During this same period, the rate of vaginal birth after previous cesarean (VBAC) doubled, from 12.6 to 25.4 percent. In both 1988 and 1993, rates of cesarean delivery were higher in the South than in other regions, for mothers 35 years or older than for younger women, for proprietary than for nonprofit or state and local government hospitals, and for women with private insurance than for women with Medicaid or self-pay as the expected source of payment. Even if VBAC rates continue to increase at the same rate as in the past, the Year 2000 goal of an overall cesarean rate of 15 percent cannot be met without reducing the primary cesarean rate by 50 percent.

Reducing pain and enhancing progress in labor: a guide to nonpharmacologic methods for maternity caregivers.

Abstract: Many simple, effective, low-cost methods to relieve labor pain can be initi- ated by nurses, midwives, or physicians with the potential benefits of improved labor progress, reduction in use of riskier medications, patient satisfaction, and lower costs. These nonpharmacologic methods are categorized by the mechanisms through which they reduce pain or improve labor progress: diminishing the painful stimulus at the source; providing alternate stimuli to inhibit pain awareness; and reducing the woman S negative reaction to the pain. This is a review of numerous pain relief techniques and a guide for maternity caregivers. (BIRTH 22:3, September 1995)

Women's reasons for not seeking prenatal care: racial and ethnic factors.

Abstract: Our objective was to determine if there were differences in the reasons for not seeking early prenatal care among low-income black, Hispanic, and white women who had four or fewer prenatal care visits or care only in the third trimester, and who gave birth at Denver General Hospital in Colorado. Data were gathered from 606 women (48% Hispanic, 26% black, 26% white) after delivery, using a 188-item questionnaire and abstracted medical charts. The most important reasons for not seeking early prenatal care were attitudinal (47%), financial (26%), and structural and system problems (8.5%). Financial reasons were more important to white than to black or Hispanic women, and attitudinal reasons were more important to black and Hispanic than to white women. The analysis showed that education and marital status were sometimes confounding variables. Clear differences in reasons for not seeking prenatal care were reported by women of dissimilar racial and ethnic groups in this public hospital. Cultural variations in women's views should be taken into account in developing programs intended to improve prenatal care and pregnancy outcome in Denver.

Pica and Olfactory Craving of Pregnancy: How Deep Are the Secrets?

Abstract: The practice of pica during pregnancy is described in contemporary literature as the ingestion of nonfood substances and food staples in response to craving. A previously unnamed practice, olfactory craving of pregnancy, is the smelling by pregnant women of selected substances in response to craving, which may occur alone or with pica. Observations and descriptions of women's experiences of pica and olfactory craving were documented during individualized postpartum bedside instruction of 300 women at a midwestern hospital between 1992 and 1994. Most women were African American and low income. Eight themes about pica of pregnancy were keeping practices secret, singularity of the experience, obtaining the craved substance, fears for effects on the fetus, yielding or not yielding to cravings, use of substances as medication, pica and food intake, and sensory experiences other than taste. Three themes about olfactory craving of pregnancy were changes in sense of smell during pregnancy, types of craved substances and settings, and escalation in use during pregnancy. The clinical stages of pica and olfactory craving require further investigation, and perinatal caregivers have to seek and remove the barriers that cause pregnant women to isolate themselves with the practices that stem from these cravings.

Anemia and insufficient milk in first-time mothers.

Abstract: Insufficient milk is a poorly understood problem that is often identified as a major reason for early discontinuation of breastfeeding This study explored the relationship between anemia and insufficient milk in 630 first-time mothers The frequency of anemia (postpartum hemoglobin < 10 g/dL) was 22 percent Anemic mothers reported a higher level of symptomatology associated with insufficient milk and were more frequently classified as having insufficient milk syndrome Mothers with the syndrome reported a shorter period of full breastfeeding, and weaned at an earlier age They identified not having enough milk, baby nursing too often, and baby not gaining enough weight as the main reasons for discontinuing breastfeeding, compared with baby's disinterest and conflicts with school or work as main reasons among mothers not reporting symptoms related to insufficient milk syndrome The study results suggest that anemia is associated with the development of insufficient milk, which in turn, is related to duration of full breastfeeding and to age at weaning

Do Childbirth Classes Influence Decision Making about Labor and Postpartum Issues

Abstract: This study investigated the role of childbirth education for women attending the Royal Women's Hospital Family Birth Center, Melbourne, Australia, in relation to making decisions about breastfeeding, pain medication, and length of hospital stay. Fifty-nine primiparous women completed a questionnaire after delivery about the influence of childbirth education classes on their decisions during pregnancy, birth, and the postnatal period. The results indicated that although the women enjoyed childbirth education classes, the information they received had minimal effect on their decision to breastfeed and the appropriateness of a 24-hour stay. Information gained about the use of pain medication in labor was clearly helpful when women made decisions about pain relief. Educational strategies have failed to address the tendency of nulliparous women to postpone making decisions about the postnatal period such as early discharge, and further investigation on this aspect of a childbirth education program is suggested.

Mothers Touching Newborns: A Comparison of Rooming‐in versus Minimal Contact

Abstract: We compared the maternal behaviors of women who had extended and early contact (rooming-in) with their infants with those who had contact only during feedings. Thirty-one young, unmarried, predominantly black, lower-socioeconomic mothers and their infants were observed in the mother's hospital room for 15 minutes after a morning feeding approximately 18 hours after delivery. A time sample unit checklist was used to record each mother's behavior, looking, talking, and touching directed toward their infants and others, as well as watching television and talking on the telephone. Analyses of variance revealed that the rooming-in mothers looked at, talked to, and touched their infants more, watched less television, and talked less on the telephone than mothers with minimal contact with their infants. These findings suggest that increased postpartum contact with infants leads not only to more interaction, but also to more touching as well as touching in more intimate places (face and head), thus highlighting the value of rooming-in arrangements for mothers and infants.

Hmong women in Wisconsin: what are their concerns in pregnancy and childbirth?

Abstract: Childbirth in different cultures is treated as a traumatic life crisis and a time of vulnerability for the mother and infant. This qualitative descriptive study explored specific concerns related to pregnancy and childbirth in 52 Hmong women living in central and northeastern Wisconsin. Women were questioned using a semistructured interview about 4.6 months after childbirth. They described concerns related to breastfeeding, contraception, touch, communication with health caregivers, and procedures performed during childbirth. Women preferred bottle-feeding over breastfeeding. They reported difficulty practicing birth control because of cultural expectations of male and female roles, but were aware of the need for education about methods of contraception. Fear of miscarriage if they were touched by doctors and nurses resulted in delayed prenatal visits. The women believed that invasive procedures such as episiotomies and circumcisions are not natural, and they preferred natural tearing and healing. It is important for health caregivers to be culturally sensitive and understanding of Hmong practices and beliefs when touching and communicating with these women and when educating them about breastfeeding, contraception, and medical procedures during hospitalization.

Decreased cesarean birth rates and improved perinatal outcome: a seven-year study.

Abstract: Physicians analyzed data on all cesarean section (C-section) births at Princess Basma Teaching Hospital the primary referral hospital in north Jordan during 1987-1993 to examine the decrease of C-sections in relation to perinatal deaths. Between 1987 and 1993 the C-section rate fell from 15.5% to 8.7%. The leading reasons for this decrease were a reduction in C-sections for abnormal childbirth (10.5-5.6%) repeat C-sections (5-3.1%) and failure to progress and cephalopelvic disproportion (4-0.9%). The overall perinatal mortality rate fell from 52 to 20.9 deaths/1000 live births. Despite the reduction in perinatal mortality inadequate prenatal care admission of many high-risk women in poor condition and a rising frequency of three or more previous C-sections kept the perinatal mortality rate about two times as high as that in many countries. Other contributing factors to high perinatal death were older mothers high parity low socioeconomic and education status and poor maternal nutrition. These findings show that the new guidelines in clinical management of labor and delivery reduced the C-section rate and perinatal mortality. These guidelines consisted of active management of abnormal childbirth a trial of labor in women with one previous C-section birth selective vaginal breech delivery and continuous intrapartum fetal monitoring.

Change and power in midwifery.

Abstract: Midwives are experiencing problems in playing their full part in the maternity services and the communities in which they practice. Mothers, babies, and families require greater care from these caregivers for healthier pregnancy and birth outcomes. Change to renew the power, skills, and knowledge of midwives is evident in many parts of the world. Processes of change require an examination of the purpose of midwifery. The starting point of change is an awareness of the meaning of birth to individuals and society, and of the role of midwives in supporting families around the time of birth. Midwives should use their power to resolve the considerable problems facing childbearing families, and to enrich the event.

Classifying Meconium‐Stained Liquor: Is It Feasible?

Abstract: Four samples each of clear and lightly (thin), moderately, and heavily (thick) meconium-stained amniotic fluid were divided in two portions and submitted twice for assessment to 20 midwives (a total of 320 case assessments). None of the midwives completely agreed with the standard assessment for more than 85 percent of the cases. When disregarding clear samples, for which there was good agreement, each of the midwives classified on average only 35.8 percent of the meconium-stained samples in the same category on each of the four occasions that they were presented to them. Calculation of kappa statistics, which express proportional agreement corrected for chance, indicated that none of the midwives showed very good agreement (κ > 0.81) with the standard and that fewer than 10 percent showed very good agreement with themselves. The data indicate that grading the severity of meconium staining by visual assessment has such poor accuracy and precision that it cannot provide a valid basis for assigning different care policies to different degrees of meconium staining.

Does a Twin Pregnancy Have a Greater Impact on Physical and Emotional Well‐Being than a Singleton Pregnancy?

Abstract: A prospective, population-based study was conducted to assess the impact of twin pregnancy on a woman's physical and emotional well-being. It compared women's reports of their general health, experience of a range of specific symptoms, and emotional well-being during pregnancy using the Edinburgh Postnatal Depression Scale. The subjects were 147 women expecting twins and 11,061 women expecting a single child who completed questionnaires at both 20 and 32 weeks' gestation as part of the Avon Longitudinal Study of Pregnancy and Childhood. Results suggested that women expecting twins experienced poorer physical well-being but not poorer emotional well-being than those expecting a single child, even though a significant association between poor health and emotional well-being was found for the population as a whole. It was suggested that the transitory nature of a twin pregnancy, the "special" status of a twin pregnancy, greater social support, and modified expectations about health may buffer the effects of poor physical health on emotional well-being in a twin pregnancy. The findings should alert those who care for women expecting twins to the greater physical stress these women may feel.

Midwifery care and medical complications: the role of risk screening.

Abstract: This study analyzed the 147,293 births attended by midwives in the United States in 1989. It used the revised and expanded standard national certificate of a live birth, which for the first time systematically records prenatal medical risk, intrapartum complications, obstetric procedures, and birth outcomes. It builds on earlier findings of positive outcomes for midwife-attended births to examine the prenatal medical risk profile of mothers served by midwives, the performance of obstetric procedures by midwives in different birth settings, more specific measures of outcomes, and possible explanations for these findings. Although midwives attending births in birth centers and homes generally serve mothers who are at much less than average medical risk, and in cases of intrapartum complications risk screening appears to occur, nurse-midwife-attended births in hospitals involve mothers whose risk profiles compare with, and in some cases are worse than, the national average. Nonetheless, the outcomes of these births are better than the national average. Mothers attended by midwives in birth centers and homes also have a different pattern of prenatal care, which begins later and includes fewer visits, but gives more apparent attention to self-care, and results in less smoking and alcohol use and greater weight gain.

Cesarean delivery rates in women cared for by certified nurse-midwives in the United States: a review

Abstract: The frequency of cesarean deliveries for women attended by certified nurse-midwives in the United States (1.8-10.4%) is lower than the rate for the general population of woman who gave birth in the United States in 1990 (23%). This paper describes the research that reported cesarean birth rates for certified nurse-midwives. Major methodology limitations of the research suggest that significant information gaps exist regarding nurse-midwifery care and its effect on cesarean delivery. Issues surrounding this common clinical procedure are complex, with its high cost and controversy over determinant factors. It is important to develop convincing evidence about the influence of nurse-midwives' care on reducing the frequency of cesarean delivery in the United States.