Birth Events Research Articles

Chinese herbal medicine for subfertile women with polycystic ovarian syndrome.

Chinese herbal medicine for subfertile women with polycystic ovarian syndrome.

Spiritual care, compassion and associated factors of midwives working in delivery rooms.

This study aimed to determine the level of spiritual care and compassion among midwives working in delivery rooms and associated factors. A descriptive design was utilized to collect data using self-report questionnaires from 181 midwives working in delivery rooms in Turkey. Data were collected between 1 February 2020 and 20 March 2020. The mean Spiritual Care-Giving Scale (SCGS) (min: 25- max: 175) and Compassion Scale (CS) (min: 24- max: 120) scores were 147.88 ± 17.84 and 96.37 ± 12.84. It was determined that there was a significant difference between the SCGS and CS scores of the midwives based on age, working year, work schedule, job satisfaction and traumatic birth experiences. Furthermore, there were positive correlations between scores on certain SCGS and CS subdimensions. Midwifery is a continuously evolving profession based on helping others. However, long working hours and their exposure to traumatic birth events negatively affect both spiritual caregiving and compassion levels of midwives. Working conditions of midwives need to improve and this would contribute to the quality of maternal healthcare. Also, studies should be conducted in different contexts, societies and cultures to identify barriers to compassionate and spiritual care during childbirth.

PIH7 Cost-Effectiveness of a Proteomic Test for Preterm Birth Prediction

Preterm birth (PTB) carries increased risk of health problems for infants as well as higher healthcare costs for both infants and mothers. We evaluated the cost-effectiveness of a risk-screening-and-treat strategy, compared to usual care, for a population of commercially-insured pregnant US women without known risk factors for PTB. The strategy included a novel PTB prognostic test (PreTRM®) in the 19th-20th week of pregnancy and treatment with vaginal progesterone and high-intensity case management for the remainder of the pregnancy for women assessed as high-risk. A decision-tree with Markov nodes representing 1-week cycles from week 19 of pregnancy to birth (preterm or full-term) was developed, using a payer’s perspective and time horizon from pregnancy start to 12-months post-delivery in mothers and 30-months from birth in infants. PTB rates and costs were based on real-world cohorts of >40,000 mothers and infants with birth events in 2016, as identified in administrative claims from the HealthCore Integrated Research Database®. Estimates of test performance and treatment effectiveness were derived from published literature. Uncertainty was explored via scenario, one-way, and probabilistic sensitivity analysis (PSA). In the base-case analysis, the risk-screening-and-treat strategy dominated usual care with 870 fewer PTBs (20% reduction) and $54 million less in total cost ($863 net savings per pregnant woman). Reductions were also seen for neonatal-intensive-care-unit admissions (10%), overall length-of-stay (7%), and births <32 weeks gestation (33%). Treatment effectiveness had the most influence on cost-effectiveness estimates per one-way sensitivity analysis, followed by infant care costs and test costs. The risk-screening-and-treat strategy was dominant in the majority of PSA simulations and model scenarios. Use of a novel prognostic test during pregnancy to identify women at risk of PTB combined with evidence-based treatment can reduce total costs and prevent preterm deliveries and their consequences in a representative population of commercially-insured US women.

What may happen if you are pregnant during COVID-19 lockdown? A retrospective study about peripartum outcomes.

One of the provisions implemented to contain the spread of COVID-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. This is a retrospective study including all consecutive patients who delivered at the Maggiore della Carità Hospital in Novara, Italy, in April-May 2017 (group 1, N.=294), a period prior to the pandemic, and during the same months in 2020 (group 2, N.=256) during and immediately after lockdown. Clinical data were extracted from the report "Childbirth Assistance Certificate (CedAP) - Birth Event Analysis." Demographic characteristics were similar between the two study groups, except for a decreased number of married couples in group 2 (P=0.018) and an increased percentage of patients with clinical checkups at family planning facilities in 2020 (P=0.04). The number of hospitalizations during pregnancy was 26 (8.9%) vs. 10 (3.9%) with a significative reduction during 2020 (P=0.004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs. 35.9%; P=0. 002), a reduction of amniorrhexis (11.3% vs. 5.5% P=0.015), a reduction of supine positions with an increase of vertical and all four positions in 2020 (49.3% vs. 61.9% and 9.5% vs. 12.4% respectively, P=0.023), and a reduction of left occipito-anterior presented part (63.2% vs. 55.4%) in favor of right occipito-anterior (34.7% vs. 41.2%, P=0.019). There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate psychological, behavioral, and epigenetic effects of maternal physical inactivity on obstetric outcomes.

An evolutionary model identifies the main evolutionary biases for the evolution of genome-replication profiles.

Recent results comparing the temporal program of genome replication of yeast species belonging to the Lachancea clade support the scenario that the evolution of the replication timing program could be mainly driven by correlated acquisition and loss events of active replication origins. Using these results as a benchmark, we develop an evolutionary model defined as birth-death process for replication origins and use it to identify the evolutionary biases that shape the replication timing profiles. Comparing different evolutionary models with data, we find that replication origin birth and death events are mainly driven by two evolutionary pressures, the first imposes that events leading to higher double-stall probability of replication forks are penalized, while the second makes less efficient origins more prone to evolutionary loss. This analysis provides an empirically grounded predictive framework for quantitative evolutionary studies of the replication timing program.

Progestogens for preventing miscarriage: a network meta-analysis.

Progestogens for preventing miscarriage: a network meta-analysis.

Factors influencing fertility rates in Australian women receiving kidney replacement therapy: analysis of linked Australia and New Zealand Dialysis and Transplant Registry and perinatal data over 22 years.

Pregnancy in women receiving kidney replacement therapy (KRT) is uncommon, and trends and factors influencing fertility rates remain poorly defined. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) was linked to mandatory perinatal data sets (all births from 1991 to 2013, ≥20 weeks' gestation) in four Australian jurisdictions. Overall, age- and era-specific fertility rates were calculated based on general and KRT population denominators. From 2 948 084 births, 248 babies were born to 168 mothers receiving KRT (37 babies born to 31 dialysed mothers; 211 babies born to 137 transplanted mothers). Substantial agreement between ANZDATA and perinatal data sets was observed for birth events and outcomes. Transplanted women had higher fertility rates than dialysed women in all analyses, with 21.4 live births/1000 women/year [95% confidence interval (CI) 18.6-24.6] in transplanted women, 5.8 (95% CI 4.1-8.1) in dialysed women and 61.9 (95% CI 61.8-62.0) in the non-KRT cohort. Fertility rates for dialysed women rose in recent years. After adjusting for maternal age and treatment modality, Caucasian women had higher fertility rates, while women with pre-existing diabetes, or transplanted women with exposure to KRT for ≤3.0 years had lower rates. As expected, transplanted women with a pre-conception estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m2 or transplant-to-pregnancy interval of <1.0 year had lower fertility rates. Geographical location, socioeconomic status and primary disease (glomerulonephritis versus other) did not affect fertility rates. Reporting of births to ANZDATA is sufficiently accurate to justify ongoing data collection. Rising fertility rates in dialysed women may indicate permissive attitudes towards pregnancy. Treatment modality, ethnicity, diabetes, pre-conception eGFR, transplant-to-pregnancy interval and duration of KRT exposure were associated with fertility rates. These factors should be considered when counselling women with kidney disease about parenthood.

Perinatal depression.

Perinatal depression is a common and debilitating complication of pregnancy and childbirth. Recent studies have elucidated relationships between acute birth events on depression risk, and novel treatments for postpartum depression have been discovered and approved. This article reviews current understandings about birth events on depression, new screening standards, and novel treatments for postpartum depression. Pain, analgesia, and depression are complex traits that are inter-related during and after pregnancy. Certain individuals may benefit more than others from addressing pain and suffering around childbirth. Exposures to general anesthesia or postdural puncture headache are associated with postpartum depression symptoms, although a causal relationship is unlikely. Brexanolone, ketamine and its related compounds, and nonpharmacologic options offer new or alternative therapies for depression, although safety information for some of these treatments in pregnancy and lactation are needed. Maternal health bundles call for close attention to perinatal mental health screening with validated instruments, and for timely treatment referrals in the 'fourth trimester'. Clinical monitoring and timely treatment of depression in the perinatal and postpartum periods is critical for maternal postpartum health and recovery. Perinatal specialists and researchers should continue to focus on tailored treatments specific to this special population.

Olfactory function in the trace amine-associated receptor family (TAARs) evolved twice independently

Olfactory receptor families have arisen independently several times during evolution. The origin of taar genes, one of the four major vertebrate olfactory receptor families, is disputed. We performed a phylogenetic analysis making use of 96 recently available genomes, and report that olfactory functionality has arisen twice independently within the TAAR family, once in jawed and once in jawless fish. In lamprey, an ancestral gene expanded to generate a large family of olfactory receptors, while the sister gene in jawed vertebrates did not expand and is not expressed in olfactory sensory neurons. Both clades do not exhibit the defining TAAR motif, and we suggest naming them taar-like receptors (tarl). We have identified the evolutionary origin of both taar and tarl genes in a duplication of the serotonergic receptor 4 that occurred in the most recent common ancestor of vertebrates. We infer two ancestral genes in bony fish (TAAR12, TAAR13) which gave rise to the complete repertoire of mammalian olfactory taar genes and to class II of the taar repertoire of teleost fish. We follow their evolution in seventy-one bony fish genomes and report a high evolutionary dynamic, with many late gene birth events and both early and late gene death events.

Chromosome painting: How recombination mixes ancestral colors

We consider a Moran model with recombination in a haploid population of size N. At each birth event, with probability 1−ρNR the offspring copies one parent’s chromosome, and with probability ρNR she inherits a chromosome that is a mosaic of both parental chromosomes. We assume that at time 0 each individual has her chromosome painted in a different color and we study the color partition of the chromosome that is asymptotically fixed in a large population, when we look at a portion of the chromosome such that ρ:=limN→∞ρNN 2→∞. To do so, we follow backwards in time the ancestry of the chromosome of a randomly sampled individual. This yields a Markov process valued in the color partitions of the half-line, that was introduced by Esser, Probst and Baake (J. Math. Biol. 73 (2016) 161–197), in which blocks can merge and split, called the partitioning process. Its stationary distribution is closely related to the fixed chromosome in our Moran model with recombination. We are able to provide an approximation of this stationary distribution when ρ≫1 and an error bound. This allows us to show that the distribution of the (renormalised) length of the leftmost block of the partition (i.e., the region of the chromosome that carries the same color as 0) converges to an exponential distribution. In addition, the geometry of this block can be described in terms of a Poisson point process with an explicit intensity measure.

The birthing brain: A lacuna in neuroscience

During pregnancy, maternal brain neuroplasticity indicates vast neurofunctional and neuroanatomical changes. Recent findings documented a similarly massive readjustment after pregnancy. Currently, these brain changes are interpreted as preparation for and adjustment of the maternal brain to motherhood. Yet, this perspective leaves many questions unsolved. Neuroscientific studies have not yet been conducted to determine the brain areas that function during natural childbirth even though physiological birth is the natural process of women who have reproduced successfully throughout two million years of evolution of the genus Homo. It is rational to believe that the female brain is an active and crucial actor during birth and that birth, itself, is a process that requires brain neuroplasticity. Lack of studies of the birthing brain and brain preparation for birth is a significant lacuna in neuroscience research. I demonstrate theoretically that a new hypothesis for complementary interpretation of maternal brain neuroplasticity is reasonable: Certain maternal brain changes during pregnancy can be interpreted asbrain preparation for birth and certain maternal brain changes after birth can be interpreted asbrain recovery after the tremendous event of birth. This essay can be a starting point for new directions in neuroscience studies.

Mutability of demographic noise in microbial range expansions

Demographic noise, the change in the composition of a population due to random birth and death events, is an important driving force in evolution because it reduces the efficacy of natural selection. Demographic noise is typically thought to be set by the population size and the environment, but recent experiments with microbial range expansions have revealed substantial strain-level differences in demographic noise under the same growth conditions. Many genetic and phenotypic differences exist between strains; to what extent do single mutations change the strength of demographic noise? To investigate this question, we developed a high-throughput method for measuring demographic noise in colonies without the need for genetic manipulation. By applying this method to 191 randomly-selected single gene deletion strains from the E. coli Keio collection, we find that a typical single gene deletion mutation decreases demographic noise by 8% (maximal decrease: 81%). We find that the strength of demographic noise is an emergent trait at the population level that can be predicted by colony-level traits but not cell-level traits. The observed differences in demographic noise from single gene deletions can increase the establishment probability of beneficial mutations by almost an order of magnitude (compared to in the wild type). Our results show that single mutations can substantially alter adaptation through their effects on demographic noise and suggest that demographic noise can be an evolvable trait of a population.

Assisted hatching on assisted conception (in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI)).

Failure of implantation and conception may result from inability of the blastocyst to escape from its outer coat, which is known as the zona pellucida. Artificial disruption of this coat is known as assisted hatching and has been proposed as a method for improving the success of assisted conception by facilitating embryo implantation. To determine effects of assisted hatching (AH) of embryos derived from assisted conception on live birth and multiple pregnancy rates. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group Specialised Register (until May 2020), the Cochrane Central Register of Controlled Trials (CENTRAL; until May 2020), in the Cochrane Library; MEDLINE (1966 to May 2020); and Embase (1980 to May 2020). We also searched trial registers for ongoing and registered trials (http://www.clinicaltrials.gov - a service of the US National Institutes of Health; http://www.who.int/trialsearch/Default.aspx - The World Health Organization International Trials Registry Platform search portal) (May 2020). Two review authors identified and independently screened trials. We included randomised controlled trials (RCTs) of AH (mechanical, chemical, or laser disruption of the zona pellucida before embryo replacement) versus no AH that reported live birth or clinical pregnancy data. We used standard methodological procedures recommended by Cochrane. Two review authors independently performed quality assessments and data extraction. We included 39 RCTs (7249 women). All reported clinical pregnancy data, including 2486 clinical pregnancies. Only 14 studies reported live birth data, with 834 live birth events. The quality of evidence ranged from very low to low. The main limitations were serious risk of bias associated with poor reporting of study methods, inconsistency, imprecision, and publication bias. Five trials are currently ongoing. We are uncertain whether assisted hatching improved live birth rates compared to no assisted hatching (odds ratio (OR) 1.09, 95% confidence interval (CI) 0.92 to 1.29; 14 RCTs, N = 2849; I² = 20%; low-quality evidence). This analysis suggests that if the live birth rate in women not using assisted hatching is about 28%, the rate in those using assisted hatching will be between 27% and 34%. Analysis of multiple pregnancy rates per woman showed that in women who were randomised to AH compared with women randomised to no AH, there may have been a slight increase in multiple pregnancy rates (OR 1.38, 95% CI 1.13 to 1.68; 18 RCTs, N = 4308; I² = 48%; low-quality evidence). This suggests that if the multiple pregnancy rate in women not using assisted hatching is about 9%, the rate in those using assisted hatching will be between 10% and 14%. When all of the included studies (39) are pooled, the clinical pregnancy rate in women who underwent AH may improve slightly in comparison to no AH (OR 1.20, 95% CI 1.09 to 1.33; 39 RCTs, N = 7249; I² = 55%; low-quality evidence). However, when a random-effects model is used due to high heterogeneity, there may be little to no difference in clinical pregnancy rate (P = 0.04). All 14 RCTs that reported live birth rates also reported clinical pregnancy rates, and analysis of these studies illustrates that AH may make little to no difference in clinical pregnancy rates when compared to no AH (OR 1.07, 95% CI 0.92 to 1.25; 14 RCTs, N = 2848; I² = 45%). We are uncertain about whether AH affects miscarriage rates due to the quality of the evidence (OR 1.13, 95% CI 0.82 to 1.56; 17 RCTs, N = 2810; I² = 0%; very low-quality evidence). This update suggests that we are uncertain of the effects of assisted hatching (AH) on live birth rates. AH may lead to increased risk of multiple pregnancy. The risks of complications associated with multiple pregnancy may be increased without evidence to demonstrate an increase in live birth rate, warranting careful consideration of the routine use of AH for couples undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). AH may offer a slightly increased chance of achieving a clinical pregnancy, but data quality was of low grade. We are uncertain about whether AH influences miscarriage rates.

Obstetric history and its association with cardiometabolic risk factors: a case-control study among Bhil Women of Rajasthan, India

Pregnancy and childbearing are special reproductive events having an impact on women’s health and demographic trends. Reproductive health is not only linked to biological events of gestation and birth, but also are intricately linked to women`s status and their role in society. The current study focuses on the impact of bad obstetric history in the development of cardiometabolic risk factors. The present retrospective case-control study was conducted among Bhil tribal women of Rajasthan, India. A total of 287 women participated in this study which included 125 cases and 162 controls. Data on somatometric measurements, physiological measurements and lipid profile were recorded and analysed using SPSS version 25.0. The mean number of conceptions differed significantly between pregnancy in cases (5.06±1.85) and pregnancy in controls (3.19±1.56). Cases were characterised with significantly increased mean SBP (p=0.010), although the values (116.68±23.04) fell within the normal range. Bad obstetric history was found to be a risk factor for central obesity, hypertension and dyslipidemia among the Bhil women. It was also found to be relatively associated with adverse demographic/lifestyle variables which could enhance the effect of cardiometabolic risk factors. Women with bad obstetric history need special care and lifestyle variables need to be adjusted for better health outputs.

Cardiac and obstetric outcomes in pregnant patients with heart disease: a retrospective cohort study

Background Cardiac diseases complicate 4% of pregnancies, with a mortality rate between 0 and 15%. Early referral has shown to reduce the risk of maternal major cardiac events (MACEs). Methods We retrospectively analyzed a cohort of pregnant women with heart disease from two referral centers in Mexico City. We examined MACEs: maternal death, pulmonary edema, acute heart failure, endocarditis, stroke, myocardial infarction, acute aortic syndromes, arrhythmias requiring urgent treatment, and the need for an urgent intervention; preterm birth and obstetric events such as HELLP syndrome, preeclampsia, eclampsia, placental abruption, obstetric hemorrhage. We analyzed the association between each modified World Health Organization (mWHO) group and MACEs, preterm birth and obstetric outcomes between March 2014 and March 2019. Results Using the mWHO classification, 399 deliveries were included and stratified as follows: I, 162; II, 133; II–III, 21; III, 18; and IV, 52 patients. MACEs were observed in 12.5% of the cohort and were associated with mWHO II (odds ratio [OR], 3.0; 95% confidence interval [95% CI], 1.1–8.1; p = 0.027), II–III (OR, 3.3; 95% CI, 0.9–1.0; p = 0.116), III (OR, 5.3; 95% CI, 1.2–23; p = 0.026), and IV (OR, 8.2; 95% CI, 2.7–24.5; p < 0.001) after adjusting for age, desaturation, previous functional class, and gestational age at referral. An association between mWHO and frequency of preterm birth was observed. Association between mWHO and obstetric events, even when adjusted, was not observed. Conclusions The prevalence of MACEs and preterm birth is similar to that seen worldwide; MACEs and preterm birth are associated with the severity of heart disease stratified by mWHO, but there is no association between the severity of heart disease and obstetric events.

Examining the Causal Impact of Prenatal Home Visiting on Birth Outcomes: A Propensity Score Analysis.

In Ohio, African American babies die at 2.5-3 times the rate of White babies. Preterm birth and low birth weight are the leading causes of infant mortality. Home visiting is an evidence-based strategy for serving low-income pregnant women; however, there are relatively few rigorous studies examining its effect on birth outcomes. This study uses a propensity score technique to estimate the causal effect of participation in home visiting on prematurity and low birth weight among a low-income, predominantly African American sample (N = 26,814). We found that participation in home visiting significantly reduced the odds of experiencing both adverse birth events, with a larger program effect for the low birth weight outcome. Results suggest that selective prevention strategies must be accompanied by universal attempts to improve the health and life circumstances of low income and minority women.

A retrospective study investigating the association of parity, breed, calving month and year, and previous parity milk yield and calving interval with twin births in US dairy cows

Twinning costs the dairy industry an estimated $96 million each year. Twin pregnancy occurrence in high-producing dairy cows is primarily a result of multiple ovulations associated with low circulating concentrations of progesterone due to high milk production. The present retrospective observational study aimed to identify associations between (1) previous parity milk yield and subsequent twin birth prevalence, (2) twin birth with same parity milk production and calving interval (CInt), and (3) twin birth and the subsequent twin calving. The final data set included almost 2.9 million US dairy calving and production records between 2001 and 2020. Variables considered were parity, breed, milk production, CInt, calving month, and year. Logistic and linear regression modeling were used to assess the effects of predictors on outcomes. Herd within state was used as a random effect for all regression models. Twin birth probability increased for cows with increased previous parity milk yield independent of breed or parity. Third and greater parity (3+) compared with second parity (2) and all breeds compared with Jerseys were associated with greater twin probability. Calving between April and September that corresponded to conceiving in July through December was associated with greater twin birth probability. Twin births were associated with decreased milk production following the birth event in Holsteins and parity 2 cows and in the calving months between June and September. Surprisingly, twin births in parity 3+ cows were associated with an increased 305-d milk yield. Cows that had a twin birth were more likely to calve twins in the subsequent parity and had a greater risk of having a CInt between 413 and 600 d. The hazard to subsequent calving after single births was greater compared with twin births. These data can be instrumental in guiding research focus on reducing twinning in lactating dairy cows.

A Panel Study of Fertility Preferences and Contraceptive Dynamics in the Presence of Competing Pregnancy Risks in Uganda.

Although many studies have examined the influence of women's fertility preferences on subsequent fertility behavior and the role of contraceptive use intentions on unmet need, very few have explored their concurrent effects on contraceptive use dynamics. This study examines the independent concurrent effects of women's fertility preferences and contraceptive intentions on subsequent adoption and discontinuation, treating pregnancy as a competing risk factor that may alter contraceptive need. The data are derived from a 2018 follow-up survey of a 2014 national sample of 3,800 Ugandan female respondents of childbearing age. The survey included a contraceptive calendar that recorded pregnancy, birth, and contraceptive event episodes, including reasons for discontinuation. We use competing risk regression to estimate the effect of fertility preferences and contraceptive intentions on the cumulative incidence function of contraceptive behaviors, accounting for intervening pregnancy, female background covariates, loss to follow-up, and complex survey design. We find that women's contraceptive intentions significantly increase the rate of contraceptive adoption. After having adopted, women's contraceptive intentions have been realized and do not prolong use. The risk of discontinuation among women who adopted after baseline was significantly higher than for those using at baseline, irrespective of their initial intentions. The effectiveness of the type of contraceptive method chosen significantly lowered discontinuation risk. Fertility preferences were not significantly associated with either time to adoption or discontinuation. The pace of the fertility transition in this sub-Saharan African setting is likely being shaped by reproductive regulation through the intentional use of contraception that enables spacing births.

Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

BackgroundThe intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable.MethodsWe assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (< 72 h) and asked to report circumstances of labor and delivery. A subset was revisited 1–24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence.ResultsOne thousand five hundred two mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions.ConclusionsThis study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

A qualitative study of the impact of adverse birth experiences on fathers

BackgroundBeing present during labour and birth can, for some fathers, result in feelings of fear, uncertainty, anxiety, and helplessness. Witnessing birth complications or adverse events may cause immediate and long-term anxiety and stress. In turn, this experience can impact on men’s sense of self and identity as a man and father and can affect his relationship with his infant and partner. The aim of this study was to explore the immediate and longer-term impact of witnessing a complicated or adverse birth experiences on men in heterosexual relationships and their role as a father. MethodsAn interpretive qualitative approach informed the design of this study. A total of 17 fathers, one from New Zealand and sixteen from Australia participated through face to face, telephone and email interviews. The ages of the men were between 24 to 48 years, and the time since the adverse birth experience ranged from 4.5 months to 20.5 years. FindingsThematic analysis revealed three major themes representing men’s experiences of witnessing a complicated birth or adverse event; ‘Worst experience of my life’, ‘Negotiating my place: communicating with health professionals’ and ‘Growing stronger or falling apart’. Men were unprepared and feared for the lives of their infants and partners, they expected and wanted to be involved in the birth and the maternity care journey, instead they were pushed to the side and excluded from the labour and birth during times of emergency. Being excluded from part or all of the birth perpetuated worry and vulnerability as, at times, men were left not knowing anything about what was happening to their partners. Midwives and other health professionals’ support was important to the way fathers adjusted and processed the complications of the labour and birth event. This experience impacted on their own mental health and their relationship with their baby and partner. ConclusionFindings demonstrate that following a complicated or adverse birth experience, men questioned their role as a father, their place in the family and their role at the birth. There is a need to include and inform the expectant father that help is available if they experience negative feelings of hopelessness or despair. Maternity services and care providers need to involve fathers so that they feel part of the maternity care system and journey which may mitigate feelings of helplessness.