Low-risk Maternity Research Articles

Breastfeeding duration and its relation to weight gain, eating behaviours and positive maternal feeding practices in infancy

Research examining the relationship between breastfeeding and infant weight has generated conflicting results. Few studies account for significant covariates and many suffer methodological problems such as retrospective self-report. The current study aimed to investigate relationships between breastfeeding duration, infant weight and eating and positive maternal mealtime behaviours, whilst overcoming many of the limitations of previous research. Eighty-one women on low-risk maternity units gave informed consent and were visited at home at 1-week, 1-, 6- and 12-months postpartum. Infants included 45 males and 36 females (mean birth-weight 3.52 kg [SD 0.39]). Mothers and infants were weighed and measured and feeding information was recorded at each visit. Infant weight was converted to a standard deviation score (SDS), accounting for age and sex. Mothers reported infant eating behaviours at 12-months using the Children's Eating Behaviour Questionnaire and were observed feeding their infants solid food at home at 6- and 12-months. Partial correlations (covariates: maternal age, education, BMI, smoking during pregnancy, household income, infant birth weight SDS and age introduced to solid foods) revealed negative associations between breastfeeding duration and 1- to 6- and 1- to 12-month weight gain, and 6- and 12-month weight. Breastfeeding duration was also associated with a slower rate of infant eating and greater observed maternal vocalisations, appropriateness and sensitivity. Results support a dose-response relationship between breastfeeding and infant weight and suggest that breastfeeding may encourage the development of obesity-protective eating behaviours through learning to attend to internal hunger and satiety signals. Future research should investigate whether relationships between slowness in eating and weight extend to satiety responsiveness after infancy.

Obstetric Outcomes of First- and Second-Generation Pakistani Immigrants: A Comparison Study at a Low-Risk Maternity Ward in Norway.

This population-based study compares obstetric outcomes of first- and second-generation Pakistani immigrants and ethnic Norwegians who gave birth at the low-risk maternity ward in Baerum Hospital in Norway from 2006 to 2013. We hypothesized that second-generation Pakistani immigrants are more similar to the ethnic Norwegians because of increased acculturation. Outcome measures were labor onset, epidural analgesia, labor dystocia, episiotomy, vaginal/operative delivery, postpartum hemorrhage, preterm birth, birth weight, transfer to a neonatal intensive care unit, and neonatal jaundice. Compared to first-generation Pakistani immigrants, the second-generation reported more health issues before pregnancy, and they had a higher proportion of preterm births compared to Norwegians. Newborns of first-generation immigrants were more often transferred to a neonatal intensive care compared to Norwegian newborns. Few intergenerational differences in the obstetric outcomes were found between the two generations. A high prevalence of consanguinity in second-generation immigrants suggests the maintenance of a traditional Pakistani marriage pattern.

Detecting Breech Presentation Before Labour: Lessons From a Low-Risk Maternity Clinic.

Evaluation of fetal position is an important part of prenatal care. A woman with a breech presentation may need referral for external cephalic version, for assisted breech delivery, or to schedule a Caesarean section. In many centres, a breech presentation undetected until labour will result in an emergency Caesarean section, a less desirable alternative for both the mother and the health care system. The anecdotal reports of undiagnosed breech presentations at a busy maternity clinic prompted a study to quantify the missed breech presentations and to evaluate the effectiveness of the current detection process, with the aim of allowing no more than 1% of breech presentations to remain undetected until labour. We performed a retrospective analysis of 102 breech deliveries over a 14 month period to quantify missed breech presentations, and used a prospective physician survey documenting how fetal presentation was determined at 186 prenatal visits over four months to analyze the current detection process. We found that approximately 8% of breech presentations were undetected until labour. We concluded that within the limitations of the small sample size evaluated, the current practice of using a vaginal examination to verify fetal presentation determined by abdominal palpation (Leopold's manoeuvres) may not be more accurate than abdominal palpation alone. The current detection process resulted in an unacceptably high rate of missed breech presentations. The results of this study prompted the clinic's acquisition of bedside ultrasound capability to assess fetal position.

Neonatal hearing screening in a low-risk maternity hospital in São Paulo state

IntroductionThe literature indicates that neonatal hearing screening should be universal, so a description of programs that adopt this recommendation is relevant. ObjectiveTo describe the results of newborn hearing screening and the profile of mothers and newborns attended to in a low-risk maternity setting, and to correlate the characteristics of this population with the results of transient evoked otoacoustic emissions. MethodsA contemporary cross-sectional cohort study. The sample consisted of 670 infants and the procedures performed were audiological history, transient-evoked otoacoustic emissions (TEOAE), distortion product-evoked otoacoustic emissions (DPEOAE), and automated-brainstem auditory evoked potential (ABSAEP). ResultsThe rate of success in this program was 98.5%, the failure rate was 0.62%, and that of non-attendance to finalize the diagnostic process, 0.93%. When correlating the variables studied with the results of transient evoked otoacoustic emissions, there was a significant negative correlation only for age of infant. ConclusionThe program of this maternity hospital was effective and complies with national and international recommendations. The population consisted of young mothers with few pregnancy complications and healthy infants. The only variable that influenced transient evoked otoacoustic emission results, after hospital discharge, was the age at which infants were evaluated.

Neonatal jaundice and the immigrant population: A comparison study at a low-risk maternity ward in Norway

The aim of this study was to examine differences in distribution of neonatal jaundice by migration indicators. In this population-based study at the low-risk maternity ward at Baerum Hospital in Norway, 11,516 mother–child pairs were enrolled and divided into 7 groups by regions/country of origin. First registered live birth babies of mothers who gave birth between 1 January 2006 and 31 December 2010 were included. The study found that a total of 769 infants were treated for neonatal jaundice. Compared to Norwegians, infants born to mothers from East, Southeast and Central Asia had an increased risk and African infants had a decreased risk of neonatal jaundice. Jaundiced infants of African origin were more often transferred to neonatal intensive care units. Ethnicity is an important factor affecting the risk of neonatal jaundice requiring hospitalization in our clinic. To reduce this risk, parents should be adequately informed about the signs of neonatal jaundice requiring medical intervention.

Correlation between Otoacoustic Emissions Transient Evoked and Distortion Product in a Group of Neonates

Objectives: This study aims to correlate the results of transient evoked otoacoustic emission (TEOAE) and distortion product (DPOAE) of neonates born in a low risk maternity.

Rupture and dehiscence of uterine scar: cases study at a low-risk maternity in the Brazilian Southeast

To evaluate the cases of uterine rupture and dehiscence of the uterine scar at a low-risk maternity and to point out possibilities for an improved approach to these complications. A descriptive study was conducted at a 30-bed low-risk maternity hospital that provides care to users of the public health system. The investigation was carried out by searching for cases in the delivery room registry book and later reading the medical records in order to obtain the data. The information was inserted on a form previously elaborated for this study. Cases of uterine rupture and dehiscence of the uterine scar diagnosed from 1998 to 2012 were included, with the determination of incidence, aspects related to risk factors and diagnosis, association with the use of misoprostol and oxytocin, and the outcomes observed. A total of 39,206 deliveries were performed in this maternity during the study period, with 12 cases of uterine rupture and 16 cases of dehiscence of uterine scar being observed. The most relevant results were a high perinatal mortality associated with uterine rupture and the unsuccessful diagnosis of this complications. It was not possible to demonstrate an association with the use of misoprostol or oxytocin. The adverse outcomes of uterine rupture could be minimized if efforts were directed at improving the diagnostic performance of the assisting teams.

Obesity and pregnancy: a transversal study from a low-risk maternity.

BackgroundObesity is a public health problem and is increasing in all populations, including pregnant women. It influences maternal and neonatal outcomes; however, data are scarce in developing countries. We aimed to compare perinatal results between obese and non-obese pregnant women in a low-risk maternity.MethodsTransversal study of 1,779 40-week-pregnancies from 2005 to 2009 that completed a standard questionnaire with sociodemographic, obstetrical and neonatal variables and performed an ultrasound with amniotic fluid index (AFI) measurement and foetal vitality (FBP, non-stress test). They were analysed about their association with obesity on pregnancy.ResultsWhen compared with non-obese women, the group of obese patients had higher systolic (118.1 vs 109.2 mmHg; p < 0.01) and diastolic (76.6 vs 70.4 mmHg; p < 0.01) pressure levels, AFI (12.52 vs. 9.61 cm; p = 0.02), presence of meconium on labour (20.52 vs. 14.67%; p = 0.02), birthweight (3602 vs. 3437 g; p < 0.01) and caesarean section (39.74 vs. 29.98%, p < 0.01).ConclusionsLabour induction before 40 weeks in the antenatal period associated with foetal weight estimation should be considered as a recommendation for decreasing high percentages of caesarean delivery found in obese women.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-249) contains supplementary material, which is available to authorized users.

PA.45 Hand Hygiene in an Obstetric Out-Patient Clinic: is it really possible to follow recommendations?

BackgroundSubstantial evidence has proven that careful hand hygiene will reduce healthcare-associated infection (HCAI). However, lack of systemic evaluation of the risk of HCAI in an out-patient setting, as well as...

T-ACE and predictors of self-reported alcohol use during pregnancy in a large, population-based urban cohort

Hicks, M., Tough, S., Johnston, D., Siever, J., Clarke, M., Sauve, R., Brant, R., &amp; Lyon, A. (2014). T-ACE and predictors of self-reported alcohol use during pregnancy in a large, population-based urban cohort. The International Journal Of Alcohol And Drug Research, 3(1), 51-61. doi:10.7895/ijadr.v3i1.117Aims: To determine 1) the relationship between T-ACE score and maternal self-reported alcohol use prior to and during pregnancy, and 2) the relationship between T-ACE score and maternal demographics, mental health and life circumstances.Design: Prospective, population-based cohort study.Setting: Three urban maternity clinics in Calgary, Canada.Participants: 1,929 pregnant women attended by family physicians at low-risk maternity clinics.Measures: Women completed three standardized questionnaires over the telephone in the first and third trimesters and eight weeks post-delivery, including the T-ACE and questions about drug and alcohol use, demographics, mental health and life circumstances.Findings: 43.6% of subjects had a positive T-ACE score at intake (score 2 or greater). A positive T-ACE score was predictive of alcohol use throughout pregnancy, although most women reported no alcohol after the first trimester (93.1%). Multivariate analysis indicated that a positive T-ACE score was significantly associated with being less than 30 years of age; being Caucasian; smoking during pregnancy; having an income of less than $80,000 per annum; having a history of depression; having a history of alcohol use and binge drinking during a previous pregnancy; lower social support; and poor network orientation.Conclusions: There was a positive association between the T-ACE score and maternal self-report of alcohol use, poor mental health and poor social support. Routine use of the T-ACE to assess for risk of an alcohol-exposed pregnancy may also help identify women with complex needs who could benefit from additional prenatal support.

Telemedicine for neonatal resuscitation.

Maintaining high levels of readiness for neonatal resuscitation in low-risk maternity settings is challenging. The neonatal resuscitation program (NRP) algorithm is a community standard in the United States; yet training is biannual, and exposure to enough critical events to be proficient at timely implementation of the algorithm and the advanced procedures is rare. Evidence supports hands-free leadership to help prevent task saturation and communication to promote patient safety. Telemedicine for neonatal resuscitation involves the addition of remote, expert NRP leadership (a NICU-based neonatal nurse practitioner) via camera link to augment effectiveness of the low-risk birth center team. Unanticipated outcomes to report include faster times to transfer initiation and neuroprotective cooling. The positive impact of remote NRP leadership could lead to use of telemedicine to support teams at birthing centers throughout the United States as well as around the world.

Fetal monitoring in a low risk maternity unit: Usage and indications

Casey Hospital opened as one of three campuses within Southern Health in 2005 providing maternity services to low risk women in the southeastern suburbs of Melbourne. Numbers have grown from 500 to 1500 births per annum. In this time there has been an increase in the use of continuous fetal monitoring in labour and rates of caesarean section. This finding posed the questions: (1) Is there a relationship between more frequent use of continuous fetal monitoring at Casey Hospital and the increased caesarean section rate? (2) What is the impact of the rising caesarean birth rate on neonatal outcomes? (3) Is this consistent with best practice?

Contribution of safe motherhood solidarity groups in using and accessing maternity services during a period of armed conflict

This report presents the results of a study on Reproductive Health done in North Kivu in September 2009. It was conducted by HEAL Africa, in partnership with the Provisional Division of Health, and financed by the University of Ottawa, Canada/CRDI with technical assistance from Western Cape University of South Africa. The study was conducted in the health zones of Birambizo and Kayna within the framework of the central office. The focus of the report is on one aspect of Reproductive Health—Low Risk Maternity. This study was conducted in rural areas given that Reproductive Health indicators are much weaker when compared with urban areas, according to EDS RDC, 2007 [1]. This study emphasizes the following points: General characteristics of the participants in the study, and the utilization and accessibility of maternity services in rural areas in conflict situations. The formula SPSS 12.0.1 was used to facilitate data analysis in the study. This study comes at a point in time when its relevance to HEAL Africa’s work will assist HEAL and its partners in determining the focus of interventions done in health zones in order to improve maternal and neonatal health. HEAL Africa firstly stepped into a Safe Motherhood pilot project in June 2006 for 9 months in the Masisi zone, then in 2007 in the Birambizo and Kayna health zones. In November 2007, HEAL expanded into Walikale and in October 2008, into Kirotshe, Binza, and Lubero. The intervention kit consists of reinforcing the capacity of existing health facilities, training traditional midwives who serve as a link between the community and the health structures, the provision of sanitary equipment, medical essentials and community mobilization was done through local leaders about health and reproduction, and organizing women of reproductive age in solidarity groups (SG) to generate maternity insurance. The community approach “Solidarity Groups for Maternity Insurance” constitutes the spine of HEAL Africa within the support it provides in Reproductive Health. The principal idea is to educate and train communities on how to use the MMR services that are available in their community, and to remove financial barriers to accessing health services. The 4 pillars that comprise the Safe Motherhood program are: family planning, prenatal care, safe assisted delivery and essential obstetric care. These four strategic measures are integral in assuring primary health care and equality for women. This study evaluates this approach, keeping in mind local strategies and their effects on improving the utilization and accessibility of reproductive health services.

Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial

BackgroundThe increased prevalence of obesity in pregnant women in Australia and other developed countries is a significant public health concern. Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care. There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated. The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range. The secondary aims of the study are to assess the impact of continuity of midwifery care on: women's experience of pregnancy care; women's satisfaction with care and a range of psychological factors.Methods/DesignA two arm randomised controlled trial (RCT) will be conducted with primigravid women recruited from maternity services in Victoria, Australia. Participants will be primigravid women, with a BMI≥30 who are less than 17 weeks gestation. Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy. Women allocated to the control group will receive routine care in addition to the same informational leaflet. Weight gain during pregnancy, standards of care, medical and obstetric information will be extracted from medical records. Data collected at recruitment (self administered survey) and at 36 weeks by postal survey will include socio-demographic information and the use of validated scales to measure secondary outcomes.DiscussionContinuity of midwifery care models are well aligned with current Victorian, Australian and many international government policies on maternity care. Increasingly, midwifery continuity models of care are being introduced in low risk maternity care, and information on their application in high risk populations is required. There is an identified need to trial alternative antenatal interventions to reduce perinatal risk factors for women who are obese and the findings from this project may have application in other maternity services. In addition this study will inform a larger trial that will focus on birth and postnatal outcomes.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12610001078044.

Does Allocation of Low Risk Parturient Women to a Separate Maternity Unit Decrease the Risk of Emergency Cesarean Section?

In response to escalating rates of cesarean section, the Norwegian Parliament in 2001 decreed that maternity units should be organized into separate units to differentiate between low and high risk deliveries. This action was based on the assumption that low risk patients were being subjected to unnecessary and possibly harmful interventions when treated together with high risk patients. Moreover, it was suggested that the calmer environment for low risk women and less need for medical interventions would achieve a better outcome for mother and child. Accordingly, a number of obstetrical departments were reorganized by physical separation of perceived high and low risk patients. However, the benefit of separate maternity units for low risk patients is questionable. A Cochrane review reported that births in home-like settings appeared to have only a marginally lower rate of cesarean births. No studies have examined the effect of separating low and high risk pregnancies on frequency of cesarean deliveries. This hospital-based registry study investigated whether assignment of women with low risk births to special maternity units reduced emergency cesarean section rates compared with giving birth in a unit with mixed cases. The patient population was comprised of women with intended vaginal delivery during 2001-2003 at 2 urban university hospitals in Norway. There were a total of 11,686 low and high risk deliveries. Data were obtained from standardized prenatal and perinatal health charts. The primary study outcome measure was the risk of emergency cesarean section. The risk of emergency cesarean section was higher in the low risk maternity unit compared with a maternity unit with both high and low risk women; the adjusted odds ratio was 1.4, with a 95% confidence interval of 1.2 to 1.6. These findings provide no support for the separation of maternity wards into high and low risk units. Lower rates of emergency cesarean section among the mixed cases may be due to the better maternity care of low risk women by personnel who are trained to manage high risk pregnancies.

Reference distribution of the bioelectrical impedance vector in healthy term newborns

Bioelectrical impedance vector analysis (BIVA) is a new method that is used for the routine monitoring of the variation in body fluids and nutritional status with assumptions regarding body composition values. The aim of the present study was to determine bivariate tolerance intervals of the whole-body impedance vector and to describe phase angle (PA) values for healthy term newborns aged 7-28 d. This descriptive cross-sectional study was conducted on healthy term neonates born at a low-risk public maternity. General and anthropometric neonatal data and bioelectrical impedance data (800 μA-50 kHz) were obtained. Bivariate vector analysis was conducted with the resistance-reactance (RXc) graph method. The BIVA software was used to construct the graphs. The study was conducted on 109 neonates (52.3% females) who were born at term, adequate for gestational age, exclusively breast-fed and aged 13 (SD 3.6) d. We constructed one standard, reference, RXc-score graph and RXc-tolerance ellipses (50, 75 and 95%) that can be used with any analyser. Mean PA was 3.14 (SD 0.43)° (3.12 (SD 0.39)° for males and 3.17 (SD 0.48)° for females). Considering the overlapping of ellipses of males and females with the general distribution, a graph for newborns aged 7-28 d with the same reference tolerance ellipse was defined for boys and girls. The results differ from those reported in the literature probably, in part, due to the ethnic differences in body composition. BIVA and PA permit an assessment without the need to know body weight and the prediction error of conventional impedance formulas.

Does allocation of low risk parturient women to a separate maternity unit decrease the risk of emergency cesarean section?

To study whether the selection of low risk parturient women into a separate maternity unit leads to a lower risk of emergency cesarean section, compared to giving birth in a unit with mixed cases. Hospital based registry study. Maternity units in two university hospitals in Oslo, Norway. All low risk parturient women with attempted vaginal deliveries in the years 2001-2003, a total number of 11,686 deliveries. Data were obtained from standardized patient records and risks of cesarean section were estimated as odds ratios. Emergency cesarean section risk. Compared with women giving birth in a unit with mixed cases, women giving birth in a maternity unit with low risk cases only had a higher risk of emergency cesarean section (OR 1.4; 95% CI 1.2-1.6). Giving birth in a low risk maternity unit is associated with a higher risk of cesarean section for low risk parturient women compared with giving birth in a maternity unit with mixed cases.

Women's perceptions of midwifery care in Lusaka, Zambia

Uncovering women's perceptions of maternity care provided give insight into their expectations and needs. This qualitative research study, using modified grounded theory approach, was done to explore views and experiences of women users of lowrisk maternity care services in Lusaka. In this city a series of maternity centres run by midwives were established to relieve pressure on an overworked maternity staff at the only tertiary hospital. Data was collected through semi-structured tape-recorded interviews with eleven women who were determined by theoretical saturation. Two categories of ‘trust in midwives’ and ‘recognition of the women’ were identified. These were integrated in one core category of ‘relationship between the midwife and the woman’. The findings demonstrated that for midwives to offer maternity services that are satisfactory to women, emphasis should not only be on a live baby and mother, but should also include building a good and trusting relationship with the mother.

Nausea and Vomiting of Pregnancy

Dr. Lane is Clinical Assistant Professor, Department of Family Medicine, Faculty of Medicine, University of Calgary, Low Risk Maternity Clinic, 182-1402 8th Avenue NW, Calgary, Alberta, T3G 3S5, Canada; E-mail: [email protected]. The ruthoa has disclosed that she is/was a speaker for Duchesnay, Inc. All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Lippincott CME Institute, Inc., has identified and resolved all faculty and staff conflicts of interest regarding this educational activity. This article was published originally in Clin Obstet Gynecol 2007;50:100–111.

Is Fetal Anatomic Assessment on Follow-up Antepartum Sonograms Clinically Useful?

The purpose of this study was to evaluate the clinical usefulness of a fetal anatomic survey on follow-up antepartum sonograms. A retrospective follow-up study was conducted at a low-risk maternity clinic from July 1, 2005, to June 30, 2006. Eligible women had at least 1 prior sonographic examination beyond 18 weeks' gestation with a complete and normal fetal anatomic assessment and at least 1 follow-up sonogram. Full fetal anatomic surveys were performed on all follow-up sonograms regardless of the indication. Neonatal charts were reviewed for those patients whose follow-up sonograms revealed unanticipated fetal anomalies. Neonatal intervention was defined as surgical or medical therapy or arranged subspecialty follow-up specifically for the suspected fetal anomaly. Of a total of 4269 sonographic examinations performed, 437 (10.2%) were follow-up studies. Of these, 101 (23.1%) were excluded because the initial sonogram revealed a suspected fetal anomaly, and 42 (9.8%) were excluded for other reasons. Of the remaining 294 women, 21 (7.1%) had an unanticipated fetal anomaly, most often renal pyelectasis. Compared with follow-up sonography for other reasons, repeated sonography for fetal growth evaluation yielded a higher incidence of unexpected fetal anomalies: 15 (12.3%) of 122 versus 6 (3.5%) of 172 (P = .01). When compared with the neonates in the nongrowth indications group, those neonates whose mothers had sonographic examinations for fetal growth had a higher rate of neonatal interventions: 6 (40.0%) of 15 versus 0 (0%) of 6 (P = .04). A fetal anatomic survey on follow-up sonograms may identify unanticipated fetal anomalies, especially when the indication is for fetal growth.