bluuebunny/crossref_metadata_2025 huggingface dataset:
An Experiment in Cooperative Child Care
Authors: Watson Joellen , Goldberg Linda
Published: April 2007

ABSTRACT: Neither traditional day care nor a proprietary preschool, this parent‐organized and operated day care center arose out of the needs of a group of parents and their children. The cost is less than traditional day care, and infants can be enrolled. The program is developed and carried out by parents. The results are that the children develop a sense of self and community, and they get experience in learning and relating to others, while their parents get free time to follow their own interests.
Paternal Behavior at First Contact with the Newborn in a Birth Environment without Intrusions
Authors: McDonald Darren L.
Published: April 2007

ABSTRACT: The behavior of seven fathers immediately after the births of their children in a home‐like birth environment was videotaped by remote control cameras. Seven repetitiously exhibited behaviors were independently quantified by trained observers, using a continuous flow, slow motion video play‐back technique. The first three minutes of neonate‐oriented paternal behavior were examined for stability, to see if they emerged in uniform sequence, and were compared with the same behaviors shown in later minutes. The results indicate that initial father‐newborn behaviors were stable. All the fathers showed the same sequence in the emergence of behaviors toward their new babies. After hovering and hand pointing behavior, contacts were made with the tips of the fingers, followed by palm contact with the newborn. These findings suggest that the repertoire of paternal behavior at initial encounters with their newborns may be species‐characteristic of the human father, and may function to establish the father‐to‐newborn affectional bond.
A Home Obstetric Service With Expert Consultation and Back‐Up
Authors: Estes Milton N.
Published: April 2007

ABSTRACT: The medical literature comparing home and hospital obstetric outcomes is reviewed. A home obstetric service with hospital and obstetrician back‐up is described, including screening, care during pregnancy and delivery and management of complications. Of 495 women who were accepted for home delivery, 77 miscarried or moved, 49 changed to hospital delivery, 19 had premature labor, and 61 were transferred to the hospital during labor. Maternal and perinatal mortality and morbidity are described. In this well‐selected low risk population, careful prenatal and intrapartum care resulted in outcomes which are comparable to those of hospital programs.
The Influence of Maternal Position on Time of Spontaneous Rupture of the Membranes, Progress of Labor, and Fetal Head Compression
Authors: Caldeyro‐Barcia Roberto
Published: April 2007

ABSTRACT: The results of the Latin American Collaborative Study of maternal Position in Labor are presented. 225 women comprised the “horizontal” group and 145 were allowed to assume the position of choice during labor. All women were matched otherwise and had normal pregnancies and onset of labor. Maternal position had no effect on time of spontaneous rupture of membranes, Labor was 36% shorter in primiparous women and 25% shorter in all women who were upright during labor. Maternal position had no effect on fetal head molding or Type I and Type II heart rate patterns. The upright position was preferred by 95% of women.
Toward Really Improving the Outcome of Pregnancy: What You Can Do
Authors: Sugarman Muriel
Published: April 2007

ABSTRACT: Despite long‐standing consumer efforts to make childbirth more natural and emotionally rewarding, recent efforts to close small, local maternity units and to consolidate maternity care in large, technologically advanced units have led to increasingly costly, interventive focus by maternity care providers. Health planning on the local, regional and national levels offers the consumer many avenues for instituting community‐based, preventive, primary maternity care. This paper sounds a warning and provides information necessary for consumers to take a more politically active role in planning for maternity and newborn care.
The Effects of Catecholamines and Drug Treatment on the Fetus and Newborn
Authors: Fox Howard A.
Published: April 2007

ABSTRACT: The fetus is capable of producing catecholamines from early in gestation. Normal concentrations of these compounds are necessary for fetal and neonatal homeostasis, and for successfully completing the transition from fetal to neonatal life. Fetal and neonatal stress result in marked elevations of catecholamine levels, causing a large number of physiologic derangements. While fetal catecholamines are endogenously produced, maternal illness and anxiety can initiate the chain of maternal catecholamine production, causing dysfunctional labor and uterine hypoperfusion, and through this mechanism, fetal distress. Measures to reduce maternal anxiety should have a high priority in the management of labor. While nonpharmacologic methods may suffice, the use of analgesic agents in moderate doses may be protective to the fetus in selected circumstances.
Catecholamines: The Effects of Maternal Fear and Its Treatment on Uterine Function and Circulation
Authors: Levinson Gershon , Shnider Sol M.
Published: April 2007

ABSTRACT: Catecholamines, epinephrine and norepinephrine, cause characteristic “fight or flight” responses of increased heart rate and blood pressure, vasoconstriction, and other autonomic responses. In animal studies, either injection of Catecholamines or fright causing secretion of these hormones resulted in lower uterine blood flow and fetal bradycardia or acidosis.

Anxious human mothers had weaker contractions and longer labors and higher circulating catecholamine levels. In the presence of lower uterine circulation the normal fetus may compensate by extracting the oxygen needed, while the previously compromised fetus is less able to compensate for the reduced blood supply.
Assessing the Quality of Childbirth Education: Can Teachers Change?
Authors: Humenick Sharron S.
Published: April 2007

ABSTRACT: The subjects of the study were five childbirth educators and sixty expectant couples enrolled in one of two monitored series of classes for each teacher. Expectant mothers were measured before and after classes for relaxation skill and attitude towards participation in labor. Both mothers and fathers were quizzed on class content. Both series of classes were tape recorded for each teacher, and the percentage of time a teacher spent eliciting responses from parents or giving parents feedback was calculated. After the first class series, teachers were shown all data collected about their couples and their teaching style. In the subsequent series of classes, teachers increased feedback to couples but did not extend practice time. Mothers in the second series showed no further improvement in relaxation or attitude, but both parents performed better on the written quiz. Larger classes correlated negatively with achievement of relaxation skill for expectant mothers. Furthermore, apparent differences between teachers' groups for learning relaxation skill could be explained by class size, when class size was held constant, in an analysis of covariance. It is suggested that measures of parents' knowledge, relaxation and attitudes be further developed both as a basis for teacher evaluation and as a basis for providing quality assurance in childbirth education classes.
Research in Ultrasound Bioeffects: A Public Health View
Authors: Stratmeyer M. E.
Published: April 2007

ABSTRACT: A review is made of the human and laboratory studies of bioeffects of ultrasound. These include developmental, hematological, neurological, behavioral, immune and genetic effects after exposures to ultrasound in doses now used clinically. Some problems with the human and laboratory studies are described. It is questioned whether curves of intensity/exposure times can be drawn to delineate safe usage of ultrasound without more data on long‐ and short‐term effects in animals and humans.
Postpartum Teaching and the Subsequent Use of Milk Supplements
Authors: Ann Cohen Sylvia
Published: April 2007

ABSTRACT: Of 70 first‐time mothers, 35 were randomly given a single postpartum teaching session on breastfeeding in the first 24 hours after delivery. Interviews at 6 weeks revealed that significantly more of the mothers who had been taught about breastfeeding were not using milk supplements and had not discontinued breastfeeding. This trend became nonsignificant at 3 months. Reasons for supplementing and discontinuing breastfeeding are analyzed.
Making Love After Birth
Authors: Leander Kristine , Grassley Jane
Published: April 2007

ABSTRACT: This paper describes the major physiological and emotional changes which affect making love after birth and suggests ways that health care professionals can help couples making this transition. Factors such as physician's instructions and choice of birth control are discussed.
How Does Strenuous Maternal Exercise Affect The Fetus? A Review
Authors: Woodward Susan L.
Published: April 2007

ABSTRACT: The preponderance of studies suggest that in physically fit women, physiologic mechanisms have been developed which increase fetal tolerance to the circulatory and respiratory challenges of strenuous maternal exercise. Ventilatory reserve and cardiovascular changes of pregnancy join to protect the fetus in normal pregnancy, and some of these changes are further developed by physical training.

The fetal heart rate response to strenuous maternal exercise may provide early diagnosis of uteroplacental insufficiency (UPI). In UPI, the fetal heart rate responds with tachycardia during the exercise, followed by bradycardia for a prolonged period. In preliminary investigations, fetal breathing movements have been more responsive to maternal exercise than have fetal heart rates.
Mastery: The Key to Childbirth Satisfaction? A Review
Authors: Humenick Sharron S.
Published: April 2007

ABSTRACT: Two models are presented. The first proposes pain management as the key factor leading to satisfaction with childbirth. The second proposes mastery in childbirth as the key factor leading both to satisfaction and potentially to changes in personality traits such as self‐esteem and locus of control A review of the literature is presented which is supportive of the Mastery Model.
Grief at Stillbirth: An Annotated Bibliography
Authors: Kirkley‐Best Elizabeth , Kellner Kenneth R.
Published: April 2007

ABSTRACT: In the last 10 years there has been a proliferation of articles dealing with the emotional aspects of stillbirth. Most of these articles have dealt with supportive care of parents grieving for a stillborn child. Several articles have sought to describe the processes and characteristics of mourning after a perinatal death. Only a few authors have taken on the difficult task of research in this area of grief.

As members of the Perinatal Mortality Counseling Program* (PMCP) at Shands Teaching Hospital, Gainesville, Florida, a crisis intervention and information and research team, we have become painfully aware of the need for informed counseling and research which may aid both parents and professionals who encounter stillbirth. Since much of the literature has dealt exclusively with neonatal death, we have compiled an annotated bibliography to acquaint the obstetrical community with the literature particular to stillbirth, the type of perinatal death that obstetricians are most likely to encounter.
Validation of a Scale to Measure Relaxation in Childbirth Education Classes
Authors: Humenick Sharron S. , Marchbanks Polly
Published: April 2007

ABSTRACT: Prenatal neuromuscular dissociation relaxation skill of 31 women was measured both using rater judgment and biofeedback equipment. A correlation of .88 was obtained when the two rating methods were compared. Prenatal relaxation skill achievement was significantly related to mothers’reports of medication used in childbirth. The authors conclude that childbirth educators can be trained to give reliable feedback to clients on achievement of relaxation skill and that achievement of neuromuscular dissociation relaxation skill may be predictive of the use of medication in childbirth.
Breastfeeding and Jaundice
Authors: Maisels M. Jeffrey
Published: April 2007

ABSTRACT: The data to date clearly demonstrates neither an association between breastfeeding and jaundice, nor a significant correlation between weight loss and serum bilirubin levels in the neonate. Breastmilk jaundice is a distinct syndrome in about two percent of breastfed babies. In these infants the bilirubin levels are elevated for prolonged periods but tend to rise more slowly than is characteristic of physiologic jaundice. Although kernicterus has not been reported from breastmilk jaundice, there is little reason to assume this form of hyperbilirubinemia is any less toxic to the neonate than hyperbilirubinemia from any other source.
The Romance and Power of Breastfeeding
Authors: Bloom Mayra
Published: April 2007

ABSTRACT: The romantic qualities of the breastfeeding relationship include elemental physicality, intensity, and transience. The paper explores the implications of nursing in terms of a woman's sexuality, competence and power, and offers breastfeeding as an economic model of a renewable resource.
The Risks and Benefits of Episiotomy: A Review
Authors: Banta David , Thacker Stephen B.
Published: April 2007

ABSTRACT: A review of the medical literature shows that episiotomy is done in about two‐thirds of births in the US, and routinely in many settings, especially in primiparas. While episiotomy can be clinically justified in specific circumstances such as impending laceration of the perineum, the literature does not support its routine use, since it is associated with significant risks of pain and infection, and the benefits claimed for routine episiotomy have not been subjected to randomized controlled trials.
Maternal Lateral Preference at First Contact with Her Newborn Infant
Authors: Trevathan Wenda R.
Published: April 2007

ABSTRACT: Previous studies report a preference of human mothers for holding their infants on the left side of the body, regardless of maternal handedness. This study describes maternal lateral preferences during the first hour after 100 deliveries. Seventy‐one of the women pulled their infants to their left sides when they first held them and 29 held them on the right. The disparity persisted for the full hour following birth. These results are similar to those reported in previous studies and support the hypothesis that the human mother has a natural tendency to hold her infant on the left side of the body. The implications of this preference are discussed.
Maternity Care in China: Report of a 1982 Tour of Chinese Medical Facilities
Authors: McKay Susan
Published: April 2007

ABSTRACT: This article reports on maternal and infant care in China, including the physical facilities and customs. There is little attention to organized childbirth and parent education, support in labor, or maternal‐infant contact, in part due to crowded maternity and nursery facilities. Acupuncture is used for many medical indications. Intensive maternal‐fetal and newborn care is beginning, and a 3‐level regional referral System is being used in larger metropolitan centers.
Studies of Nutrition Intervention in Pregnancy
Authors: Lechtig Aarón
Published: April 2007

ABSTRACT: The main conclusion of this review of 8 nutritional intervention studies during pregnancy is that, in mothers with protein‐energy malnutrition–either acute or chronic‐food supplementation during pregnancy can improve birthweight and decrease the incidence of low birthweight babies. It is stressed that programs to reduce the incidence of low birthweight babies must be aimed at the major causes of low birthweight, which differ among populations. For example, in Harlem the major probable cause of low birthweight is not dietary protein‐energy deficiency but short birth intervals, very young primiparas, highparity, and smoking.
Childbirth Education Programs: A Study of Women Participants and Non‐participants
Authors: Vinal Donna Frede
Published: April 2007

ABSTRACT: Of a random sample of 201 married postpartum women, 109 had chosen to attend childbirth education classes and 92 had not. Women who attended classes were younger, had fewer children, were married fewer years, and had had slightly more years of education than non‐participants. Most frequently cited reasons for not attending childbirth classes were having already attended in a previous pregnancy, having no interest, knowing as much as is needed, having scheduling problems, and not having doctor's recommendation to attend. Results point to the need to devise a childbirth education curriculum for parents who have older children.
III Studies of Maternal Nutrition and Infant Outcome: Statistical Versus Biological Significance
Authors: Margen Sheldon
Published: April 2007

ABSTRACT: Nearly all of the nutritional supplementation programs for malnourished pregnant women have resulted in statistically significant increases in birthweight. To tell whether these gains are biologically or socially significant we must factor in the effects of infections, other nutrient deficits, secular changes in health care, and stress. We must reexamine assumptions about 2,500 grams dividing low from normal birthweight, and the increase in protein in the U.S. Recommended Daily Allowance (RDA) for pregnant women. Most studies have raised questions about the mechanism of nutritional adaptation to pregnancy and methods of evaluating the nutritional status of pregnant women.
Infant Outcome in Relation to Second Stage Labor Pushing Method
Authors: Barnett Mary M. , Humenick Sharron S.
Published: April 2007

ABSTRACT: To test the hypothesis that long, hard Valsalva pushing during second stage labor may increase fetal acidosis and decrease neonatal Apgar scores, ten women with normal pregnancies and first stage labors were randomly assigned to a long Valsalva pushing group or a short, open glottis pushing group. Neonatal outcomes were measured by umbilical vessel blood gasses. Open glottis pushers showed a non‐significant trend toward longer second stage labors and higher umbilical artery pH. Umbilical vein pH was significantly higher among open glottis pushers. Long Valsalva pushers had less frequent expulsive contractions.

Whether women use long Valsalva or open glottis pushes may be only one of several factors which affect neonatal outcome, including not only the length and force of the push but also the condition of the fetus at the onset of pushing, the frequency and length of contractions during second stage, and the speed of delivery after crowning of the fetal head.
Effect of Childbirth Educator Communication Skills Training on Postpartum Reports of Parents
Authors: Cogan Rosemary , Winer Jane L.
Published: April 2007

ABSTRACT: The purpose of this study was to determine how providing childbirth education teachers with supplementary communication training would affect parents' reports of their birth. The teachers were randomly assigned to either a control group or a treatment group which received communication skills training. Questionnaires describing the birth experience were received from 79 new parents. Data were analyzed with a series of two‐by‐two analyses of variance, with groups (training versus control) and time (pre‐ versus post‐workshop) as the factors. New parents whose teachers had received communication skills training reported significantly more pain during the active phase of labor than did other new parents. It is likely that more open communication resulted from the communication training of childbirth educators which allowed parents in the treatment group to report negative feelings and experiences more freely.
IV. Nutritional Supplementation in Pregnancy: What Improvement in Outcome is Possible?
Authors: Campbell‐Brown Mary , Eng H.
Published: April 2007

ABSTRACT: Studies of maternal famine or nutritional rehabilitation can be grouped into three patterns: those in which famine occurred at conception or in the first trimester and was reversed by the end of pregnancy; those in which famine or nutritional therapy occurred in the second and third trimester; and pregnancies of chronically undernourished women in which the effect on birthweight of supplementation of the diet was studied. Overall, the effect of dietary supplementation in chronically undernourished women has been disappointing, either because the women may not have been sufficiently nutritionally deprived, or chronically undernourished women may have had difficulty increasing their energy intakes. The timing of the supplements in pregnancy was probably not a factor. It is postulated that the growth potential of the fetuses of chronically undernourished women may be lower than that of acutely malnourished fetuses.
Risks from Maternal Exposure to Photographic Chemicals in Pregnancy
Authors: Lappe Marc
Published: April 2007

:The potential effects of photographic developers, fixers, replenishers, bleaches, washes, metallic salts, and radioactive emulsions and chemicals on pregnant women and the fetus are reviewed, mainly in terms of animal findings. Those chemicals which are best avoided, or used only with protective hand, eye, and respiratory protection are discussed, and resources for more information are given. (BIR TH10:3, Fall 1983)
Prenatal Diagnosis of Fetal Disorders Part I: Technological Capabilities
Authors: Beeson Diane , Douglas Rita
Published: April 2007

:The indications, techniques, and results of amniocentesis, sonography, fetos‐copy, and maternal serum screening for alpha‐fetoprotein are described, along with some of the controversies over interpretation of studies. Down syndrome, neural tube defects, sickle cell anemia, hemophilia, Duchenne muscular dystrophy, alpha‐thalassemia, beta‐thalassemia, galactosemia, and Toy Sachs disease are among the genetic disorders for which such diagnosis is sought. The diagnosis of cystic fibrosis and studies of the efficacy and safety of first trimester diagnosis by chorionic biopsy are two directions of future promise. (BIRTH 10:4, Winter 1983)
Prenatal Diagnosis of Fetal Disorders Part II: Issues and Implications
Authors: Beeson Diane , Douglas Rita , Lunsford Terry F.
Published: April 2007

Some of the important issues raised by genetic diagnosis include the psychological implications of parents waiting weeks for test results, aborting a defective fetus, accidentally aborting, learning that a fetus is unaffected, and learning the sex of a fetus. Some ethical and legal controversies and social policy issues are described. (BIRTH 10:4, Winter 1983)
Effects of the Father's Presence or Absence During a Cesarean Delivery
Authors: Cain Richard L. , Pedersen Frank A. , Zaslow Martha J. , Kramer Eva
Published: April 2007

ABSTRACT: In a sample of 23 couples, those whose infants were delivered by cesarean section with the father present described more positive feelings, greater involvement in decisions related to labor and delivery, and less delay in handling their baby than did couples in which the father was not present during the surgery. Parent‐infant behaviors observed in the home at 3 months postpartum were not significantly differentiated by father's presence or absence at birth, except for more intense positive affect toward the infant by fathers who were not present at the cesarean.
Revelations: A Summary and Analysis of the NIH Consensus Development Conference on Ultrasound Imaging in Pregnancy
Authors: Shearer Madeleine H.
Published: April 2007

ABSTRACT: The Consensus Development Conference on Diagnostic Ultrasound Imaging revealed that neither the energy emitted from an ultrasound transducer, nor the energy absorbed by maternal and fetal tissues has been quantitated. For convenience, the energy is expressed in watts/square centimeter. Although in vitro and animal studies have shown various bioeffects of ultrasound, none obtained under 100 mW/cm2 has been reproducible, and none can be translated reliably to humans. Four randomized controlled trials of ultrasound imaging failed to show harmful effects, and also failed to show benefits of routine screening in terms of infant mortality or morbidity.

The panel accordingly recommended that ultrasound imaging be used only with a specific indication, and listed 27 indications. They recommended that women be supplied with information about exposure time, intensity, indication, alternatives, and benefits and risks of an ultrasound scan, if they request the information. The panel also recommended further research on outputs, bioeffects, and efficacy of routine screening by ultrasound during pregnancy.
Unanticipated Cesarean Birth from the Father's Perspective
Authors: May Katharyn Antle , Sollid Deanna Tomlinson
Published: April 2007

ABSTRACT: Despite the paucity of research on men's experiences of cesarean birth, fathers' attendance at cesareans has become well‐established in some areas of the U.S. In this study, interviews were conducted with 46 fathers whose wives had an uncomplicated pregnancy culminating in an unanticipated cesarean birth with a healthy neonate and no major complications for mother and child. Interviews were tape recorded, transcribed and analyzed. Of these 46 fathers, 52 per cent attended the cesarean, and 48 per cent did not, primarily because hospital policy prohibited it.

Fathers' predominant emotional reaction to the decision for cesarean was relief (52%); 27 per cent described their reactions as acceptance, 10 per cent expressed moderate disappointment, and 11 per cent were strongly disappointed or angry. Most negative reactions centered not on the cesarean itself, but on policies which excluded fathers from attendance arbitrarily, and on staff behaviors which reflected disregard for the fathers'need to feel included in the birth, whether they were permitted to attend the delivery or not.

Seventy per cent of these fathers expressed some displeasure at physician or nurse behaviors, expressing disappointment and resentment about being excluded from discussions leading to the decision for the cesarean, having little previous contact with the obstetrician, the nursing staff failing to provide the father with adequate information and support during and immediately after the cesarean, and being denied access to the wife and infant after the cesarean for apparently arbitrary reasons.
Childbirth Education Programs: The Relationship Between Confidence and Knowledge
Authors: Walker Barbara , Erdman Ann
Published: April 2007

ABSTRACT: One hundred sixty‐five male and female participants in childbirth preparation programs rated their own knowledge, anxiety, practical skills, and confidence to cope with labor. These assessments were made before classes, after classes, and after labor. Self‐reported ratings of knowledge of labor, of labor ward management and hospital routine, and of practical skills increased after classes but were unchanged after labor. The importance of practical skills was rated highly in all three questionnaires. Self‐reported ratings of confidence increased slightly after classes and returned to the pre‐class level after labor. Selfreported ratings of anxiety were unchanged by classes in males and multiparous females, but declined significantly for primiparous females. Self‐reported confidence was significantly associated with knowledge of labor before classes began. After classes, rating of confidence was significantly related to knowledge of practical skills.
Effective Smoking Intervention During Pregnancy
Authors: Nowicki Patricia , Gintzig Linda , Hebel J. Richard , Latham Rebecca , Miller Valerie , Sexton Mary
Published: April 2007

ABSTRACT: About one‐third of women enter their pregnancies as smokers. Attempts to help those who do not quit on their own have not been effective. As part of a 3‐year study to test the hypothesis that smoking reduction during pregnancy improves the birthweight of the infant (an hypothesis which was confirmed), a smoking intervention program was developed that resulted in a twofold increase in the percentage of women who stopped smoking cigarettes during their pregnancy. There was no comparative evaluation of the different kinds of intervention activities that were used, but because they were successful in the aggregate, they are described here and a judgment made of the effectiveness of the different components.

The main method of contact for the counseling was a single face‐to‐face session at the smoker's home, followed by frequent phone contacts. Although information was given on the risks of smoking during pregnancy, the emphasis was on how to stop through the use of behavioral skills such as developing commitment, self‐monitoring, stimulus control, substitute and incompatible behaviors, and positive associations with not smoking. A series of contacts through mailed information was maintained throughout the pregnancy. The findings have implications for strengthening the intervention activities that are presently offered to pregnant smokers.
Postpartum Depression: A Review
Authors: Affonso Dyanne D. , Domino George
Published: April 2007

ABSTRACT: Some studies link postpartum depression with the 4‐day “blues,” and with severe postpartum mental illness, while other studies show differences between these or define each distinctly. Research on possible contributors to postpartum depression has moved from psychoanalytic and hormonal theories to factors in the pregnancy, birth, and postpartum periods. Interpersonal and adaptational models are presented in detail.
1984 Hospital Survey of Circumcision Rates in the United States
Authors: Davenport Christopher , Romberg Rosemary
Published: April 2007

ABSTRACT: A questionnaire on changes in rates and attitudes toward circumcision was sent to the head nurses in 500 urban and suburban hospitals in the U. S. and returned by 311. An average of 76.4 per cent of boys are circumcised. Almost half reported unchanged rates; 43.8 per cent said circumcisions had decreased and 5.5 per cent said they had decreased markedly. Nearly all parents were thought to have decided on circumcision before birth. Few if any physicians were said to counsel parents for or against circumcision.
Protecting Intellectual Property: Copyright for Journal Authors and Conference Speakers
Authors: Bunnin Brad
Published: April 2007

Everyone who creates publishable work should understand the rights and obligations copyright law provides. This article describes what copyright law protects, how to obtain that protection, and how to give and get permission to use copyrighted work.
Recent Trends in Cesarean Delivery Rates in California
Authors: Petitti Diana B.
Published: April 2007

ABSTRACT: To determine the effect in California of the 1980 Consensus Development Task Force recommendations to lower cesarean delivery rates, we analyzed California vital statistics for 1978 through 1982. There was no evidence of either a decline or a leveling off of cesarean delivery rates in California as a whole. In university‐affiliated teaching hospitals cesarean rates were lower in 1982, but not as low as in 1981. A change in the attitudes of doctors now being trained may have a noticeable effect within 5 years as they assume full practices in the community.
The Birth of a First Child: Do Women's Reports Change Over Time?
Authors: Bennett Adrienne
Published: April 2007

ABSTRACT: Seventy‐two women who had been interviewed three weeks postpartum in an earlier study were re‐interviewed two years after the birth. There was a significant decrease over time in their ratings of each of the medical and preparation procedures they had had. Those women who had the one child or who were pregnant with a second child showed no change in overall perception of their labor and delivery after the two‐year interval, while those who had had a second child were more negative than at the first interview.

Women's recall of the events of their first birth was generally accurate and their pain ratings for all but the second stage labor were not significantly different at the two interviews. The results indicate that “time of interview” is an important factor to take into account in childbirth research.
Doctors, Maternity Patients and Social Scientists
Authors: Oakley Ann
Published: April 2007

ABSTRACT: Obstetric practice cannot be understood without appreciating that doctors are motivated by personal and professional feelings. Among these feelings, perhaps the most influential is the need to maximize job satisfaction within a framework in which quality control over obstetrical work is exercised by the fragile brake of peer review.
High Risk Infant: Concerns of the Mother After Discharge
Authors: Goodman June R. , Sauve Reg S.
Published: April 2007

ABSTRACT: This study was undertaken to determine the concerns of mothers of high risk infants and whether they differed from those of mothers of normal newborn infants. Thirty mothers of high risk infants and those of normal newborns, were interviewed in their homes on two separate occasions, at two weeks and again at six weeks after their infants’ hospital discharge. Following a semi‐structured questionnaire format, the mothers were asked to rate their concerns in several areas and to specify concerns they may have had which were not identified on the questionnaire. Areas in which mothers expressed concerns were: feeding, gastrointestinal problems, sleeping, crying, attachment, rashes, appearance, and concerns about the mother herself, her husband, and other children.

Mothers of normal newborn infants expressed worries in those areas already identified by the high risk group but they had fewer concerns and a lower degree of concern. However, no mother of a normal newborn infant was concerned about her infant's appearance and there was a tendency for mothers of normal newborn infants to have a more positive perception of their infants.
Possible Hazards of Imaging and Doppler Ultrasound in Obstetrics
Authors: Mole Robin
Published: April 2007

ABSTRACT: Cell damage is a natural part of fetal development, and the embryo and fetus have some self‐repair ability. Studies indicate that ultrasound imaging and Doppler applications do not harm by heating where circulation exists to dissipate heat. The shortness of the ultrasound pulses mitigates against cell damage by cavitation. Ultrasound scans are often recommended at 16 to 18 weeks LMP, when the most vulnerable fetal organ is the forebrain, or at 32 to 34 weeks LMP, when the fetal cerebellum is vulnerable and defects in vision or hearing are possible. Negative animal experiments cannot show damage of rates less than I in 1000. When considering possible links between ultrasound and childhood cancers or development defects, risk levels cannot be assessed until a large, adequately designed, randomized controlled trial with sufficient follow‐up is conducted.
How Can we Translate Good Science into Good Perinatal Care?
Authors: Grimes David A.
Published: April 2007

ABSTRACT: Scientific skepticism, known more formally as the discipline of epidemiology, can help overcome five obstacles that impede perinatal care: seduction by authority, the false idol of technology, letting sleeping dogmas lie, the pursuit of pedantry, and numerators in search of denominators. When the seduction by authority is strong, epidemiology shows us how to judge data on their own merit and not on the stature of their proponent. Epidemiology teaches us that we need not blindly worship technology; that technology can be our servant, not our master. Epidemiology compels us to rouse those slumbering dogmas and make them prove their merit. Despite the powerful lure of medical pedantry, epidemiology shows us the way out of this multiple‐choice mentality. When we are still stinging from our last unpleasant case, epidemiology guides and sustains us through science, reason, and logic—rather than through clinical impression.
Postpartum ‘Missing Pieces’: Sequela of a Passing Obstetrical Era?
Authors: Stolte Karen
Published: April 2007

ABSTRACT: Of 70 women interviewed 24 to 74 hours postpartum, six described events during childbirth as confusing and six identified ‘missing pieces’(17% total). The latter six defined missing pieces as external events related to the use of technological equipment and directions from others. Those who said they were confused but experienced no feeling of missing pieces described global events, such as losing track of time. The incidence of confusion and missing pieces was only a fraction of the percentage Affonso reported in 1977 (90%), perhaps because mindaltering medication is used less frequently today than it was in 1977 or because women are better educated about modern management of labor and delivery.
A Proposed Alliance of Midwives and Family Practitioners in the Care of Low‐Risk Pregnant Women
Authors: Feinbloom Richard I.
Published: April 2007

ABSTRACT: Only 63.4 percent of family practitioners have hospital privileges for obstetrics, and this number is declining. Family practitioners who do not practice obstetrics also are less involved in child care and tend to treat only one member of the family. Teaming up with nurse‐midwives and functioning as midwives may be a way for doctors to overcome the barriers to practicing maternity care, including the disruptive nature of obstetrics on their personal and professional lives, high mal‐practice insurance rates, and lack of adequate reimbursement from insurers when care must be transferred to an obstetrician. Midwives and family practitioners often have common philosophies of maternity care that could be advantageous to both practitioners and families in their childbearing years.
The Dublin Trial of Fetal Heart Rate Monitoring: The Final Word?
Authors: Parer J. T.
Published: April 2007

ABSTRACT: Although superior to the five other randomized controlled trials of electronic fetal monitoring, the Dublin Trial cannot be considered the last word. Use of paper speed at 1 cm per minute makes it impossible to detect beat‐to‐beat variability, which is vital to correct interpretation of a tracing. Nevertheless, there were half as many neonatal seizures in the electronically monitored group than in the auscultated group. Neither the criteria for abnormal FHR tracings nor the frequency and duration of auscultation is translatable to obstetric practice in North America.
Nausea and Pregnancy Outcome
Authors: Petitti Diana B.
Published: April 2007

ABSTRACT: The relationship of nausea during pregnancy with pregnancy outcome was studied using information from a post‐pregnancy survey of a sample of women in a cohort of 7,767 pregnancies. Seventy‐one percent of women were nauseated at some time during pregnancy. Nausea was unrelated to race and education. Younger women and those of higher parity were significantly (p < 0.05) more likely to be nauseated than older women and primiparas. The percentage of women nauseated during pregnancy was 70.1 in those who delivered a boy and 73.3 in those who delivered a girl, a difference that was not statistically significant (X2= 1.8, df 1, p = 18). The relative risks of spontaneous abortion and of ectopic pregnancy were significantly (p < 0.01) increased in women who were not nauseated at all during pregnancy, but there was no significant association of freedom from nausea with increased or decreased risk of stillbirth, congenital anomaly, or intrauterine growth retardation (IUGR). Twelve percent of women whose pregnancy lasted two or more trimesters had nausea throughout pregnancy. The relative risks of IUGR and of major and minor congenital anomaly were elevated in women with persistent nausea, although the elevations in risk were small and not statistically significant. Information about nausea of pregnancy may be useful in counseling pregnant women. It may help guide the evaluation of patients in whom ectopic pregnancy is a possibility, particularly where ultrasound is not available. If nausea is a biological marker for good placental function, better delineation of its physiologic basis might contribute to our understanding of variations in placental function and could result in development of a tool for monitoring it.
Stress, Pain, and Catecholamines in Labor: Part 2. Stress Associated with Childbirth Events: A Pilot Survey of New Mothers
Authors: Simkin Penny
Published: April 2007

ABSTRACT: A convenience sample of 159 women, all between 10 days and 2 months postpartum, filled out the Childbirth Events Stress Survey. All had attended the childbirth classes of the author during 1982 through mid‐1985. Only those who had had vaginal births in the hospital were included in the results. Those labor events most frequently described as highly stressful were: induction or augmentation with pitocin; administration of anesthesia; restriction to bed; restriction of movement in bed; forceps and vacuum extractor delivery; limited time with the baby; and circumcision. Because excessive stress is detrimental to labor progress and fetal and neonatal well‐being, alternatives to these stressful policies and procedures are suggested. Many stressful events are done without indication and may thus be eliminated.
A History of Accouchement Forcé: 1550–1985
Authors: Ashford Janet Isaacs
Published: April 2007

ABSTRACT: ‘Accouchement force’or forcible delivery referred originally to the internal podalic version and extraction descibed by French surgeon Paré in the 1500s. The term was later used by DeLee and others to describe several methods of forcible cervical dilatation and delivery. American obstetrics literature from 1903 to 1958 describe several devices and techniques for “accouchement forcé”: manual dilatation, metal cervical dilators, hydrostatic bags, cervical incisions, and prophylactic episiotomy and forceps. The use of postural change or abdominal support to facilitate the mother's expulsive efforts has been rare. Current methods of forcible delivery include the use of oxytocin, laminaria, prostaglandins, and cesarean section. Methods of ‘accouchement forcé’were first used only for complicated cases, but intervention eventually became widespread. Older forms of ‘accouchement forcé’have been abandoned in favor of safer, more refined methods. But debate continues over the use of forcible techniques in normal labor.
SOME ANSWERS TO QUESTIONS RAISED ABOUT THE DUBLIN TRIAL
Authors: Grant Adrian
Published: April 2007

In the Dublin trial a hypothesis tested (and sustained) was that electronic fetal monitoring (EFM) reduces the risk of neonatal seizures. Only secondary analyses of the data suggest that this benefit was concentrated in labors of more than 5 hours and those in which oxytocin was used. Claims that EFM is only protective under these conditions, and claims of superior methods of monitoring the fetus or interpreting fetal heart rates tracings, must themselves be tested in formal clinical experiments.
ELECTRONIC MONITORING IN LABOR: TOO GOOD TO BE PUT TO THE TEST?
Authors: Keirse Marc J. N. C.
Published: April 2007

Obstetric litigation in the U.S. has rendered electronic fetal monitoring “efficacious and capable of detecting asphyxia at an early enough stage to avoid neurologic damage.”Court decisions are “directly translatable to one's practice”when randomized controlled trials, apparently, are not.

Nevertheless, hypotheses regarding the benefits of certain paper speeds and the importance of beat‐to‐beat variability cannot be accepted until they are tested in properly designed randomized controlled trials. Among several difficulties to surmount is the repeated finding that interobserver agreement on fetal heart rate tracings has never exceeded 70 percent.
Nurses’ Responses to Changes in Maternity Care, Part I. Family‐Centered Changes and Short Hospitalization
Authors: Stolte Karen , Myers Sheila Taylor
Published: April 2007

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.
A Comparison of Women's Expectations of Labor with the Actual Event
Authors: Stolte Karen
Published: April 2007

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.
Do Hospitals with Family‐centered Maternity Care Policies Have Lower Intervention Rates?
Authors: Lumley Judith , Davey Brian A.
Published: April 2007

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.
In Vitro Fertilization: Reflections on the State of the Art
Authors: Holmes Helen Bequaert
Published: April 2007

ABSTRACT: Using data collected from in vitro fertilization/embryo transfer (IVF/ET) programs, which have mushroomed worldwide during the past eight years, I summarize current clinical practices and results with regard to success rates, patient selection, ovulation induction, oocyte retrieval, semen collection, laboratory fertilization, embryo transfer, and pregnancy outcome. Each step may entail risks, clinical problems, and/or ethical issues. Among concerns that arise from reflection on the practices and issues are risks to offspring, psychologic/emotional effects, use of women in experiments, possible overuse of IVF, financial issues, and proposed future extensions of reproductive engineering.
Some Consumer Aspects of In Vitro Fertilization and Embryo Transfer
Authors: Bonnicksen Andrea
Published: April 2007

ABSTRACT: Twenty‐five women who tried in vitro fertilization and embryo transfer (IVF/ET) at six hospitals were interviewed. All expressed satisfaction with the procedure, but some voiced concerns about the way they were treated. Their comments, together with a review of IVF clinic promotional literature and the medical literature, suggest the need to investigate the way this technology is marketed, particularly the way success rates are calculated and communicated to patients, hospitals sell experimental procedures to patients, and physicians disclose the risks and disappointing possibilities during attempts at IVF/ET.