Birth Practices Research Articles

Teaching in a Patient-Centered Medical Home

Teaching Lamaze International classes in a patient-centered medical home allows the childbirth educator the best environment for giving evidence-based information and empowering parents to give birth their way. Patient-centered medical home facilities and providers practice evidence-based care and adhere to the principles of family-centered maternity care. In patient-centered medical homes, women can expect to give birth using the Lamaze Healthy Birth Practices and to fully participate in their care with appropriate interventions and the right to informed consent and informed refusal.

Interaction between social category and social practice: explainingwas/werevariation

AbstractThis paper explores the ways in which structural and practice-based social constraints contribute to the maintenance of nonstandardwerein Bolton, England. Using data from a school ethnography, 2747 tokens of first- and third-person singularwas/wereare analyzed according to informants' social class, community of practice, self-identification, and place of birth. Varbrul analyses reveal consistencies in the linguistic constraints on variation irrespective of the type of social analysis undertaken. These patterns generally confirm the findings of previouswas/werestudies. However, comparisons of log likelihood results suggest that although different social factors constrain this variation with varying degrees of accuracy, no one factor alone sufficiently explains it. Comparisons of groups and individual speakers reveal that nonstandardweremaintenance is in fact explained by the combined effect of an established correlation between nonstandardwereand local social structures and on-going revitalization of the form in contemporary forms of social practice.

Lack of Association between Measles-mumps-rubella Vaccination and Autism in Children: A Case-Control Study

This case-control study compared measles vaccination in 96 causes of autism and 192 controls in Poland. Cases were found using general practitioner records, and two controls were selected for each affected child. The controls were matched by year of birth, gender, and physician's practice. Potential confounders including mother's age, gestational age, medications during pregnancy, perinatal injury, and Apgar score were evaluated. All except mother's education had a statistically significant association and were carried into the final model.

Birthing Practices of Traditional Birth Attendants in South Asia in the Context of Training Programmes

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes.

Understanding Gender and Power Dynamics Within the Family: A Qualitative Study of Nepali Women's Experience

Among the Maori of New Zealand, Aboriginals of Australia, and other Indigenous peoples, family dynamics strongly influence the ways that issues emerge in counseling. This study explores aspects of gender and power within the context of birth practices in rural Nepal. In‐depth interviews were conducted with 15 postpartum women, as well as family members, to collect narratives of birthing experiences that highlight issues of oppression, marginalisation, and power struggles. Implications for multicultural and social justice awareness in family therapy are discussed, especially with regard to the subtle, disguised ways that power operates behind the scenes, often sabotaging efforts by health and mental health professionals to bemost helpful.

Práticas obstétricas e resultados maternos e neonatais: análise fatorial de correspondência múltipla em dois centros de parto normal

OBJETIVO: Descrever as práticas obstétricas e os resultados maternos e neonatais de dois Centros de Parto Normal do Município de São Paulo, comparandose as unidades intra e extra-hospitalares. MÉTODOS: Estudo observacional, transversal e retrospectivo com dados secundários provenientes de 192 prontuários das instituições envolvidas. As variáveis de estudo foram as práticas selecionadas para o parto normal: a utilização de ocitocina, o tipo de rompimento das membranas amnióticas, a realização de episiotomia ou perineotomia e o tempo de permanência materna e neonatal. Foi elaborado um instrumento informatizado para coleta de dados com base nas variáveis de estudo. Os dados foram tratados através de análise estatística multivariada. RESULTADOS: O centro de parto normal intra-hospitalar utilizou com maior frequência às intervenções relacionadas à utilização de ocitocina, rompimento artificial de membranas amnióticas e tempo de permanência materna e neonatal superior às 48h, após o parto. O centro de parto normal extra-hospitalar apresentou maior frequência de parturientes com períneo íntegro após o parto, rompimento de membranas de maneira espontânea e tempo de permanência materna e neonatal inferior a 48 horas pós-parto. Os resultados maternos e neonatais não evidenciaram complicações relacionadas às práticas utilizadas. CONCLUSÃO: As práticas obstétricas pouco diferiram, comparando-se os dois tipos de Centros de Parto Normal; ambos seguem as recomendações da Organização Mundial de Saúde e aplicam as intervenções somente nos casos indicados.

INTRA- AND INTER-HOUSEHOLD DIFFERENCES IN ANTENATAL CARE, DELIVERY PRACTICES AND POSTNATAL CARE BETWEEN LAST NEONATAL DEATHS AND LAST SURVIVING CHILDREN IN A PERI-URBAN AREA OF INDIA

Nearly a quarter of the world's neonatal deaths take place in India. The state of Uttar Pradesh alone accounts for one-quarter of all neonatal deaths in the country. In this study 892 married women aged less than 50 years living in a peri-urban area of Kanpur city in Uttar Pradesh were interviewed. In all, 109 women reported neonatal deaths. Characteristics of the last neonatal deaths of these 109 women were compared with those of the last surviving children. Also, characteristics of women who had a neonatal death were compared with those of 783 women who had no neonatal death. It was found that as compared with neonatal deaths, the last surviving children of the 109 women had: (a) significantly better antenatal tests during pregnancy, intake of iron/folic acid tablets and higher percentage of tetanus toxoid immunization; (b) safer delivery practices such as a higher percentage of institutional delivery, sterilization of instruments and application of antiseptic after removal of umbilical cord; (c) postnatal care, such as application of antiseptic to the navel and postnatal checkups; and (d) higher maternal age and greater birth spacing. Likewise, better antenatal care and safer delivery practices and postnatal care were observed among the 783 women with no neonatal deaths, when compared with women who had experienced neonatal death. The complexities of inter- and intra-household differences in health care are discussed. The paper concludes that to improve child survival general education and awareness regarding safe delivery should be increased. Continuing cultural stigmas and misconceptions about birth practices before, during and after childbirth should be an important part of the awareness campaigns.

Power of birth: uncontrollable urges and the transition to motherhood

As part of a final-year show for the BSc(Hons) Fine Art at Oxford Brookes University, a series of paintings attracted a lot of attention, particularly on the part of the author who is a registered midwife and midwife teacher. The intentions behind the creation of the canvasses were explored in an interview with the artist and were analysed in light of birth practices in the developed world and feminist theories. The main themes identified were: the nature and experience of labour in the developed world with its potential to position labouring women as risks to themselves; the fetus and neonate; and the economics of the health-care organization. In societies where birth is removed from the home, expectations are constructed from representations, few of which depict women as powerful and capable of birthing. The animal–human hybrids of the canvasses highlighted anachronistic discourse of the hierarchy of man, woman, animal, while also reframing the essential act of reproduction as potent and powerful.

Home Versus Hospital Birth—Process and Outcome

A constant small, but clinically important, number of American women choose to deliver at home. Contradictory professional and public policies reflect the polarization and politicization of the controversy surrounding this birth option. Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control. However, home deliveries in developed Western nations are often associated with excess perinatal and neonatal mortality, particularly among nonanomalous term infants. On the other hand, current home birth practices are, especially when birth attendants are highly trained and fully integrated into comprehensive health care delivery systems, associated with fewer cesareans, operative vaginal deliveries, episiotomies, infections, and third and fourth degree lacerations. Newborn benefits include less meconium staining, assisted ventilation, low birth weight, prematurity, and intensive care admissions. Existing data suggest areas of future research regarding the safety of home birth in the United States. Obstetricians & Gynecologists, Family Physicians. After completion of this educational activity, the participant should be better able to assess perinatal outcomes described in the reported literature associated with home births in developed countries, list potential advantages and disadvantages of planned home births, and identify confounders in current literature that impact our thorough knowledge of home birth outcomes.

Lamaze Certified Childbirth Educators: Drawing Strength From Our Past to Build the Future

This year's 50th anniversary of Lamaze International is a time to reflect upon our past and present as we work together to build the future of childbirth. In the 1950s and 1960s, thoughtful men and women such as Elisabeth Bing began to look carefully at the birthing practices in the United States. Lamaze Certified Childbirth Educators became leaders in improving birthing practices by teaching women and their partners the truth about how women were cared for during childbirth. Currently, the rise in maternal mortality and morbidity in the United States illustrates the pressing need for more changes. Lamaze Certified Childbirth Educators are leading change by pushing for the wide adoption of Lamaze International's Six Healthy Birth Practices to promote natural, safe, and healthy birth.

Revisiting the Classics in Childbirth Education

In celebration of Lamaze International's 50th anniversary, reviewers share their thoughts on some classic Lamaze resource materials and how their content relates to today's viewpoints on birth and childbirth education. Although some of the material may be outdated, all of the resources offer timeless insights as well as a unique view on the history of childbirth education. The following topics are addressed: past cultural views of birth; advocacy for change in birth practices; Lamaze method; pioneers in childbirth; importance of childbirth education; and birth advocacy.

What Once Was Old Is New Again

Through seminars and continuing educational opportunities, recently certified Lamaze childbirth educators beginning their teaching careers have learned of the changes in birth practices over the past 50 years. However, they may not have heard the personal stories about the locations and conditions in which Lamaze educators first taught. In this column, five childbirth educators share their memories of the birthing climate, teaching strategies, class populations, and other aspects of Lamaze childbirth education 50 years ago and how the "old ways" compare with today's classes. Their stories not only provide an important, historical perspective to build on the past and improve future educational opportunities for expectant women and their families but also illustrate Lamaze's ongoing efforts to promote natural, safe, and healthy birth practices.

The Power of Numbers: Transforming Birth Through Collaborations

Collaborative efforts and coalitions have replaced exclusivity as birth organizations and individuals unite to humanize birth and provide women with transparency of information about maternity care providers and facilities and about access to the midwifery model of care. The Coalition for Improving Maternity Services and the upcoming 2010 "Mega Conference" to jointly celebrate the 50th anniversaries of Lamaze International and the International Childbirth Education Association serve as excellent examples of collaborative efforts to support natural, safe, and healthy birth practices as well as women's choices in childbirth. Childbirth educators are encouraged to learn from and support national coalitions devoted to improving maternity care and to use local resources to develop their own collaborative efforts on behalf of childbearing families.

Turning the Tide for Birth

In this column, the editor of The Journal of Perinatal Education discusses the escalating cesarean surgery rate and the need for evidence-based practice changes that support vaginal birth after cesarean. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth practices.

Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital

Introduction:The misfortunate incident of formation of a urogenital fistula remains a major challenge for surgical urologists worldwide. Such fistulae may not be a life-threatening problem, but surely the women face demoralization, social boycott and even divorce and separation. The fistula may be vaginal, recto-vaginal or a combination of the two. The World Health Organization (WHO) has estimated that in the developing nations, nearly 5 million women annually suffer severe morbidity with obstetric fistulae being the foremost on the list. The objective of our study was to enunciate the patient demography, patient profile, incidence, type of surgery, as well as the long-term outcomes encountered in the management of all types of genital fistulae at a tertiary care centre.Materials and Methods:50 consecutive patients, attending the outpatient department with urogenital fistulae, were studied during the period of 5 years from July 2005 to July 2009. All female patients with complaints of urinary incontinence and fecal incontinence and dribbling, patients having a history of obstructed labor, radiotherapy, instrumental delivery, foreign body or trauma and with a history of hysterectomy (abdominal/ vaginal) and lower segment caesarean section (LSCS) were included. A thorough urological examination included a dye study using methylene blue, Renal function tests, X-ray KUB and intravenous urography (IVU). Cystoscopy along with examination under anaesthesia (EUA) were done to assess the actual extent of injury. All patients were subjected to appropriate surgical interventions via the same combination of surgeons . Post operatively, prophylactic antibiotics were administered to all patients and patients were managed till discharge and followed thereafter via regular outpatient visits for a period of 3 years.Results:Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40% illiterate and 69% were short Statured. Vesico vaginal fistulae (VVF) was seen in 64% cases of which 50% were due to obstructed labor, 19% cases post LSCS and 31% cases post total abdominal hysterectomy (TAH). 68% of urogenital fistulae were between 1 to 3 cms. We obtained a 75% cure rate in UVF, 87.5% cure rate in RVF while a 93.75% cure rate was observed in patients with VVF. 76% of all patients were cured while 8% had a recurrence, probably due to the large size of fistula.Conclusion:Genital fistula is preventable, yet it remains a significant cause of morbidity among females of reproductive age group. Despite facilities available, certain conditions like physical, social, economic, illiteracy, and a very casual attitude towards maternal health and children birth practices limit utilization of services for women. It is important that the modern health care providers should be aware of these aspects, so that they can recognize services that are appropriate and acceptable to the people. Thus, one must agree that in cases of urogenital fistulae, "prevention is better than cure".

After a Cesarean…What's a Birth Professional to Do?

The discrepancy between the evidence supporting vaginal birth after cesarean and actual medical practice illuminates the larger issues of evidence-based care versus current obstetrical practice. Although the reasons for the disconnect between what we know to be healthy birth practices and what women actually experience are multiple and complex, a commitment to providing accurate education, truly client-centered support, and active patient advocacy will give women the ability to insist on best practice care for themselves and their babies. The International Cesarean Awareness Network believes that all childbirth professionals and advocates share a responsibility to promote change and must work together to be effective.

Nurse‐Midwives' Experiences with Planned Home Birth: Impact on Attitudes and Practice

Health care providers' attitudes toward maternity care options influence the nature of informed decision-making discussions and patient choice. A woman's choice of birth site may be affected by her provider's opinion and practice site. The objectives of this study were to describe American nurse-midwives' attitudes toward, and experiences with, planned home birth, and to explore correlates and predictors of their attitudes toward planned home birth as measured by the Provider Attitudes towards Planned Home Birth (PAPHB) scale. A survey instrument, which incorporates the PAPHB and assesses demographic, education, practice, personal experience, and external barrier variables that may predict attitudes toward planned home birth practice, was completed by 1,893 nurse-midwives. Bivariate analysis identified associations between variables and attitudes. Linear regression modeling identified predictors of attitudes. Variables that significantly predicted favorable attitudes to planned home birth were increased clinical and educational experiences with planned home birth (p < 0.001), increased exposure to planned home birth (p < 0.001), and younger age (p < 0.001). External barriers that significantly predicted less favorable attitudes included financial (p = 0.03) and time (p < 0.001) constraints, inability to access medical consultation (p < 0.001), and fear of peer censure (p < 0.001). Willingness to practice in the home was correlated with factors related to nurse-midwives' confidence in their management abilities and beliefs about planned home birth safety. The results suggest that nurse-midwives' choice of practice site and comfort with planned home birth are strongly influenced by the nature and amount of exposure to home birth during professional education or practice experiences, in addition to interprofessional, logistic, and environmental factors. Findings from this research may inform interdisciplinary education and collaborative practice in the area of planned home birth.

Birth as a Spiritual Initiation

In Western, industrialised culture, menstruation and birth are generally seen as medical concerns. Women learn to detach from their menstrual rhythms which become associated with shame, pathology and the profane. Obstetric medicine, which is widely accepted as the norm for our birth practices, does not regard spirituality as its remit. Yet pre-patriarchal and non-patriarchal cultures have revered both menstruation and childbirth as spiritual phenomena. My doctoral research examined the links between Western cultural attitudes to menstruation and spirituality, and women’s experiences of birth. Using the Organic Inquiry methodology, I conducted ten interviews and seven groups with Australian women to explore the spirituality of their female body experiences. My findings reveal that despite the presence of patriarchal constraints, some women transcended the cultural givens and discovered the ecstatic potential of their embodied spirituality. Menstruation was experienced as a sacred connection with the Divine and birth was a transformative opening to Spirit.

New Resources for Childbirth Educators and Parents

In this column, reviewers offer perspectives and comments on a variety of new media resources for childbirth educators and for expectant and new parents. The DVDs and books reviewed in this issue's column address the following topics: cultural views of labor and birth, as portrayed in the U.S. media; natural, safe, and healthy birth practices; memoirs of a midwife; a description of doula care to share with the children of expectant parents; baby behaviors; empowering women to choose the birth experience they want; making informed decisions about cesarean surgery; information and stories of hope for parents dealing with an infant in the neonatal intensive care unit; ways for parents to cope with perinatal or neonatal loss; and fathers' supportive role during the prenatal and postpartum periods.

Cupidos Bogen: Zu Tibull 2, 1, 67–72 und Ovid met. 1, 454–465

In 2, 1, 67–72 Tibull mentions Cupido′s birth and first archery practice in the countryside. This detail has been regarded as isolated; the fact that Tibull introduces it with dicitur has been interpreted as a typically Alexandrian reference to a learned authority and show of erudition. This article states, (1) that there is a parallel for Tib. 2, 1, 67–72 in Ov. met. 1, 454–465, not yet recognized; both passages go back to a common, probably Hellenistic, source. (2) An analysis of Tibull′s use of phrases like dicitur can show that dicitur is not used as a typically Hellenistic learned reference, but as a reference to the authority of common knowledge.