bluuebunny/crossref_metadata_2025 huggingface dataset:
The alchemy of training
Authors: Egger‐Biniores Deborah
Published: April 2007

Abstract:  Training in Zurich has its own special character but also is marked by the very fact that it is in Zurich. Zurich radiates its own distinct energy and carries a specific historical significance in the world of analytical psychology. This, like all things with psychic energy, has a spectrum of meaning. This spectrum, as well as the ‘spirit’ of the place, will be critically examined, taking into account the ‘blessings’ and ‘curses’ of such genius loci.

Training in Zurich is experientially based and is first and foremost an initiation: an initiation into symbolic life, or rather life where symbol plays an important role. Training is understood to involve a transformation of one's self, much like the 8th century alchemist Morienus Romanus understood the opus as a ‘human transformation system’. It is not merely an education.

The requirement of ‘immersion’ is core to the experience of becoming an analyst in Zurich and this sets up a valuable discomfort between rational intellectual learning and intuitive experience, between knowing and not‐knowing. How does this dis‐serve the making of an analyst? What is implicit in this immersion and its discomfort? Does it have a role in today's emphasis on clinical and empirical training? Does Zurich still offer something unique and valuable in the world of training, or is it passé? From these questions, the dichotomy of what is ‘urgent’ and ‘essential’ in training will be examined.
Evaluating progress in training: character or competence?
Authors: Wiener Jan
Published: April 2007

Abstract:  Jung was mercurial in his attitudes to method and technique, leaving us a problematic legacy when it comes to evaluating the progress of trainees. Some would say that those of us involved with the assessment of candidates during their training continue to rely too heavily on intuition and subjective assessments. However good our admissions' procedures and the structures in place to review progress, the emotional and financial demands for trainees of embarking on an analytic training, the tendency for analytic institutes to remain opaque and slow to link up with the external world and the cliques within our profession make more objective assessments of progress and readiness to qualify at best haphazard and at worst inadequate.

Some trainees have an immediate talent for analytic work; others develop their gifts more slowly; some never find this capacity. Working from a definition of analytic talent, the paper begins to map out a Jungian framework for assessing progress, emphasizing the significance of both character and competence and the developing relationship between them.
Flumazenil selectively prevents the increase in α4‐subunit gene expression and an associated change in GABAAreceptor function induced by ethanol withdrawal
Authors: Biggio Francesca , Gorini Giorgio , Caria Stefania , Murru Luca , Sanna Enrico , Follesa Paolo
Published: April 2007

The actions of ethanol on γ‐aminobutyric acid type A (GABAA) receptors are still highly controversial issues but it appears that some of its pharmacological effects may depend on receptor subunit composition. Prolonged ethanol exposure produces tolerance and dependence and its withdrawal alters GABAAreceptor subunit gene expression and function. Whereas benzodiazepines are clinically effective in ameliorating ethanol withdrawal symptoms, work in our laboratory showed that benzodiazepines also prevent,in vitro, some of the ethanol withdrawal‐induced molecular and functional changes of the GABAAreceptors. In the present work, we investigated the effects, on such changes, of the benzodiazepine receptor antagonist flumazenil that can positively modulate α4‐containing receptors. We here report that flumazenil prevented both the ethanol withdrawal‐induced up‐regulation of the α4‐subunit and the increase in its own modulatory action. In contrast, flumazenil did not inhibit ethanol withdrawal‐induced decrease in α1‐ and δ‐subunit expression as well as the corresponding decrease in the modulatory action on GABAAreceptor function of both the α1‐selective ligand zaleplon and the δ‐containing receptor preferentially acting steroid allopregnanolone. These observations are the first molecular and functional evidence that show a selective inhibition by flumazenil of the up‐regulation of α4‐subunit expression elicited by ethanol withdrawal.
Fetal Monitoring: Do the Benefits Outweigh the Drawbacks?
Authors: Shearer Madeleine H.
Published: April 2007

PROLOGUE

Recently I returned to teaching prenatal classes after an absence of 18 months. In my first class was a young girl who had been told that her baby was breech. She asked me if I would come with her and her husband in labor. I agreed, anticipating a chance to find out what was new at her teaching hospital and to help her, as well. A few weeks later I got her call, drove over and made my way up to her little labor room. For five minutes we talked. Then she panted quietly and rubbed her abdomen, her husband holding her other hand. At this point the door was propped open and a cabinet‐sized machine was rolled into the room, pushed by a nurse. It stopped next to the bed, with a brief pause for the removal of the husband's chair to the corridor outside. The hand which had held the husband's was searched for a vein, and an intrevenous drip of glucose installed. The other arm was connected to a continuous blood pressure gauge. The abdomen was encircled with two belts and the electronic devices on the belts were squirted with jelly and planted firmly on the mother's abdomen, the belts then tightened securely. The monitor was turned on and out rolled a continuous strip of paper bearing the fetal heart rate tracing, the uterine contraction tracing, and the blood pressure tracing. The husband found a perch on a window sill across the room. For the next 7 hours a nurse or resident would come in at 30 minute intervals, study the tracing carefully, and tell the mother that all was well.

In the next weeks I learned that nearly half of the women in my classes were being monitored, and the trend has increased in many areas. As a parent educator, I needed to know about fetal monitoring. Are the benefits so great as to justify such absolute domination of labor by machines? Is monitoring too complex to explain ahead of time to parents? I was disturbed by the lack of personal contact on the part of the staff, by the unseated husband and the lack of mobility of the mother. These worries led me to begin a search of the literature and correspondence with monitor manufacturers and several obstetricians who have pioneered in their development.
Can Parents Choose the Sex of Their Baby?
Authors: Shettles Landrum B. , Vande Wiele Raymond L.
Published: April 2007

On April 21, 1970 an article appeared in LOOK Magazine reporting that patients could sometimes predetermine the sex of their offspring by using acid or alkaline douches, timing coitus and manipulating the cervical milieu. Subsequently, the doctor quoted in the article, Landrum B. Shettles, wrote a book titled Your Baby's Sex–Now You Can Choose, in which various procedures were outlined. Dr. Shettles' evidence for precoital sex determination has been widely disputed, however. Some of the aspects of the controversy may be clarified by the following papers.
The Effects of Regionalization of Perinatal Care on Hospital Services for Normal Childbirth
Authors: Shearer Madeleine H.
Published: April 2007

ABSTRACT: Regionalized perinatal care first arose out of progress made in the mid 1960s in treating the sick newborn. There are three types of regionalization systems. One involves statewide transport of critically ill newborns and high‐risk pregnant women to regional intensive care centers. A second system involves county‐wide referral, with transport when needed, of sick newborns and pregnant women who are likely to deliver a seriously ill baby. The third system is reorganized obstetric care, which arose out of the crisis to urban hospitals of a low birth rate and government reimbursement for obstetrical care. Known as the Level I, II and HI system, it incorporates Recommendations for closing small hospital obstetrical units and setting up standards for the remaining units, including minimum occupancy rates, specialty staffing, and high‐risk technology. No provision is made in this system for normal, uncomplicated childbirth care in hospitals. Effective consumer roles involve (1) alerting the community to the safety and benefits of normal childbirth, (2) publicizing the risks of obstetric intensive care which are unnecessary in normal birth, and (3) cooperating with other groups to inform governing bodies and influence legislation.
A Survey of Cesarean Childbirth Education Classes and a Hospital Parent Education Program For Repeat Cesarean Delivery
Authors: Hayes Barbara
Published: April 2007

ABSTRACT: The couple who anticipate a cesarean delivery may find difficulty preparing themselves for this type of childbirth. While such parents share the needs of others who are giving birth, they also present special needs that are not met within the usual prenatal or Lamaze class format. This article describes a survey of cesarean classes in the United States, and a “Preparation for Cesarean Delivery” class offered at a university teaching hospital. Suggested class content as well as the emotional aspects of the scheduled cesarean delivery are discussed.
Siblings at Birth: A Survey and Study
Authors: Anderson Sandra VanDam
Published: April 2007

ABSTRACT: The recent literature describing sibling presence at childbirth is reviewed. The parents of 43 children who were present at the births of their siblings were interviewed to assess the reactions of the children to the birth, the parents and the new baby. Based on this information, guidelines are presented to assist parents in preparing their children to be present at the birth, and to care for their older child during labor and delivery.
An Evaluation of Childbirth Education for the Clinic Patient
Authors: Gaziano Emanuel P. , Vis Marlene Gar , Levine Elaine
Published: April 2007

ABSTRACT: A study was made of 97 clinic women who attended a series of preparation for childbirth classes and 24 primigravida clinic women who elected not to attend such classes. Both groups completed a standardized knowledge and understanding (KU) questionnaire related to pregnancy, labor and delivery. In addition, a post‐delivery structured interview was undertaken to determine the relative importance of certain subjective variables relating to the labor and delivery experience. KU scores were significantly higher in clinic women who elected to attend such classes. Class attendance was associated with a significant increase in KU scores following 4 class sessions. An inverse correlation was observed between KU scores and the number of anesthesia encounters for prepared clinic women during first and second stage of labor. Prepared multigravidas had significantly fewer medication encounters than did prepared primigravidas (P <.001) and, as a group, prepared women had significantly fewer medication encounters than unprepared primigravid women (P <.001). Both groups of clinic women rated medication during labor of less importance than the presence of a labor companion.
Results of the First 124 Deliveries in the Birth Room at Roosevelt Hospital in New York City
Authors: Nelson Linda P.
Published: April 2007

ABSTRACT: The organization and use of the birth room at Roosevelt Hospital are described, along with the results of the first 124 births there. All but 5 births were attended by midwives. After admittance to the regular obstetric area, and transfer to the birth room at 5–8 cm dilation, 5 women were transferred back to the labor room for various procedures. Of those transferred, there was 1 cesarean, 1 forceps delivery. All mothers and babies had normal postpartum courses.
FDA Action on the Brackbill‐Broman Report on Long‐term Effects of Obstetric Medication: Implications for Informed Consent
Authors: Shearer Madeleine H.
Published: April 2007

ABSTRACT: FDA testimony regarding the validity of the Brackbill‐Broman research showing long‐term effects of obstetric medications resulted in a conclusion that the study did not support long term effects, but that a subcommittee would be named to consider whether short‐term drug effects warrant patient informed consent warnings. Action to encourage such warnings is described, both at the FDA and on the state legislative level.
Nutrition in Pregnancy: Some Current Concepts and Questions
Authors: Worthington Bonnie S.
Published: April 2007

ABSTRACT: Adequate nutritional preparation of women for pregnancy includes the information on individualized weight gain ranges, which may be as little as 20 lb or as much as 35 lb gained gradually over the course of pregnancy. Discussions with mothers should focus on their possible reluctance to gain or to accept normal fat deposits laid down during pregnancy, as well as how to deal with edema, nausea, indigestion and other discomforts.

Changes in requirements for individual nutrients include those for protein, iron, folic acid, several vitamins, calcium, phosphorous and sodium. Discussions may include the potential teratogenic effects of food additives and contaminants, and, most importantly, the suspected effects of deficits and specific excesses. Concerns about excess relate in particular to vitamins A, D, and C, caffeine, alcohol and selected minerals.
Contact During the First Hour with the Wrapped or Naked Newborn: Effect on Maternal Attachment Behaviors at 36 Hours and Three Months
Authors: Curry Mary Ann Huesgen
Published: April 2007

ABSTRACT: Twenty women matched for parity, pregnancy and delivery criteria, medical history and infant outcome were randomly given their wrapped or naked babies to hold during the first hour after birth. At 36 hours after delivery and again at 3 months, an observer who was unaware of whether early contact had been skin‐to‐skin or with the wrapped baby recorded maternal attachment behaviors while the mother was breastfeeding (36 hours) or playing with her baby (3 months). There were no significant differences in the maternal attachment behaviors of the two groups 36 hours after delivery or 3 months after delivery. It is suggested that in other studies which showed more maternal attachment behaviors after skin‐to‐skin contact in the first hours and days after birth, it may have been the amount and timing of contact which accounted for observed differences in maternal behaviors, rather than whether the contact was skin‐to‐skin or with the wrapped newborn.
The Maternity Center at El Paso
Authors: McCallum Wenda Trevathan
Published: April 2007

ABSTRACT: The Maternity Center at El Paso, Texas, opened its doors in August, 1976, with three clients. By December, 1978, 560 women had begun labor under the care of midwives associated with the center. Five hundred and eighteen gave birth at home or in the center and the remainder delivered in an El Paso or Juarez hospital. A description of the services of The Maternity Center is provided, as well as pregnancy outcome statistics from the first 29 months of operation.
The Image of the Fetus in the First Trimester
Authors: Lumley Judith
Published: April 2007

ABSTRACT: Thirty women pregnant for the first time were interviewed during the first trimester to determine their image of and feeling toward their fetuses. Most women grossly underestimated the size and development of the fetus as well as its activities, attributing “formless,”“unattractive” and animal‐like features to it. Only 9 of the 30 women thought the fetus to be a real person at this stage of pregnancy. These women predicted they would feel grief if the fetus were miscarried, were more anxious about possible abnormality, more willing to abstain from intercourse to protect the fetus, thought the fetus could affect the mother, and were less ambivalent or unhappy when the pregnancy was confirmed. These 9 women differed from the other 21 in being from larger families or having jobs, such as nursing, which involved nurturing skills. The implications of these feelings or lack of them toward the fetus in the first trimester is discussed.
The Politics of Home Delivery in The Netherlands
Authors: van Arkel W.G. , Ament A.J. , Bell N.
Published: April 2007

ABSTRACT: The Netherlands has been unique among western industrialized countries in having a high proportion of home deliveries and a low infant mortality rate. It is often looked to as an example of a high quality, family‐centered system of perinatal care. Recently, with falling birth rates, an imminent oversupply of professionals, removal of financial barriers, and the technologising of medicine, some marked changes have been occurring. Midwives have maintained a constant 40% of the attendance at deliveries, but general practitioners are attending fewer births and obstetricians more.

The percent of hospital deliveries has doubled in the last 20 years. Even midwives are coming to be hospital‐based. National policy has favoured home delivery, but in practice, a number of professional, financial and political forces are working in the opposite direction. The trend to a reduction of home deliveries seems likely to continue. A stronger voice for consumers and better evaluation of the effects of home delivery are in order if home delivery is to retain a significant place in Dutch perinatal care.
The First Year at Stanford University's Family Birth Room
Authors: Schmidt Judith
Published: April 2007

ABSTRACT: The physical set‐up and first‐year use of Stanford University Hospital's family birth rooms are described. In 1979 6% of births at Stanford occurred in the family birth rooms, while 11% were labor room births. Admissions rose from 13 to 18 per month, bringing the occupancy rate to about 50%. Outcomes were favorable, as were parents’and nurses’evaluations of specific aspects of the family birth room practice.
Nine Years’Experience with Family‐Centered Maternity Care in a Community Hospital
Authors: Klass Kay , Capps Kay
Published: April 2007

ABSTRACT: Over a 9‐year period the percent of Lamaze‐trained parents grew from 10% to 68% in this community hospital. Another 25% of the couples use self‐taught Lamaze or other prepared childbirth techniques, bringing the total of prepared couples to 93%. Changes made by the nursing staff and 13 obstetricians over these 9 years include Lamaze training for staff nurses, inclusion of siblings, suspension of admission and later obstetric routines, reduction in use of medications, and many choices for type of delivery and family participation. A recent 9 month's statistics show 71.97% spontaneous deliveries, 10% cesareans, 33.3% of the vaginal deliveries done in the labor bed, and 90% of women having only local, pudendal or no anesthesia.
The Uses of Silence
Authors: Apgar Steffes Sandra
Published: April 2007

ABSTRACT: The uses of silence in childbirth education include bridging the “awkward” silence, learning how to direct silences, and how to assist parents with their work during silent periods. Silence can be used as an invitation to explore oneself, relaxation, and discussion. Finally, the “charged” silence is discussed, including its function in helping parents cope with fears and the unexpected in childbirth.
A Study of Father and Nurse Support During Labor
Authors: Klein Robert P. , Fohrell Gist Nancy , Nicholson Joanne , Standley Kay
Published: April 2007

ABSTRACT: Support behaviors directed to the woman during childbirth are documented, along with the identity of the providers in this study of 40 primiparous women. A time‐sampling method was used during labor observations to record kinds and frequencies of support behaviors provided by different individuals. In addition, a postpartum interview with mother and father included maternal recall of the support behaviors and her evaluation of the helpfulness of these activities. The data show husbands were an important source of support. Of special interest was amount of touching. Fathers were 5 times as likely to touch their wives as were nurses to touch their patients. Mothers’postpartum reports centered on the husbands’behavior, indicating that the most helpful thing was the husbands’presence. Other postpartum maternal reports are discussed.
Teaching Prenatal Exercise: Part II ‐ Exercises to Think Twice About
Authors: Shrock Pamela , Simkin Penny , Shearer Madeleine H.
Published: April 2007

ABSTRACT: Three physical therapists with widely varying views of exercise in pregnancy have pinpointed those exercises and positions which are the subject of controversy. They caution against certain thigh adductor stretches, all contorted and uncomfortable positions, any maneuver that causes the back to arch, such as “bridging,” and strenuous abdominal strengthening exercises such as the curl‐up, the sit‐up and double straight‐leg raising. They discuss pros and cons of “mobilizing” pregnant women's joints, treating back pain, squatting, and positions that might cause an air embolus.
Special Properties of Human Milk
Authors: Pittard William B.
Published: April 2007

ABSTRACT: Protective components in human milk include immunoglobulins, other antiinfective proteins, and properties which stimulate the protective development of the infant's gastrointestinal tract. Human milk is high in vitamin C and lactose, and low in iron, calcium and phosphorus. Vitamin D may be present in clinically significant amounts in a water soluble form. Although breast milk is low in protein (1–1½g/100 ml), this is sufficient to maintain normal growth in full‐term infants. Mothers of preterm infants have been found by some, but not all, investigators to have more protein in their breast milk than is found in the milk of full‐term mothers. Breast milk protein differs from that in cow's milk in both quantity and quality. Human milk includes zinc and folate binding agents, thyroid hormone, increased amounts of well‐absorbed lipids and highly bio‐utilizable proteins.
The Pharmacology of Human Milk
Authors: Bertino Joseph S.
Published: April 2007

ABSTRACT: The factors involved in the passage of drugs into breast milk will be discussed. Breast milk composition, maternal pharmacokinetic characteristics, infant pharmacokinetic characteristics, and feeding patterns all play an important role in determining whether or not a drug passes into breast milk along with the degree of infant ingestion. Drugs that are contraindicated, potentially contraindicated, and potentially not a problem are discussed.
Dancing in the Dark II. Helping and Not‐So‐Helping Hands
Authors: Blachman Linda
Published: April 2007

ABSTRACT: Mothers having difficulty with breastfeeding often find a lack of acknowledgement of the normal ambivalence about many aspects of the early mothering experience. Mothers, who need themselves to be nurtured, instead find people anxious to give advice which is biased by their own experience or dogmas. The “helpers” too easily conclude that what worked for them, or what seems “natural,” is correct for mothers in general. They are quick to make negative judgments about women who do not follow the idealized model.
Administrative Petition to Relieve the Health Hazards of Promotion of Infant Formulas in the U.S.
Authors: Blackwell Angela Glover , Salisbury Lois
Published: April 2007

ABSTRACT: This is a summary of a 180‐page Administrative Petition to the FDA and the DHHS to alleviate domestic formula misuse and to provide informed infant feeding choices, especially among low‐income, minority women. This summary documents the low and declining rates of breastfeeding among poor women, and the illnesses and costs of medical treatment in formula‐fed infants in the U.S. The practices of the infant formula industry and their effects on the attitudes of medical caregivers towards breastfeeding are described. The Petition, with over 500 references, was filed on June 17, 1981. It is available from Room 2323, Raybum House Office Bldg., Washington D.C. 20500.
A Comparative Study of Women Choosing Two Different Childbirth Alternatives
Authors: Cohen Richard L.
Published: April 2007

ABSTRACT: This is a report of the differences and similarities between two groups of 30 women each who selected widely divergent types of childbirth care. One group chose to deliver their babies in a tertiary university hospital obstetric service, the other in an out‐of‐hospital alternative birth center staffed by nurse‐midwives.

Women choosing the birth center were not demographically different from those choosing the tertiary hospital except that they were somewhat older. However, women choosing the birth center planned to emphasize autonomy and independence rather than intimacy in their child rearing, and they described their partners as much more supportive and involved in the birth, and were much more adaptive in preparation for the birth and the baby's care.
Fathers’Birth Attendance, Early Extended Contact, and Father‐Infant Interaction at Five Months Postpartum
Authors: Palkovitz Rob
Published: April 2007

ABSTRACT: Forty couples and their 5‐month old infants were observed in their homes in a study of the relationships between fathers’birth attendance, early extended contact, and involvement with their babies at five months postpartum. Fathers who were excluded from the birth were more involved with their babies, in the presence of their wives, than were fathers who attended births. The three aspects of early extended contact that were found to be significantly associated with fathers’caregiving and social involvement at five months were time of first contact, length of first contact, and total hours fathers spent with children in the hospital. The implications for research and for policy concerning early father‐infant contact are discussed.
Outcomes of the First 527 Births at The Birthplace in Seattle
Authors: Reinke Carla
Published: April 2007

ABSTRACT: The Birthplace nurse‐midwifery staffing, practice, cost, and outcomes are described. Of 527 women having initial prenatal visits 8 were referred for obstetrician care; 78 moved or dropped out; and 56 were referred to obstetricians later in pregnancy (among them 17 for spontaneous abortions and 10 for breech presentation, 5 for twins, and 6 for pre‐eclampsia).

Of 385 women cared for at The Birthplace through the onset of labor, 82 were transported to hospitals during labor, most for failure to progress before and after rupture of membranes and prolonged second stage.

Of 303 women delivered at The Birthplace, the following are discussed: the status of labor at admission, durations of stages of labor, incidence of episiotomies and lacerations, medication use, indications for 82 maternal intrapartum transports, mode of delivery of transports, indications for 11 postpartum maternal and 10 neonatal transports, and their outcomes.
The Trouble With “Choice” in Childbirth
Authors: Richards M. P. M.
Published: April 2007

ABSTRACT: The alternatives or choices available in childbirth may not address parents' or caregivers' concerns about maternity care adequately because the choices offered are limited, and because parents are not really free to choose. Obstetric care is organized in ways that limit choices, being a hierarchical system dominated by an engineering model of birth, in which caregivers contact parents very briefly and are themselves interchangeable, where efficiency is paramount, and where the technology that has been adopted is confining rather than freeing. Safety is a spurious issue in limiting most choices. Several ways to increase choices in childbirth are discussed.
ROUNDTABLE
Authors: Naeye Richard L.
Published: April 2007

The frequencies of several common antenatal disorders increased in the U.S. Collaborative Perinatal Project when women had low pregnancy weight gains. The case fatality rates of a much wider spectrum of antenatal disorders increased with low weight gains. There is indirect evidence that these high case fatality rates were mainly due to sub‐optimal maternal blood volume expansion, with resultant low blood flow from the uterus to the placenta. Metabolic acidosis, related to maternal fasting, may also have contributed to the perinatal mortality associated with low weight gain. To avoid acidosis, women should be advised not to fast during pregnancy.

There is evidence that maternal overnutrition during pregnancy sometimes predisposes to hypertension. This type of hypertension is relatively benign by comparison with the hypertension associated with low pregnancy weight gains. Finally, dietary deficiency of zinc appears to predispose to amniotic fluid bacterial infections, a major cause of preterm labor and delivery. (BIRTH 10:2, Summer 1983)
The Effects of Maternal Position on Uterine Contractility and Efficiency
Authors: Roberts Joyce E. , Mendez‐Bauer Carlos , Wodell Deborah A.
Published: April 2007

The variable designs and results of controlled trials of maternal position in labor are summarized. Following Mendez‐Bauer 's design, the effects of sitting alternated with side‐lying and supine alternated with side‐lying were compared in terms of contraction intensity and frequency, uterine activity and efficiency, and maternal comfort. The effects of each position were influenced by the position it was alternated with and the phase of labor during which it was used. While contractions were more frequent when sitting, uterine activity and efficiency were greater while side‐lying, both in early and late labor. There was no statistically significant difference in uterine activity or efficiency in the side lying position when compared to the supine (propped) position although contractions were more intense and less frequent while sidelying. These results suggest that position change is important in achieving efficient uterine contractions. (BIRTH 10:4, Winter 1983)
Childbirth Educators in the 1980s: A Survey of 25 Veterans
Authors: Shearer Madeleine H. , Bunnin T. Nenelle
Published: April 2007

A telephone survey of 25 veteran childbirth educators revealed a range of annual earnings from $600‐$40,000. Sixteen teach childbirth education part‐time. Most teach several different types of classes, such as early pregnancy, exercise, and postpartum classes, and most have diversified into writing, publishing, making and distributing teaching aids, consulting, and continuing education. Class fees range from $10‐$160. Common approaches to the field, financial management, and views of problems in the 1980s are discussed. (BIRTH 10:4, Winter 1983)
Ultrasonic Bioeffects: A View of Experimental Studies
Authors: O'Brien William D.
Published: April 2007

ABSTRACT: Diagnostic ultrasound of the pulse‐echo imaging type is used in at least 25 per cent of pregnancies, and Doppler continuous wave ultrasound, as employed in external electronic fetal monitors, is used in nearly all pregnancies. Diagnostic ultrasound energy levels are from 0.1 to 40 mW/cm2. These intensity levels depend on the characteristics of the ultrasonic beam and temporal exposure. The American Institute of Ultrasound in Medicine states that…“there have been as of October, 1982 no independently confirmed significant biological effects in mammalian tissues exposed to intensities below 100 mW/cm2.” Some of the animal studies reviewed by the AIUM to reach this conclusion are discussed.
Outcomes of a Rural Sonoma County Home Birth Practice: 1976–1982
Authors: Koehler Nan Ullrike , Solomon Donald A. , Murphy Marilyn
Published: April 2007

ABSTRACT: Of 741 women who appeared for orientation by an obstetrician/lay midwife, 521 were delivered by them. Of 258 primiparae, 191 had planned home births while 24 were transported to the hospital during labor, and 42 had planned hospital births. Of the multiparae, 233 delivered at home; 2 were transported to the hospital after birth and 3 during labor. Hospital births were planned by 25 multiparae. The cesarean rate was 6.1 per cent. There were 4 premature births (all in hospital and all with normal outcomes), 6 minor malformations, and 3 postpartum infections. The 3 perinatal deaths included a prepartum death at 34 weeks, a stillborn double footling breech with a prolapsed cord, and an infant who was resuscitated at home but died after two weeks of intensive care.
Research on Psychosocial Factors and Postpartum Depression: A Critique
Authors: Arizmendi Thomas G. , Affonso Dyanne D.
Published: April 2007

ABSTRACT: Postpartum depression appears to be related to major stress during pregnancy, birth, or early infant care. A depressive attributional style has also been implicated. However, research on psychosocial factors in postpartum depression suffers from differing definitions and measurements of depression, and samples not comparable as to parity, marital and socioeconomic status, and other important variables. None of the studies assessed changes in psychosocial factors over the course of pregnancy and puerperium, and none has included comparisons with women who do not suffer postpartum depression.
Imagery and Symbolism in the Birth Practices of Traditional Cultures
Authors: Bates Brian , Turner Allison Newman
Published: April 2007

ABSTRACT: In many traditional societies the childbirth environment is considered to be more powerful psychologically than physically. Sexual, simulative and religious imagery is employed to influence the parturient woman's feelings about the birth as a positive and active experience. The psychological assumptions involved appear to differ from western “natural” childbirth, and suggest a more holistic approach to birth experience.
Reactions to Transfer Out of a Hospital Birth Center: a Pilot Study
Authors: Shaw Irene
Published: April 2007

ABSTRACT: Whereas a questionnaire survey of reactions to transfer from a midwife‐run birth center indicated that transfer was reasonably well tolerated, later interviews conducted at home by non‐medical personnel detected more negative and critical reactions.
Risks and Benefits of Obstetric Epidural Analgesia: A Review
Authors: Avard Denise M. , Nimrod Carl M.
Published: April 2007

ABSTRACT: Based on a survey of the literature, this paper reviews the risks and benefits of epidural analgesia in normal healthy newborns and their mothers. Issues like effectiveness, maternal satisfaction, prolongation of labor, instrumental delivery and neurobehavioral effects are discussed. It seems that the slowing of labor and increased instrumental delivery are the main undesirable effects. Neonatal behavioral effects of epidural analgesia are unclear. Studies consistently show that epidurals are effective for pain relief during labor. Much remains to be learned about the specific neurobehavioral, psychological, and physiological effects of epidural analgesia.
Antenatal Counseling for Women Working Outside the Home
Authors: Bryant Heather E.
Published: April 2007

ABSTRACT: As the participation rate of women in the work force increases, so does the interest in potential effects of employment on pregnancy. Because this interest is relatively recent, little is known about many of the potential risk situations. When giving antenatal care to the employed woman, the caregiver should consider the social and economic factors which bear upon each woman's situation, as well as the physical, chemical, and biologic agents to which she may be exposed.

Counseling should be directed toward uncovering exposures to known toxins, seeking assistance from the literature or occupational medicine experts when uncertain, and toward providing realistic practical support to the woman when required.
Malpractice Issues in Childbirth: Report on a National Forum
Authors: Young Diony
Published: April 2007

ABSTRACT: The Forum on Malpractice Issues in Childbirth: 1985 brought together a multidisciplinary group of representatives of 70 major national organizations from health, government, law, insurance underwriting, and the public to examine professional liability issues in childbirth and to develop recommendations and strategies for action. The participants—67 from the United States, three from Canada, and one from England–were assigned to seven work groups, each addressing a different issue. Recommendations were made regarding the availability of maternity services and alternatives, provider‐patient relations, government action, public and provider education, professional quality control, alternatives to litigation, and legal reforms.
WHAT THE DUBLIN TRIAL SUGGESTS ABOUT BENEFITS; WHAT COMMENTS SUGGEST ABOUT WHO SHOULD INTERPRET THE TRACINGS
Authors: Lumley Judith
Published: April 2007

The Dublin Trial will probably not alter firmly held beliefs about whether electronic fetal monitoring (EFM) is better than auscultation. The neonatal seizures that EFM apparently prevented were those that did not result in serious neurologic deficit at 1 year of age. If, as had been suggested, EFM tracings are hardly ever correctly interpreted, then EFM should hardly ever be used.
Stress, Pain, and Catecholamines in Labor: Part 1. A Review
Authors: Simkin Penny
Published: April 2007

ABSTRACT: Stress in normal labor is harmless to the mother and beneficial to the healthy fetus and neonate. When stress is excessive in an otherwise healthy mother and fetus or when stress further taxes a fetus who is already compromised, it may have deleterious effects. The desirability of minimizing stressful interventions is discussed.
Indications for Ultrasonography in Obstetrics
Authors: Neilson J. P.
Published: April 2007

ABSTRACT: After analyzing similar data, the National Institutes of Health Consensus Task Force on Ultrasound in Pregnancy and the comparable British body reached opposite conclusions on the value of routine early pregnancy ultrasonography. Ultrasound appears useful in various clinical situations and as a screening technique in early pregnancy. Of five controlled trials of routine late‐pregnancy ultrasound screening, four failed to show a benefit and a fifth may have shown decreased perinatal mortality. A study of late‐pregnancy ultrasound screening where the product of fetal crown‐rump length and trunk area was calculated was highly effective in predicting small‐for‐dates infants, although no outcome or management benefits were shown.
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 militates 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. Defects in vision or heaving are possible. Negative animal experiments cannot offer reassurance to those concerned about damaging effects with low rates of occurrence such as 1 in 1000 or less. 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.
Pregnancy and Birth after Cesarean Section: A Survey Based on the Swedish Birth Register
Authors: Hemminki Elina
Published: April 2007

ABSTRACT: Two cohorts of healthy Swedish primiparae having a healthy child by cesarean section in 1973 (index women, N = 2592) and in 1976 (N = 3867) and matched vaginal delivery controls were identified from the Swedish Birth Register. The second births to these women occurring in the following five years were studied. The mean lengths of gestation were somewhat shorter and there were more problems during pregnancy, labor, and delivery among those with previous cesarean births (index women). Children born to the index women had a higher perinatal mortality and were smaller and less healthy. Comparison of the two cohorts suggests that the operation itself may have contributed to some of the problems. The decision to perform a cesarean section may have to take into account sequelae in a subsequent pregnancy.
Outcomes and Procedures in Low Risk Birth: A Comparison of Hospital and Birth Center Settings
Authors: Feldman Elizabeth , Hurst Marsha
Published: April 2007

ABSTRACT: Two retrospectively matched groups of low‐risk women were studied, one that chose to give birth in an out‐of‐hospital birth center staffed and run by nurse‐midwives, and another that labored and delivered in a tertiary care teaching hospital. The groups were matched for low risk status at 37 weeks. Although outcomes for both groups were similar, the use of almost all interventions during labor and delivery was significantly more frequent in the hospital group. These findings are consistent with studies of other settings in which the place of birth was shown to have an impact on childbirth experience, thus demonstrating that birth centers can oversee childbirth as safely and with less intervention than do hospitals. Larger comparative studies are needed to explore the impact and safety of hospital and out‐of‐hospital birth settings.
Does Advice to Assume the Knee‐Chest Position Reduce the Incidence of Breech Presentation at Delivery? A Randomized Clinical Trial
Authors: Chenia F. , Crowther C. A.
Published: April 2007

ABSTRACT: A randomized clinical trial of 76 women with a persistent singleton breech presentation at 37 weeks’ or more gestation tested the value of advising women to assume the knee‐chest position for 15 minutes three times a day in reducing the incidence of breech presentation at delivery. In the 39 women advised to perform the procedure, 16 (41.0%) fetuses underwent rotation and remained cephalic at delivery compared to 12 (32.4%) of the 37 women in the control group in whom spontaneous version to cephalic occurred. The procedure warrants further evaluation in other obstetric populations, at or in the thirty‐seventh week of gestation, and in a larger study group.
Battering During Pregnancy: Intervention Strategies
Authors: Helton Anne Stewart , Snodgrass Frances Gobble
Published: April 2007

ABSTRACT: Battering during pregnancy is a major health problem affecting not only the pregnant woman but the unborn child. Battering frequently begins or escalates during pregnancy or the postpartum period. Interviews with 290 healthy pregnant women revealed that of the sample of black (22.4%), Latino (43.1%), and white (32.1%) pregnant women, 23 percent had been battered before or during the current pregnancy. Of these, 63.8 percent were unaware of resources available for battered women. Of those who were aware, the predominant resource cited was family. Perinatal caregivers can be instrumental in primary, secondary, and tertiary prevention of battering.
A Retrospective Evaluation of a Model of Midwifery Care
Authors: Kaufman Karyn , McDonald Helen
Published: April 2007

We conducted a retrospective evaluation of intrapartum outcomes of 452 women who had no medical or obstetric complications. Seventy‐nine women were cared for in a midwifery service and the remainder were under a physician's care. Most women were white, married, and middle‐class. All deliveries occurred in a tertiary referral center in Ontario, Canada. The midwifery group had statistically significant reductions in the frequency of amniotomy, epidural block, and episiotomy, and significant increases in the use of transcutaneous nerve stimulation and the occurrence of lacerations. The observed differences in intrapartum outcomes are of interest because of the unique circumstances of this service in a country where midwifery is an unfamiliar and unregulated profession.
“It's Going to Work for Me.” Responses to Failures of IVF
Authors: Williams Linda S.
Published: April 2007

ABSTRACT: Although most in vitro fertilization (IVF) attempts end in failure, most women who try IVF once try again one or more times. This paper is based on an interview study of twenty Canadian women who underwent at least one IVF procedure, and it describes the way in which failure affected their decision to try IVF again. Since undergoing IVF increases awareness of each step in the biological process of becoming pregnant, it allows a woman to think of herself as “getting closer” to becoming pregnant, depending on the number of steps she successfully completes in the process, even if her attempt ultimately fails. Since a subsequent attempt might progress even further, perhaps to pregnancy, it therefore becomes difficult to stop trying. Women must be informed of this aspect of IVF if they are to make informed decisions concerning its use.
Revised U.S. Certificate of Birth—New Opportunities for Research on Birth Outcome
Authors: Taffel Selma M. , Ventura Stephanie J. , Gay George A.
Published: April 2007

Abstract: The 1989 revision of the U.S. Standard Certificate of Live Birth includes a number of new items on medical and life‐style risk factors of pregnancy and birth, obstetric procedures performed, method of delivery, abnormal conditions and congenital anomalies of the infant, expanded information on birth attendant and place of birth, and questions on the Hispanic origin of the parents. This major enhancement of medical and health data available on mothers and infants can greatly expand the scope of research on pregnancy outcome in the United States.
A Randomized Controlled Trial of a Nursery Ritual: Wearing Cover Gowns to Care for Healthy Newborns
Authors: Rush Janet , Fiorino‐Chiovitti Rosalina , Kaufman Karyn , Mitchell Aha
Published: April 2007

ABSTRACT: The routine wearing of individual cover gowns by nurses and visitors for direct care of healthy newborns was usual practice on the maternity ward of a regional referral center. We conducted a randomized trial in which cover gowns were not provided for care of infants in the experimental group (n= 222), but were maintained for control infants (n= 230). The principal outcome measured was Staphylococcus aureus colonization of the newborn nares or umbilicus on day 3 or day of discharge. Twenty percent (n= 51) of the experimental group (no gown) had a positive culture compared with 21 percent (n= 47) of the controls. Of the infants with positive cultures, two in each group exhibited symptoms of overt S. aureus infection. Experimental infants were similar to controls with respect to feeding method, route of delivery, amount of time spent rooming‐in, and average number of visitors per day. In the group of positively cultured infants, the mothers experienced longer labor, and more vaginal examinations in labor, and the number of males undergoing circumcision was higher. We concluded that routine use of cover gowns was unwarranted, and we have altered the ward policy accordingly. This also has had a positive economic effect.
Vaginal Birth After Two or More Cesarean Sections: A Five‐Year Experience
Authors: Hansell Richard S. , McMurray Kathleen B. , Huey Gordon R.
Published: April 2007

ABSTRACT: Allowing a trial of labor in patients who have had a single low transverse cesarean section has become increasingly accepted and widespread in the United States. Evidence with regard to the safety of this practice in patients with two or more prior cesarean births has, however, been sparse. We performed a retrospective review of the charts of 170 patients who had undergone two or more low transverse cesarean deliveries and subsequently delivered at Wishard Memorial Hospital between January 1, 1983, and December 31, 1987. Of 35 of these women who underwent a trial of labor, 27 (77%) had a successful vaginal delivery. No increase in maternal or fetal morbidity or mortality was associated with labor. The women who underwent trial of labor had fewer postpartum complications and shorter hospital stays. Although the number of patients in this study was small, growing evidence appears to support a trial of labor in patients with two or more prior cesarean sections as a safe and successful alternative to elective repeat cesarean section.