Low-risk Maternity Research Articles

Obesity as a risk factor for cesarean in a low-risk population

Objective: To determine whether low-risk maternity patients in a nurse-midwifery service with prepregnant body mass index (BMI) above 29.0 are at increased risk for cesarean delivery. Methods: We studied 1881 women who delivered between 1994 and 1998 and were managed by an academic inner-city hospital-certified nurse-midwifery practice. We calculated prepregnancy BMI and weight gain during pregnancy by using clinical data from a comprehensive clinical database, and did descriptive analyses and univariate and multivariate logistic regression analyses. Results: The overall cesarean rate was 5.1%, but was 7.7% for obese women compared with 4.1% for women with normal BMI (19.8–25.9). The unadjusted odds ratio (OR) for cesarean for obese women was 2.02 (95% confidence interval [CI] 1.26, 3.25, P < .01). Other factors associated with increased risk of cesarean delivery included primigravidity, primiparity, maternal age 35 years or older, short stature (height under 155 cm), very low birth weight infant, failure to progress, breech presentation, abruption, fetal bradycardia, and severe preeclampsia. Maternal race and marital status were not associated with cesarean delivery. After adjustment for weight gain, short stature, advanced maternal age, primiparity, and intrapartum complications, the OR for obesity was 3.99 (95% CI 2.00, 7.95, P < .001). Conclusion: Even among low-risk women managed by nurse-midwives, the risk of cesarean delivery was higher for obese women. Short, obese women were at higher risk of cesarean delivery compared with women with normal BMIs, but were not high enough risk to preclude them from receiving nurse-midwifery care.

Choice and chance in low risk maternity care.

Choice and chance in low risk maternity care.

Drug abuse screening of childbearing-age women in Alabama public health clinics

During August 1989, the urine of 5010 women of childbearing-age in Alabama was screened for marijuana, cocaine, opiates, amphetamines, and barbiturates. The data base consisted of 2970 pregnant women, 374 of whom were at high risk, and 2019 nonpregnant women. Our findings included the following information: (1) The statewide prevalence of positive screens for any drugs tested was 12.9% for all women (11.0% for those who were pregnant and 15.6% for those who were not pregnant). (2) There was no difference between urban and rural groups for any drugs tested. (3) Positive marijuana screens were increased among white and nonpregnant women (p \\lt 0.01). (4) Positive cocaine screens were increased among black and single women (p \\lt 0.01 ). (5) More screens were positive in women older than age 20 (p \\lt 0.01). (6) There was no difference between pregnant and nonpregnant women for positive cocaine screens. (7) No difference existed among the trimesters of pregnancy for positive cocaine screens. (8) Positive screens for marijuana were more frequent in the first trimester of pregnancy than in the second trimester (p = 0.02) or the third trimester (p = 0.001). (9) There was no difference between high-risk and low-risk maternity patients for any drugs tested.

Effectiveness of certified nurse-midwives: A prospective evaluation study

A prospective evaluation study of the effectiveness of the services of certified nurse-midwives demonstrated that in a hospital setting the care of low-risk maternity patients provided by nurse-midwives was as effective as the provided by house staff physicians. A total of 438 low-risk maternity patients were studied. Selected outcomes pertaining to the prenatal period, labor and delivery, and early infancy demonstrated, with two exceptions, no significant differences. The two exceptions were: (1) overcompliance with appointment attendance was more common among the nurse-midwifery group of patients; (2) a higher rate of forceps delivery was reported among the house staff group of patients.

Lead zirconate—lead titanate piezo-electric ceramics with iron oxide additions: Weston, T.B., Webster, A.H., McNamara, W.M., journal of the American ceramic society vol 52, no 5 (21 May 1969) pp 253–257 (1922)

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.