bluuebunny/crossref_metadata_2025 huggingface dataset:
The Risk of High Multiparity with IVF/ET
Authors: Price Frances V.
Published: April 2007

ABSTRACT: From 1980 to 1985 not only were more infants delivered at higher‐order multiple births, but more survived. The rise in multiple gestation has been attributed in part to the drugs and procedures used in the management of infertility and assisted conception, especially multiple embryo transfer after in vitro fertilization and multiple egg transfer in the gamete intrafallopian transfer procedure. Very often, survival of small infants from higher‐order multiple gestations taxes the resources of the medical and social services. If they survive the perinatal period, the feeding, nurturing, and physical care of triplets, quadruplets, quintuplets, or sextuplets places extraordinary demands on their caretakers. The problems and risks extend far beyond individual clinical cases to the wider social ramifications of the birth and care of these children.
Rethinking Oxytocin Protocols in the Augmentation of Labor
Authors: Curtis Peter , Safransky Norma
Published: April 2007

ABSTRACT: Over the past 30 years oxytocin has been used extensively to augment labor. The physiologic responses of the uterus to oxytocin are reviewed in relation to current practices in the augmentation of labor. The data suggest that excessive doses are being used in routine obstetric care, and that a much more cautious approach is needed, as well as clinical trials to evaluate the efficacy of high‐ and low‐dose protocols.
Unexplained Differences in First Stage Labor Duration in Primiparas at North American and European Hospitals
Authors: Thomson Molly
Published: April 2007

ABSTRACT: Data were reviewed on first stage labor duration, as measured from onset of contractions or from hospital admission, in primiparas at three North American and three European hospitals in the past decade. Median durations were found to be over an hour longer in the North American hospitals where labor stimulation with oxytocic drugs appeared to be more frequent. It is concluded that shorter durations at the European hospitals must be attributed to factors other than the “active management of labor” with oxytocic drugs.
How Can Aspiration of Vomitus in Obstetrics Best Be Prevented?
Authors: McKay Susan , Mahan Charles
Published: April 2007

ABSTRACT: Concern about the incidence of maternal aspiration and its effect upon maternal morbidity and mortality has resulted in restricting oral intake of laboring women, although data show maternal death to be rare. Among many factors that can be linked to the occurrence of aspiration, the most important appears to be faulty administration of obstetric anesthesia.
Lead and Pregnancy
Authors: Rabinowitz Michael
Published: April 2007

ABSTRACT: Excessive lead exposure, not only from lead‐based paint in older homes, but also in yard soils, remains a public health problem in America despite centuries of knowledge of the poisonous nature of lead. Heightened concern about communitywide lead exposure has followed recent research findings that show lead to be toxic at levels previously thought to have no effect. Because mothers and children have been considered to be at particular risk, pregnant women and those responsible for perinatal care require greater understanding of the sources and effects of lead.

In a study of 4354 women, the risk of pregnancy hypertension and of congenital anomalies doubled as umbilical cord lead levels increased from about 1 to 10 μg per dL. A subgroup of about 240 was further studied for environmental sources of lead and follow‐up of the children's development. This is a continuing longitudinal study; many of its published results are summarized here, with information from other studies. The effects of pregnancy on lead metabolism are also discussed.
Predictors of a Positive Childbirth Experience
Authors: Crowe Kathryn , von Baeyer Carl
Published: April 2007

Abstract: Knowledge of childbirth, fears regarding pregnancy, locus of control, state anxiety, expectation of pain, and confidence in ability to control pain were examined as possible predictors of positive childbirth experience. Self‐reports of these variables were collected from 30 primiparous women enrolled in prenatal courses, on three occasions: before the first class, after the last class, and 24 to 48 hours after delivery. The number of women completing postdelivery measures was 21. It was found that those who demonstrated greater knowledge of childbirth and higher confidence after classes subsequently reported a less painful childbirth. Of interest, those with higher levels of childbirth‐related fear before classes reported experiencing less anxiety during labor and delivery. It was suggested that these women may have recognized and dealt with their concerns earlier. Psychologic factors that appear to be most predictive of a positive childbirth experience include knowledge, confidence, and anxiety. The present findings support the current emphasis in prenatal education on imparting knowledge, instilling confidence, and providing a forum for dealing with childbirth‐related fears.
A Randomized Trial of the Effects of Monitrice Support During Labor: Mothers' Views Two to Four Weeks Postpartum
Authors: Hodnett Ellen D. , Osborn Richard W.
Published: April 2007

Abstract: One hundred three women who were randomized to receive either routine nursing care (controls) or routine care plus one‐to‐one support by an experienced monitrice (experimental) were compared as to obstetric outcomes and their memories of types of support they had from nurse, monitrice, and mate. Women assigned a monitrice arrived at the hospital significantly further along in labor, and nearly twice as many had no medication during labor and delivery. Significantly fewer of these women used stirrups during delivery, and more had intact perineums. There was no difference between groups in use of forceps or cesarean sections. Length of labor was confounded by use of medications. Mothers in the experimental group remembered receiving more physical comfort measures, emotional support, and advocacy from monitrices compared to control mothers who received intrapartum care from nurses.
Cesarean Childbirth in New York State: Trends and Directions
Authors: Zdeb Michael S. , Logrillo Vito M.
Published: April 2007

Abstract: During 1987 the New York State Department of Health prepared a report that showed trends in cesarean childbirth from 1970 through 1986 and analyzed related factors for the period 1984–1986. As a result, a joint task force was formed consisting of members of the state health department, The American College of Obstetricians and Gynecologists, and the Hospital Association of New York State. The task force met regularly through 1988 to discuss obstetric care in New York state. These discussions led to a joint education and research project intended to improve the understanding of the patterns of obstetric care in the state, to assess a method of quality‐of‐care review of obstetric programs to improve maternal and fetal outcomes, and to establish an educational framework within this review process. The project will continue through June 1990, when recommendations will be made leading to a more formal, continuing review process for ongoing improvements in quality of obstetric care and institutional management.
A longitudinal Study Comparing the Prenatal Care of Puerto Rican and White Woman
Authors: Lazarus Ellen S. , Philipson Elliot H.
Published: April 2007

ABSTRACT: This study examined the effect of ethnicity on health‐seeking attitudes and behavior, including patient compliance, use of the clinic, knowledge of childbirth, and the relationship between the patient and primary health care provider. Anthropologic techniques of observations and interviews were conducted longitudinally with 27 Puerto Rican women and 26 white women who received perinatal care at a tertiary‐level hospital throughout the antepartum, intrapartum, and postpartum periods. Approximately 500 standardized and open‐ended interviews and 150 observations of clinical interactions with resident physicians and nurse‐midwives compared reproductive knowledge, beliefs, and practices. Results of this three‐year study indicated that both groups of women were similar in age, years of education, and percentage receiving financial assistance. Puerto Rican women identified strongly as a separate ethnic group; all spoke Spanish and most were bilingual. Office visits and explanations from primary care providers were more important to women in both groups than information obtained from families, friends, or folk beliefs. Knowledge of pregnancy care procedures and childbirth, although limited, was no different between the groups. Long waits, depersonalized service, and a lack of continuity of care adversely affected patient and physician satisfaction and diminished effective doctor‐patient interactions. This study suggests that differences in ethnic background do not necessarily adversely affect the delivery of reproductive health care. Indigent white and Puerto Rican women wanted the same thing: quality perinatal care and education.
Breastfeeding and Fathers: Illuminating the Darker Side
Authors: Jordan Pamela L. , Wall Virginia R.
Published: April 2007

ABSTRACT: Although breastfeeding may be the best form of infant nutrition and be an important practice for mother and infant, it may be perceived as negative by the father and thus inhibit the development of the father‐infant relationship. This study provides a summary of data from a longitudinal study of the male experience of expectant and new parenthood, and a summary of the literature on breastfeeding and fathers. Fathers' concerns about breastfeeding included the lack of opportunity to develop a relationship with their child, feeling inadequate, and being separated from their mate by the baby. The professional literature fails adequately to represent the negative aspects of breastfeeding for fathers. The parents' literature contains one father's candid and humorous account that caregivers might use, together with other techniques, to make parents aware of these aspects.
How Voluntary Prenatal Diagnosis and Selective Abortion Increase the Abnormal Human Gene Pool
Authors: Boss Judith A.
Published: April 2007

ABSTRACT:It is often assumed that prenatal diagnosis followed by the selective abortion of “defective’ fetuses has a positive eugenic effect. Although mandatory selective abortion of “defective’ fetuses and, more important, carriers would tend to reduce the number of deleterious genes in the gene pool, the present program of voluntary prenatal diagnosis and selective abortion actually increases the number of deleterious genes. This raises the issue of freedom of choice regarding selective abortion and societal pressure on parents to undergo prenatal testing and to abort their fetus should it have a genetic disorder or be a carrier of one.
Outcomes of 1001 Midwife‐Attended Home Births in Toronto, 1983–1988
Authors: Tyson Holliday
Published: April 2007

ABSTRACT: A retrospective descriptive study of 1001 midwife‐attended home births in Toronto, Ontario, was carried out between January 1983 and July 1988. Interviews with 26 midwives and reviews of client records provided data on maternal age, socio‐economic status, gestation, ruptured membranes, length of labor, episiotomies and perineal lacerations, transfer to hospital of mother or baby or both, infant resuscitation, and breastfeeding. Of 1001 planned home births, 361 involved primiparous women, of whom 245 (68%) remained at home and 116 (32%) required transfer of mother or baby to hospital during labor or the first four postpartum days. Of the 640 multiparous births, 591 (92%) women remained at home and 49 (8%) required transfer to hospital. Among women transferred, 91 had spontaneous vaginal births, 34 had forceps deliveries, and 35 had cesarean sections. Variables significantly associated with maternal transfer for both primiparas and multiparas were length of latent and active phases of the first stage of labor, length of the second stage of labor, and duration of ruptured membranes. Five neonates were transferred and two died, one each after birth at home and in hospital. There were no maternal deaths. The proportion of mothers breastfeeding without supplement at 28 days postpartum was 98.6 percent.
1989 U.S. Cesarean Section Rate Steadies—VBAC Rate Rises to Nearly One in Five
Authors: Taffel Selma M. , Placek Paul J. , Moien Mary , Kosary Carol L.
Published: April 2007

ABSTRACT: The 25 years of rising cesarean delivery rates in the United States may have finally run their course. In 1989 the rate of 23.8 cesareans per 100 deliveries was not significantly different from 24.7 in 1988, 24.4 in 1987, or 24.1 in 1986. The 1989 primary rate of 17.1 first cesareans per 100 women with no previous cesarean was also not significantly different from 17.5 for 1988, or 17.4 for 1987 and 1986. The percentage of vaginal births after cesarean section per 100 deliveries showed a remarkable rise between 1988 and 1989—from 12.6 percent in 1988 to 18.5 percent in 1989. Data are from the National Hospital Discharge Survey conducted by the National Center for Health Statistics, Centers for Disease Control.
Grassroots Strategies for Promoting Maternal and Infant Health
Authors: Hazen Aaronson Roberta
Published: April 2007

ABSTRACT: For the past four years, grassroots organizing efforts in Rhode Island have been directed toward improving maternal and infant health. Coalitions of consumer organizations, health care providers, and activists have achieved important legislative initiatives, such as health insurance for uninsured pregnant women and promotion of midwifery services. This article examines the processes involved in organizing for improved maternal and infant health care, the dynamics involved in achieving a particular outcome, and the ways in which grassroots mobilization can affect public policy and contribute toward improved maternal and infant health.
The Introduction of Midwifery in Ontario, Canada
Authors: Kaufman Karyn J.
Published: April 2007

ABSTRACT: Midwives in Ontario, Canada, currently have no legal status. After an announcement in 1986 that the government would recognize them, an extensive planning period ensued. Groups of health care providers, consumers, and government representatives were active participants in formulating plans to integrate midwives into the centrally organized health care system in Ontario. Efforts to introduce legislation, establish a regulatory framework, and develop an educational program are well developed, but legalized practice must yet be realized.
“You'll Feel Me Touching You, Sweetie”: Vaginal Examinations During the Second Stage of Labor
Authors: Bergstrom Linda , Roberts Joyce , Skillman Leslie , Seidel John
Published: April 2007

ABSTRACT: Videotapes of women during the second stage of labor and their caregivers were examined in this descriptive study to determine how caregivers performed sterile vaginal examinations. Conversational analysis techniques were used to analyze the data. Results showed that the examinations were performed in a ritualistic manner by all caregivers, and the way the ritual was enacted repeatedly demonstrated the power of the caregivers over the women. The most common reason for performing the procedure, to help the woman push better, seems to be specific to the second stage of labor and is not described in the literature. The authors offer suggestions for better use of the examination, and recommend that it be performed far less frequently than is common.
Case Report: Survival of an Infant with a Birthweight of 345 Grams
Authors: Sherer David M. , Abramowicz Jacques S. , Bennett Shirley L. , Mercier Charles E. , Woods James R.
Published: April 2007

ABSTRACT: Infant survival with ever‐decreasing birthweights is attainable with recent advances in maternal‐fetal medicine and enhanced neonatal intensive care. We report a gestation complicated by severe chronic hypertension and fetal distress necessitating delivery at 26 1/7 weeks. The growth‐retarded newborn weighed 345 g (12 oz) and survived with minimal sequelae despite a protracted and complicated neonatal course.
Women's Satisfaction with Birth Center Care: A Randomized, Controlled Study
Authors: Waldenström Ulla , Nilsson Carl‐Axel
Published: April 2007

This randomized, controlled trial compared women's satisfaction with care at an in‐hospital birth center with standard obstetric care in Stockholm. Subjects were 1230 women with an expected date of birth between October 1989 and February 1992, who expressed interest in birth center care, and who were medically low risk. The intervention was the random allocation of maternity care at the birth center or standard obstetric care. Birth center women expressed greater satisfaction with antenatal, intrapartum, and postpartum care, especially psychological aspects of care. Of these women, 63 percent thought that the antenatal care had raised their self‐esteem, versus 18 percent of the control group. Eighty‐nine percent of the experimental group would prefer birth center care for any future birth, and 46 percent of the control group would prefer standard care. Birth center care successfully meets the needs of women who are interested in natural childbirth and active involvement in their own care, and are concerned about the psychological aspects of birth.
Personal Beliefs and Alternative Childbirth Choices: A Survey of 552 Women Who Planned to Give Birth at Home
Authors: Bastian Hilda
Published: April 2007

In Australia, planning to give birth at home was unusual in the middle to late 1980s, a choice made by only about 0.5 percent of women. This study investigated the personal beliefs and circumstances of 552 women who planned to give birth at home. Results showed that these women came from diverse backgrounds and beliefs, although in general they were of higher than average educational and occupational status, and less likely to hold Christian beliefs relative to the Australian community in general. Their lives and experiences rejected both unconventional and more traditional choices, and the view that women who give birth at home characteristically belong to the counterculture could not be justified. The findings of this study suggest that stereotypes of women who give birth at home do not apply to the circumstances of substantial numbers of women.
Ultrasound During Pregnancy: A Discussion
Authors: Ewigman Bernard , Green Jo , Lumley Judith
Published: April 2007

PREAMBLE: Prenatal screening by ultrasound is increasing in the United States. In 1990, 52 percent of mothers who had live births received ultrasound, compared with 48 percent in 1989 (Monthly Vital Stat Rep 1993;42:2(S):6). A recent multicenter, randomized study of 15,151 low‐risk pregnant women, conducted by the Routine Antenatal Diagnostic Imaging With Ultrasound (RADIUS) Study Group, reported no significant differences in pregnancy outcomes between women who received no ultrasound scan and women who received two scans during pregnancy (N Engl J Med 1993;329:821–827). Ewigman et al concluded, “The adoption of routine ultrasound screening in the United States would add considerably to the cost of care in pregnancy, with no improvement in perinatal outcome.”

This interview and discussion took place at the Tenth Birth Conference, October 31‐November 1, 1992, in Boston. It was conducted by Max Allen, producer, Canadian Broadcasting Corporation, and broadcast as part of a radio program, “Birth and Technology,” on CBC Ideas, February 15, 1993.
Redefining Women's Work During Pregnancy: Toward a More Comprehensive Approach
Authors: Deloseph Jeanne F.
Published: April 2007

The potential effects of work and activity on the processes and outcomes of pregnancy should be assessed when a woman's care plan is developed. Perinatal caregivers are limited by a narrow definition of work that encompasses only employment. This commentary expands the description of women's work during pregnancy, and proposes the addition of some activities not currently considered in most prenatal assessments, including home care responsibilities, the maintenance and development of intimate relationships, and the tasks identified with becoming a mother. All this has implications for research, clinical practice, and public and health policy.
Attenders and Nonattenders at Childbirth Education Classes in Australia: How Do They and Their Births Differ?
Authors: Lumley Judith , Brown Stephanie
Published: April 2007

This study assessed the associations between attendance at childbirth preparation classes and the health behaviors, birth events, satisfaction with care, and later emotional well‐being of women having their first child. A postal survey was conducted of a population‐based cohort of 1193 women who gave birth in two weeks in 1989 in Victoria, Australia. The response was 71.4 percent (79011107). Classes were attended by 245 (83.9%) of 292 primiparous women. Those who did not attend were significantly more likely to be under age 25 years, not to have completed secondary education, to be single, to have a low family income and no health insurance, and to be public hospital clinic patients. Differences between women who attended classes and those who did not, with respect to measures of pain and to the use of procedures, interventions, and pain relief, were rare and minor. No differences occurred between the groups in their satisfaction with the provision of information through pregnancy, birth, and the postnatal period. Only one of five measures of satisfaction with cure was less favorable in nonattenders. Attenders were not more confident about looking after their infants at home or less likely to be depressed eight months after birth. Significant differences occurred between the groups on four health behaviors: cigarette smoking, missed antenatal appointments, breastfeeding, and alcohol consumption during pregnancy. Attendance at childbirth preparation classes in Victoria is not associated with differences in birth events, satisfaction with care, or emotional well‐being among women having their first child. (BIRTH 20:3, September 1993)
A Plan for Implementing Mother‐Baby Nursing
Authors: Steensma Judith
Published: April 2007

This article describes the plan and implementation for converting from traditional obstetric nursing to a mother‐baby care delivery system in a level 2 hospital in upstate New York. It identifies the pitfalls, problems, and process to follow for the successful implementation of mother‐baby nursing. (BIRTH 20:3, September 1993)
A Time To Be Born: Implications of Animal Studies in Maternal‐Fetal Medicine
Authors: Nathanielsz Peter W.
Published: April 2007

ABSTRACT: Recent studies on the capabilities of the fetus in the last third of gestation demonstrated that the fetus actively prepares for its journey to the extrauterine environment. The most remarkable of these preparations is that the fetal brain gives the signal to begin the birth process. Several studies, particularly those conducted in sheep, showed that endocrine signals from the fetal brain are sent to the placenta to stimulate increased estrogen production. The increased estrogen production initiates uterine contractility, and starts the labor process. The mother's oxytocin production also plays a role by determining the precise time of the day that the baby is born. These studies produced fascinating insights into fetal and uterine physiology that have already begun to be employed in clinical care. One primary example in the application of this new knowledge obtained originally from studies on fetal sheep is in understanding the endocrine regulation of fetal production of surfactant to treat women in preterm labor and to produce artificial surfactants for the treatment of babies delivered too early. It is important to obtain and use reproducible data gained from carefully controlled animal experiments to rationalize clinical management practices. Basic research should precede changes in clinical management, rather than follow them, as is so often the case.
Cesarean Section Rates in Teaching Hospitals: A National Survey
Authors: Sanchez‐Ramos Luis , Moorhead Rebecca I. , Kaunitz Andrew M.
Published: April 2007

ABSTRACT: This survey investigated the cesarean section rate in teaching hospitals in the United States and the factors that may influence it. A national survey was performed by mailing a questionnaire to 277 accredited residency programs in obstetrics and gynecology. The estimated cesarean rate in all hospitals, with residencies in obstetrics and gynecology in the United States in 1990 was 20.3 percent, compared with an overall national rate of 23.5 percent. Women delivering in teaching hospitals were less likely to have a cesarean section than those delivering in hospitals without residency programs (odds ratio = 0.77, 95% CI 0.77–0.78, p = 0.0001). As centers for training and research, teaching hospitals represent an appropriate setting to begin the process of lowering the United States cesarean section rate.
Women's Experiences with Breastfeeding Longer Than 12 Months
Authors: Hills‐Bonczyk Sharon C. , Tromiczak Kristine R , Avery Melissa D. , Potter Susan , Savik Kay , Duckett Laura J.
Published: April 2007

ABSTRACT: This prospective, longitudinal study was conducted to describe the experiences of 82 primiparas who breastfed longer than 12 months. They were compared with 541 primiparas who weaned their infants within the first year. Greater age, education, and weeks of exclusive breastfeeding were associated with longer duration of breastfeeding. More than two‐thirds (68%) of the women who breastfed longer than one year returned to employment before their infant was 1 year old. The most frequently chosen reason for long‐term breastfeeding was that breastfeeding was a special time for mother and baby that the mother was not ready to give up. Nearly half of the women reported breastfeeding their‐ babies on demand. At 12 to 15 months, 54 percent of the babies slept in a crib in a separate room, and 37 percent slept in the same bed with their mother all or part of the night. Most mothers (57%) considered their support group to be slightly or moderately important in influencing their decision to breastfeed beyond a year, and 10 percent considered it to be extremely important. The major themes that emerged from women's comments were the importance of being strong in the face of social unacceptability, development of n close mother‐child bond, and the naturalness of breastfeeding beyond 12 months. Health caregivers should recognize the emotional and interpersonal aspects of long‐term breastfeeding, support the breastfeeding relationship, and avoid contributing to the development of “closet nursers” so that women may feel free to discuss their concerns about their child's health.
Prevention of Perineal Trauma by Perineal Massage During Pregnancy: A Pilot Study
Authors: Labrecque Michel , Marcoux Sylvie , Pinault Jean‐Jacques , Laroche Christine , Martin Sylvie
Published: April 2007

ABSTRACT: Although the performance of perineal massage by a woman or her partner during the last weeks of pregnancy may help to prevent perineal trauma at delivery, the technique has never been evaluated rigorously. This study examined the feasibility of a randomized, controlled trial, and more specifically assessed the participation rate, the acceptability of the intervention, and whether or not an attending physician could remain blind to participants' groups. The pilot study was a single‐blinded, randomized, controlled trial. Nulliparous women, 32 to 34 weeks pregnant, were recruited from June 8 to July 31, 1992, at the offices of family physicians and obstetricians who practice at the Hôpital du Saint‐Sacrement in Quebec City. Women assigned to the intervention group practiced daily 10‐minute perineal massage and completed a diary, and those in the control group had standard care. Women and attending physicians completed a questionnaire about the aspect of blindness. Among the 174 women who delivered during the study period, 104 (59.8%) were approached by a midwife and 46 (26.4%) were randomized. Twenty (91.0%) of the 22 women in the massage group returned their perineal massage diaries. Based on the postpartum questionnaire, 20 women practiced the technique at least four times a week for three weeks or longer. No woman in the control group practiced massage. The attending physician was aware of the woman's group in only three instances (6.7%). Based on the results of this pilot study, a randomized, controlled trial to evaluate the efficacy of perineal massage in preventing perineal trauma at birth appears feasible.
The Cesarean Section Rate in Sweden: The End of the Rise
Authors: Nielsen Thorkild F. , Otterblad Olausson Petra , Ingemarsson Ingemar
Published: April 2007

ABSTRACT: This nationwide study examined the annual changes in cesarean section rates in relation to perinatal mortality, the condition of the newborn at birth, and different indications for the procedure in Sweden. Since 1973 all obstetric units have sent copies of medical birth registration forms for newborns to the National Board of Health and Welfare. Information about the cesarean section rate, indications for the surgery, Apgar scores, and perinatal mortality between 1973 and 1990 was obtained from this data base. The cesarean section rate increased from 5 percent in 1973 to 12.3 percent in 1983, and thereafter declined steadily to 10.84 percent in 1990. Perinatal mortality was halved from 14.2 to 6.3 per 1000 live births, and the number of newborns with low Apgar scores (<4 at 1 min and/or <7 at 5 min) decreased from 20 to 14 per 1000 live births. We conclude that it is possible to lower the cesarean section rate on a nationwide basis without increasing risks to newborn infants.
Anemia and Insufficient Milk in First‐Time Mothers
Authors: Henly Susan J. , Anderson Cindy M. , Avery Melissa D. , Hills‐Bonuyk Sharon G. , Potter Susan , Duckett Laura J.
Published: April 2007

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 insuficient 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 insuficient 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 insuficient milk syndrome. The study results suggest that anemia is associated with the development of insuficient milk, which in turn, is related to duration of full breastfeeding and to age at weaning.
Decreased Cesarean Birth Rates and Improved Perinatal Outcome: A Seven‐Year Study
Authors: Ziadeh Saed M. , Sunna Elias I.
Published: April 2007

ABSTRACT: This study examined the decrease in cesarean section rates in relation to perinatal mortality between 1987 and 1993 at the primary referral hospital in north Jordan. Most of the population is at high risk and of low socioeconomic status. The cesarean section rate decreased from 15.5 percent in 1987 to 8.7 percent in 1993, and has remained at this low rate. During the same period the perinatal mortality dropped from 52 to 20.9 deaths per 1000 live births. These results do not include perinatal morbidity. The successful reduction of the cesarean section rate is attributed to active management of labor, trial of labor for women with a previous cesarean birth, and vaginal breech delivery in selected women. We conclude that the rate of cesarean delivery can be safely reduced in a developing country without adverse effects on birth outcomes.
Do Childbirth Classes Influence Decision Making about Labor and Postpartum Issues?
Authors: Handfield Bronny , Bell Robin
Published: April 2007

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.
Women's Satisfaction with Prenatal Care Settings: A Focus Group Study
Authors: Handler Arden , Raube Kristiana , Kelley Michele A. , Giachello Aida
Published: April 2007

ABSTRACT: Background: Patient satisfaction is considered, together with health status, to be an outcome of the delivery of health care services as well as a measure of its quality. A focus group study of 50 low‐income Mexican‐American, Puerto Rican, African‐American, and white women in Chicago, Illinois, explored the characteristics of prenatal care that affect women's satisfaction. Methods: Transcripts from the focus groups were analyzed using researcher‐derived coding categories to develop broad themes. Results: Despite their diverse ethnic backgrounds, participants revealed few differences with respect to what they value in prenatal care. Aspects of care that appeared to affect women's satisfaction included the “art of care,” the technical competence of the practitioner, continuity of caregiver, and the atmosphere and physical environment of the care setting. The one characteristic that did not appear to affect satisfaction was the caregiver's ethnicity. Conclusion: Knowledge of how the characteristics of prenatal care affect women's satisfaction can help increase use of care and ultimately improve perinatal outcomes.
Rural Maternity Care: New Models of Access
Authors: Nesbitt Thomas S.
Published: April 2007

ABSTRACT: b

Despite huge health care expenditures, many rural areas of the United States are without adequate access to basic maternity services. Hospital closures and changes in reimbursement have created new threats, even in areas with functional systems of delivering maternity care. New models of care must be developed that take advantage of attributes of low‐volume rural maternity units, increase the number of collaborative practices among various providers of maternity services, and judiciously apply new technologies to bring perinatal expertise into the rural hospital when appropriate. Local access to maternity care in rural communities is essential to improve birth outcomes and lower costs. Standardization of management of obstetric emergencies and advances in telecommunication technology may make these low‐technology, isolated communities safer than they have been in the past. Changes in health care financing, particularly managed care with capitation, may further support these changes.
Ethnicity and Sources of Prenatal Care: Findings from a National Survey
Authors: Gardner Michael O. , Cliver Suzanne P. , McNeal Sandre F. , Goldenberg Robert L.
Published: April 2007

Background: Improving pregnancy outcomes for minorities is a major goal of health providers and policy makers. Since most strategies involve an intervention during pregnancy, it is important to know where minority women with various characteristics receive prenatal care and why. Our purpose was to evaluate services of prenatal care for white, African‐American, Mexican‐American, and Puerto Rican women.Methods:The National Maternal and Infant Health Survey (1988) was used to ascertain age, income, marital status, education level, and source of funding of the study population of 21,000 women, who were assigned to an ethnic group based on self‐identification in the survey. The sources of prenatal care were classified as private (private physician, nurse‐midwife, health maintenance organization) or public (state or local health department, community health center, hospital‐based clinic).Results:When categorized by ethnic group alone, 78 percent of white women received private care compared with 51 percent of Mexican‐American women, 44 percent of African‐American women, and 37 percent of Puerto Rican women. Private health insurance was held by 78 percent of white, 50 percent of African‐American, 49 percent of Mexican‐American, and 47 percent of Puerto Rican women. Of those with private insurance, 86, 62, 69, and 59 percent, respectively, received private care. Of white women with Medicaid funding, 52 percent received private care as opposed to a range of 20 to 42 percent for minority women.Conclusions:Substantial differences in sources of prenatal care exist between white and minority women and between different minority groups, suggesting that policy makers and health caregivers should tailor prenatal care intervention to the needs of specific minority populations.
A Survey of Midwives in Quebec: What are Their Similarities and Differences?
Authors: Hatem‐Asmar Marie , Blais Régis , Lambert Jean , Maheux Brigitte
Published: April 2007

Background: Until recently, Canada was the only industrialized country that had not legalized midwifery. In the province of Quebec the government adopted a law to evaluate midwifery in eight pilot projects before generalizing the practice. This study examined the similarities and differences among midwives in Quebec.Methods:Using data from a 1991 mail survey, we compared 31 nurse‐midwives, 12 professional midwives, and 27 lay midwives to assess professional background and opinions about selected maternity care issues and aspects of future midwifery practice, such as midwife training options, responsibilities, setting for midwifery care, relationship to other maternity caregivers, autonomy, and control over their profession.Results:Midwives largely shared the same philosophy of care but had different viewpoints on two main professional aspects: compared with professional midwives and nurse‐midwives, lay midwives preferred to deliver antepartum, intrapartum, and postpartum care at a client's home or an independent birthing center; like professional midwives, they rejected nursing as a prerequisite to midwifery training. Other interrelated personal, social, political, and legal factors were also associated with different beliefs.Conclusions:Despite the differences among the three groups, the process under way in Canada is to recognize a single profession of midwife. Creating a unified profession is a challenge that Canadian midwives with different backgrounds face in the 1990s.
Prenatal Weight Gain Patterns and Infant Birthweight Associated with Maternal Smoking
Authors: Groff Janet Y. , Dolan Mullen Patricia , Mongoven Michele , Burau Keith
Published: April 2007

Background:

Maternal smoking during pregnancy is recognized as an important and modifiable risk factor for low infant birthweight. The objective of this study was to compare the effects of maternal smoking status on prenatal weight gain and infant birthweight, and to determine if maternal weight gain mediates the effect of smoking cessation on infant birthweight.

Methods:

This prospective study of 341 white, non‐Hispanic pregnant smokers, never smokers, and women who stopped smoking during pregnancy used multivariate analysis of variance to evaluate prenatal weight gain patterns. Multiple regression was used to investigate the effects of smoking status and maternal weight gain on infant birthweight.

Results:

Women who stopped smoking gained on average 39.68 lb during pregnancy. Smokers gained 32.75 lb, and never smokers gained 34.16 lb. Women who stopped gained significantly more weight than both smokers and never smokers (p= 0.01). Rates of weight gain differed significantly beginning in the second trimester, when women who stopped smoking gained more weight than never smokers (2.57 lb, 99% CI = 0.46, 8.07) and continued during the third trimester, with those who stopped smoking gaining more weight than both smokers (4.31 lb, 99% CI = 1.88, 12.00) and never smokers (1.25 lb, 99% CI = 0.56, 10.49). Infant birthweight differences were significant for women who stopped smoking versus continuing smokers (292 g, 99% CI = 145, 440) and for never smokers versus continuing smokers (253 g, 99% CI = 104, 401). Controlling for baseline maternal body mass index and infant gender, smoking status and weight gain each contributed significantly to infant birthweight (p<0.001). No evidence of interaction between smoking status and weight gain on infant birthweight was found.

Conclusions:

Maternal smoking status significantly affects prenatal weight gain and infant birthweight, but smoking cessation protects against lower birthweight through mechanisms other than increased maternal weight gain or different weight gain patterns. (BIRTH 24:4, December 1997)
Fixed and Random Effects Selection in Linear and Logistic Models
Authors: Kinney Satkartar K. , Dunson David B.
Published: April 2007

SummaryWe address the problem of selecting which variables should be included in the fixed and random components of logistic mixed effects models for correlated data. A fully Bayesian variable selection is implemented using a stochastic search Gibbs sampler to estimate the exact model‐averaged posterior distribution. This approach automatically identifies subsets of predictors having nonzero fixed effect coefficients or nonzero random effects variance, while allowing uncertainty in the model selection process. Default priors are proposed for the variance components and an efficient parameter expansion Gibbs sampler is developed for posterior computation. The approach is illustrated using simulated data and an epidemiologic example.
Longterm results of 1 CU® accommodative intraocular lens implantation: 2‐year follow‐up study
Authors: Mastropasqua Leonardo , Toto Lisa , Falconio Gennaro , Nubile Mario , Carpineto Paolo , Ciancaglini Marco , Di Nicola Marta , Ballone Enzo
Published: April 2007

Purpose:  To evaluate the longterm efficacy of 1 CU® accommodative intraocular lenses (IOLs) to restore near visual performance.

Methods:  This prospective study comprised 14 eyes previously included in a 6‐month, case‐control clinical trial, undergoing phacoemulsification and implantation of a 1 CU® accommodative IOL. The main outcome measures were subjective refraction, uncorrected distance visual acuity (UCDVA), best corrected distance VA (BCDVA), distance‐corrected near VA (DCNVA), best corrected near VA (BCNVA), and subjective amplitude of accommodation (AA). In addition, anterior and posterior capsule opacification were assessed. Patients were examined over a 2‐year follow‐up period.

Results:  Distance and near visual performance worsened after 6 months. Uncorrected DVA and BCDVA were 0.8 ± 2.1 and 1.0 ± 0.8 at 6 months and 0.4 ± 0.1 and 0.6 ± 0.1 at 1 year, respectively (p = 0.001). Distance‐corrected NVA and BCNVA were 3.7 ± 2.1 Jaeger (J) and 1.0 ± 0.7 J at 6 months and 8.1 ± 0.7 J and 1.5 ± 0.5 J at 1 year, respectively (p = 0.001). Anterior and posterior capsule opacification were present, respectively, in 28% and 21% of patients at 6 months and in 100% of patients at 1 and 2 years (p < 0.001). After Nd:YAG laser capsulotomy (performed in 100% of patients), UCDVA and BCDVA increased to 0.7 ± 0.2 (p = 0.007) and 1.0 ± 0.1 (p = 0.001), respectively, at 2 years. Distance‐corrected NVA improved to 7.3 ± 0.5 J (p = 0.006). Mean AA was 1.9 ± 0.8 D at 6 months, 0.3 ± 0.2 D (p = 0.004) at 1 year and 0.3 ± 0.2 D at 2 years.

Conclusions:  Patients implanted with 1 CU® IOLs lost their accommodation capacities with time because of the high incidence and degree of anterior and posterior capsule opacification. The accommodative lens material and design may have played a role in capsule fibrosis.
Photopic 30 Hz flicker electroretinography predicts ocular neovascularization in central retinal vein occlusion
Authors: Kjeka Ole , Bredrup Cecilie , Krohn Jørgen
Published: April 2007

Purpose:  To confirm the predictive value of photopic cone b‐wave implicit time in 30 Hz flicker electroretinography (ERG) for ocular neovascularization (NV) in central retinal vein occlusion (CRVO), and to compare the ERG results to the presumed healthy fellow eye.

Methods:  A retrospective analysis of 71 consecutive patients with CRVO. After ERG examination, all patients were followed for at least 12 months, or until NV was found. Three patients died during the study period; none of the other patients were lost to follow‐up.

Results:  Twenty‐four patients (33.8%) developed NV during follow‐up. The mean cone b‐wave implicit time of all patients was 32.6 ms [standard deviation (SD) 5.21]. All 18 patients with an implicit time of 35.0 ms or higher (> 0.5 SD from mean) developed NV. In patients who developed NV, the average implicit time was 38.5 ms (range 29.7–43.9 ms); in patients without NV (n = 47), the average implicit time was 29.6 ms (range 24.7–34.9 ms) (P < 0.0001). The average implicit time in the presumed healthy fellow eye was 28.7 ms (range 24.4–33.9 ms) in patients with NV, and 26.5 ms (range 23.7–33.2 ms) in patients without NV (P = 0.002). The mean interocular difference in implicit time was 9.9 ms (range 4.1–15.7 ms) in patients with NV and 2.9 ms (range −1.0 to 10.0 ms) in patients without NV (P < 0.0001).

Conclusion:  Patients with CRVO should be examined routinely with photopic 30 Hz flicker ERG, which is a simple and objective clinical test that can identify patients at risk of ocular NV. On the assumption that the presented ERG settings are used, implicit times of 35.0 ms or higher (> 0.5 SD from mean) are clearly associated with the development of ocular NV. To compare the ERG result of the affected eye to the presumed healthy fellow eye is probably of less value.
Equilibrium distribution of skeletal actin–tropomyosin–troponin states, determined by pyrene–tropomyosin fluorescence
Authors: Gafurov Boris , Chalovich Joseph M.
Published: April 2007

Actin–tropomyosin–troponin has three structural states, but the functional properties of regulation can be explained with models having two functional states. As a step towards assigning functional properties to all the structural states, we examined fluorescent probes that monitor changes in troponin and tropomyosin. Tropomyosin labeled with pyrene–iodoacetamide is thought to reflect the transition to the most active state, whereas N‐((2‐iodoacetoxy)ethyl)‐N‐methyl)‐amino‐7‐nitrobenz‐2‐oxa‐1,3‐diazole‐labeled troponin I is thought to monitor the transition to any state other than the inactive state. The fraction of actin in an active state determined from pyrene excimer fluoresecence agreed with that calculated from light‐scattering measurements of myosin subfragment 1 (S1)–ADP to regulated actin in both the presence and absence of Ca2+ over a range of ionic strength conditions. The only exceptions were conditions where the binding of S1–ADP to actin was too strong to measure accurately. Pyrene–tropomyosin excimer fluorescence was Ca2+ dependent and so reflected the change in population caused by both Ca2+ binding and S1–ADP binding. Pyrene labeling of tropomyosin did not cause a large perturbation of the transition among states of regulated actin. Using pyrene–tropomyosin fluorescence we were able to extend the ionic strength dependence of the parameters describing the co‐operativity of binding of S1–ADP to actin as low as 0.1 m. The probes on tropomyosin and troponin I had different responses to Ca2+ and S1–ADP binding. These different sensitivities can be explained by an intermediate between the inactive and active states of regulated actin.