Maternal Position Research Articles

Parapraxis in Mother-Daughter Testimony: Unconscious Fantasy and Maternal Function

This article examines a moment of narrative dissonance in the joint testimony of a mother (Rosalie W.) and a daughter (Jolly Z.) who survived the Holocaust together: In the context of an extremely traumatic scene—namely an infanticide both women witnessed while they were held in Eidelstedt, a concentration camp in Hamburg—the common thread of their narrative is lost and contradictory memories emerge.Although this unraveling of a shared perspective is understood as a clear indication of the trauma encapsulated in the survivors’ narratives, the testimony is not simply maimed by experience and the difficulty representing the impact of the murder on the mother–daughter relationship. The testimony becomes a creative process that creates a montage of memory fragments, revealing horrors much larger than what the narrative of both survivors can explicitly cover: The contradiction between mother and daughter is really a condensation of two murders that occurred in Eidelstedt.At the same time, the testimony is shaped by the daughter's attempt to preserve her good internal object despite the brutal onslaught of external reality. She creates a “posttraumatic screen memory” that allows her to forget a situation in which her real mother could not provide any protection. In a complex weave of knowing and not-knowing, her narrative negotiates both the threatening loss of her mother relationship and the need for an internal object that allows for relatedness. Although the presence of the real mother at the scene speaks to the collapse of the maternal position in the face of trauma, the daughter's narrative forms scar tissue in an attempt to maintain relatedness, regardless of the trauma suffered.

Peculiarities of the Inner Maternal Position of Young Child with Down Syndrome

The article studies the dominant role of the child-mother relationships in the development and formation of personality of the infants and young children with Down syndrome. The article contains the information about the distortion of the child-mother relationships which leads to the different disorders of the mental development of a child. The article describes the construct of “inner maternal position”. It contains the methods and results of investigation aimed at revealing and study of peculiarities of the inner maternal position. It also describes the possible targets of psychological and pedagogical aid depending on the variant of the inner maternal position.

The effect of "hands on" techniques on obstetric perineal laceration: A structured review of the literature.

The purpose of this structured review was to review current evidence of "hands on" and "hands off" techniques as it relates to rates of perineal laceration in order to provide direction for future research in this important area of midwifery practice. A structured literature search using all identified keywords and index terms was undertaken in MEDLINE, EMBASE Joanna Briggs Institute, CINAHL, TRIP, and OVID nursing database. A total of 24 papers were identified from the initial searches as potentially relevant to the review questions. Of these a total of nine papers were considered relevant for this review. These nine included one systematic review with meta-analysis, four randomised controlled trials (RCTs), one quasi-experimental study and three cohort studies. "Hands on" techniques have been traditionally used but not been well defined in the literature, therefore it is currently unclear as to whether or not "hands on" technique can reduce perineal laceration. More studies are required to test the effectiveness of a standardised "hands on" technique and also to determine what part other factors such as maternal position, visualisation and use of water might play in perineal laceration rates.

The development and validation of an activity monitoring system for use in measurement of posture of childbearing women during first stage of labor.

There is limited understanding of the type and extent of maternal postures that midwives should encourage or support during labor. The aims of this study were to identify a set of postures and movements commonly seen during labor, to develop an activity monitoring system for use during labor, and to validate this system design. Volunteer student midwives simulated maternal activity during labor in a laboratory setting. Participants (N = 15) wore monitors adhered to the left thigh and left shank, and adopted 13 common postures of laboring women for 3 minutes each. Simulated activities were recorded using a video camera. Postures and movements were coded from the video, and statistical analysis conducted of agreement between coded video data and outputs of the activity monitoring system. Excellent agreement between the 2 raters of the video recordings was found (Cohen's κ = 0.95). Both sensitivity and specificity of the activity monitoring system were greater than 80% for standing, lying, kneeling, and sitting (legs dangling). This validated system can be used to measure elected activity of laboring women and report on effects of postures on length of first stage, pain experience, birth satisfaction, and neonatal condition. This validated maternal posture-monitoring system is available as a reference-and for use by researchers who wish to develop research in this area.

Maternal position and development of hypotension in patients undergoing cesarean section under combined spinal-epidural anesthesia of intrathecal hyperbaric ropivacaine.

BackgroundSpinal anesthesia (SA) is usually associated with hypotension in pregnant women. We sought to assess the influence of various maternal positions on SA-induced hypotension.Material/MethodsThe study population comprised 99 women at full-term gestation scheduled for elective cesarean section. They were randomized into 3 equal groups: the LL group, in which the patient was placed in the full left-lateral position until the start of surgery with the Whitacre needle bevel oriented laterally; the LS group, in which the patient was placed in the full left-lateral position initially and then shifted to the left-tilt supine position with the needle bevel oriented laterally; and the CS group, in which the patient was initially placed in the full left-lateral position and then shifted to the left-tilt supine position with the needle oriented in the cephalad direction.ResultsThe incidences of hypotension in the LL, LS, and CS groups were 9.7%, 54.8%, and 56.3%, respectively. Ephedrine requirements were lower in the LL group than in the LS group (P<0.01).ConclusionsThe maternal position during the induction of anesthesia played an important role in the development of hypotension during cesarean delivery.

Внутренняя материнская позиция женщин, беременность которых наступила с помощью ЭКО

Внутренняя материнская позиция женщин, беременность которых наступила с помощью ЭКО

Accuracy of self-reported sleep position in late pregnancy.

BackgroundThere is emerging research to suggest that supine maternal sleep position in late pregnancy may adversely affect fetal wellbeing. However, these studies have all been based on maternal report of sleeping position. Before recommendations to change sleep position can be made it is important to determine the validity of these studies by investigating how accurate pregnant women are in reporting their sleep position. If avoiding the supine sleeping position reduces risk of poor pregnancy outcome, it is also important to know how well women can comply with the instruction to avoid this position and sleep on their left.MethodThirty women in late pregnancy participated in a three-night observational study and were asked to report their sleeping position. This was compared to sleep position as recorded by a night capable video recording. The participants were instructed to settle to sleep on their left side and if they woke overnight to settle back to sleep on their left.ResultsThere was a moderate correlation between reported and video-determined left-side sleep time (r = 0.48), mean difference = 3 min (SD = 3.5 h). Participants spent an average of 59.60% (SD = 16.73%) of time in bed on their left side (ICC across multiple nights = 0.67). Those who included left side among their typical sleep positions reported significantly longer sleep during the study (p<0.01).ConclusionsOn average participant reports of sleep position were relatively accurate but there were large individual differences in reporting accuracy and in objectively-determined time on left side. Night-to-night consistency was substantial. For those who do not ordinarily sleep on that side, asking participants to sleep on their left may result in reduced sleep duration. This is an important consideration during a sleep-critical time such as late pregnancy.

462: The effects of maternal position and habitus on left ventricular stroke volume during pregnancy measured by cardiac magnetic resonance

462: The effects of maternal position and habitus on left ventricular stroke volume during pregnancy measured by cardiac magnetic resonance

Small-for-gestational age Portuguese babies: The effect of childhood social environment, growth and adult socioeconomic conditions

ObjectiveWe aimed to estimate the extent to which differences in small-for-gestational age (SGA) according to maternal socioeconomic position (SEP) and anthropometrics are accounted for childhood background. MethodsAdult mothers of singletons (n=6893) recruited in 2005/2006 in Porto, Portugal self-reported data on socio-demographics. Grandparents' education and social class were used to characterise childhood social environment. Maternal education and marital status were used as adult SEP indicators. Height was categorised according to the 10th and 90th percentiles. The odds of SGA according to adult SEP and height were stratified by childhood conditions. ResultsSGA (14.5%) was less likely in taller [vs. 10th–90th percentiles: 0.62 (95% confidence interval (CI): 0.46–0.83)], more educated [vs. low: 0.77 (0.65–0.90)] and in married women [vs. single: 0.64 (0.47–0.86)]. No association was found between childhood social conditions and SGA. The protection provided by maternal education was found in women from deprived childhood backgrounds but not in those with more advantage conditions. Shorter women were more likely to deliver SGA babies but the effect was stronger (pinteraction<0.001) in those from least deprived childhood conditions. ConclusionsSufficient increase in education seems to overcome disadvantage earlier in life. Other pathological processes might impact physical development beyond social influence, having long lasting effects on SGA.

Effects of maternal position in the second stage of labor on delivery outcomes

Objective To evaluate the effects of the non-supine position and the supine position during the second stage of labor on delivery outcomes.Methods In total,642 singleton term primiparas in the Fourth Hospital of Hebei Medical University between January 2013 and March 2014 were divided into the non-supine position group (n=320),which included the lateral (n=204) and hands-and-knees position (n=116),and the supine position group (n=322) according to primipara's choice.Delivery outcomes in the two groups were compared using the Student's t test,Mann-Whitney rank sum test and the x2 test.Results The incidence of caesarean section was similar in the non-supine position and supine position groups [0.9％(3/320) vs 1.9％ (6/322),x2=0.438,P=0.508].Compared with the supine position group,women in the non-supine position group had a higher incidence of perineal lacerations grede Ⅰ [85.2％ (270/317) vs 65.2％ (206/316),x2=33.884],longer duration of the second stage of labor [48.0 min (31.0-78.0 min) vs 41.0 min (25.0 67.3 min),Z=-3.066] and greater blood loss after 2 hours of labor [240.0 ml (200.0-287.5 ml) vs 210.0 ml (160.0-260.0 ml),Z=-3.736],but a significant reduction in posterolateral episiotomies [5.3％(17/317) vs 23.4％ (74/316),x2=41.908],perinealedema [13.6％ (43/317) vs 21.2％ (67/316),x2=6.430] and meconiumstained liquor [20.8％ (66/317) vs 33.2％ (105/316),x2=12.356] (all P＜0.05).In the non supine position group,fetal heart rate showed fewer early decelerations,variable decelerations and late decelerations than in the supine position group [10.1％ (32/317) vs 17.1％ (54/316),x2=6.593; 2.8％ (9/317) vs 6.6％ (21/316),x2=5.079; 3.2％ (10/317) vs 7.6％ (24/316),x2 6.139; all P＜0.05,respectively].Conclusions The non supine position during the second stage of labor may improve delivery outcomes. Key words: Labor stage, second; Natural childbirth; Posture; Prognosis

Environmental influences on children's physical activity

BackgroundThis paper aims to assess whether 7-year-olds’ physical activity is associated with family and area-level measures of the physical and socioeconomic environments.MethodsWe analysed the association of environments with physical activity...

Maternal perception of decreased fetal movements from maternal and fetal perspectives, a cohort study.

BackgroundMaternal counting of fetal movement is a popular and valuable screening tool of fetal wellbeing, however it is still not known what percentage of healthy pregnant women who gave birth to healthy term newborns had experienced decreased fetal movements during gestation and what maternal and fetal factors are associated with this maternal perception of decreased fetal movements. The aim of this study was to assess the associations between maternal perception of decreased fetal movements and maternal and fetal factors in normotensive singleton pregnancies with good pregnancy outcome.MethodsThis study was conducted on 729 normotensive singleton pregnant women who had referred for prenatal visit and on follow up gave birth to healthy term newborns. A questionnaire was completed for the participants and ultrasound imaging was performed. Participants were asked to count their fetal movements for one hour/3times/day. Participants were followed till delivery to exclude mothers with preterm and/or small for gestational age delivery from the study.ResultsPerception of decreased fetal movement was independently associated with maternal employment (Odds Ratio (OR), 2.66; 95% Confidence Interval (95% CI), 1.35–5.23), not having daily exercise (OR, 4.38; 95% CI, 1.56-8.08) and maternal supine position (OR, 3.85; 95% CI, 1.71–8.83).Conclusions8.1% of healthy pregnant women who have good pregnancy outcome report perception of decreased fetal movement when asked to count their fetal movement in third gestational trimester which is independently associated with maternal employment, supine position on counting and not having daily exercise.

Position at birth as an important factor for the occurrence of anal sphincter tears: a retrospective cohort study.

This work aimed to analyze the association between maternal position at birth in spontaneous deliveries and the occurrence of anal sphincter tears (AST) given the lack of evidence related to the least traumatic birth position. A total of 7832 vaginal deliveries were included. Vaginal-operative deliveries and deliveries with fundal pressure were excluded. Birth positions on bed, in water, kneeling, and in a squatting position on a low stool were compared. Birth position on bed was considered as the reference group, and a logistic regression analysis adjusting for important fetomaternal parameters was performed. The overall incidence of AST was 1.1%. AST rate was significantly increased in squatting (2.9%) and kneeling (2.1%) positions compared with birth position on bed (1.0%) or in water (0.9%). Logistic regression analysis revealed a significantly higher risk for ASTs in squatting (OR 2.92, CI 95% 1.04-8.18) and in kneeling positions (OR 2.14, CI 95% 1.05-4.37) compared with the reference group on bed. When adjusting for risk factors, birth in a kneeling position remained significantly associated with ASTs (adj. OR 2.21, CI 95% 1.07-4.54). Birth in squatting or in kneeling position is associated with an elevated risk for ASTs. Birth in water is not associated with an increased risk for AST. Based on the results, women should be informed about the association of certain birth positions with the occurrence of AST.

Pre-eclampsia renamed and reframed: Intra-abdominal hypertension in pregnancy

This hypothesis proposes pre-eclampsia is caused by intra-abdominal hypertension in pregnancy. Sustained or increasing intra-abdominal pressure ⩾12mmHg causes impaired venous return to the heart, systemic vascular resistance, ischemia reperfusion injury, intestinal permeability, translocation of lipopolysaccharide endotoxin to the liver, cytotoxic immune response, systemic inflammatory response, pressure transmission to thoracic and intra-cranial compartments, and multi-organ dysfunction. This hypothesis is predicated on Pascal’s law, evidence founded in the intra-abdominal hypertension literature, and the adapted equation ΔIAP-P=ΔIAVF/Cab, where ΔIAP-P=change in intra-abdominal pressure in pregnancy, ΔIAVF=change in intra-abdominal vector force (volume and force direction) and Cab=abdominal compliance. Factors causing increased intra-abdominal pressure in pregnancy include: progressive uterine expansion, obstetrical factors that increase intra-uterine volume excessively or acutely, maternal anthropometric measurements that affect intra-abdominal pressure thresholds, maternal postures that increase abdominal force direction, abdominal compliance that is decreased, diminished with advancing gestation, or has reached maximum expansion, habitation at high altitude, and rapid drops in barometric pressure. We postulate that the threshold for lipopolysaccharide translocation depends on the magnitude of intra-abdominal pressure, the intestinal microbiome complex, and the degree of intestinal permeability. We advance that delivery cures pre-eclampsia through the mechanism of abdominal decompression.

Does pregnancy and/or shifting positions create more room in a woman’s pelvis?

The purpose of this study was to assess the impact of different positions on pelvic diameters by comparing pregnant and nonpregnant women who assumed a dorsal supine and kneeling squat position. In this cohort study from a tertiary referral center in Germany, we enrolled 50 pregnant women and 50 nonpregnant women. Pelvic measurements were obtained with obstetric magnetic resonance imaging pelvimetry with the use of a 1.5-T scanner. We compared measurements of the depth (anteroposterior (AP) and width (transverse diameters) of the pelvis between the 2 positions. The most striking finding was a significant 0.9-1.9 cm increase (7-15%) in the average transverse diameters in the kneeling squat position in both pregnant and nonpregnant groups. The average bispinous diameter in the pregnant group increased from 12.6 cm ± 0.65 cm in the supine dorsal to 14.5 cm ± 0.64 cm (P < .0001) in the kneeling squat; in the nonpregnant group the increase was from 12 cm ± 0.76 cm to 13.9 cm ± 1.04 cm (P < .0001). The average bituberous diameter in the pregnant group increased from 13.6 cm ± 0.93 cm in the supine dorsal to 14.5 cm ± 0.83 cm (P < .0001) in the kneeling squat position; in the nonpregnant women the increase was from 12.6 cm ± 0.92 cm to 13.5 cm ± 0.88 cm (P < .0001). A kneeling squat position significantly increases the bony transverse and anteroposterior dimension in the mid pelvic plane and the pelvic outlet. Because this indicates that pelvic diameters change when women change positions, the potential for facilitation of delivery of the fetal head suggests further research that will compare maternal delivery positions is warranted.

PLD.27 Fetal Blood Sampling in the Operating Theatre – Advised or Indefensible?

There is a body of opinion within expert witnesses that suggests that the undertaking of fetal scalp blood sampling (FBS) in a theatre setting prior to performing a perceived difficult...

PD.04 Development and rapid prototyping of an illuminated mirror for waterbirths – from concept to prototype

BackgroundWater immersion during labour and birth is recognised as a means of empowering women and reducing need for analgesia. Although waterbirth is a ‘hands off’ birth, midwives are required to...

Pregnancy complicated by valvular heart disease: an update.

Cardiovascular disease complicates ≈1% to 3% of all pregnancies and is responsible for 10% to 15% of maternal mortality. Although its prevalence is considered relatively low in pregnant women, heart disease is the most common cause of maternal mortality. Because more women with congenital or

Does the Mother’s Posture Have a Protective Role to Play During Skin-to-Skin Contact? Research Observations and Theories

Skin-to-skin contact during the first hour following birth is the gold standard in breastfeeding. Although consecutive meta-analyses report no adverse effects, a recent review shows an increase in idiopathic sudden unexpected postnatal collapse (SUPC) in healthy term babies identifying three main risk factors: skin-to-skin contact, breastfeeding, and baby lying prone. Concurrently, authoritative visual materials tacitly promote maternal supine postures illustrating the breast crawl, a form of birth skin-to-skin contact. The naked baby lies on top of his or her mother’s body, in close ventral contact with torso parallel to the floor—a position strongly associated with sudden infant death. Biological nurturing (BN) research, the first to examine maternal postural effects on breastfeeding success, suggests that a semireclined maternal position is optimal for breastfeeding initiation. The maternal body slope ensures that the baby lies tilted, a position known to promote oxygenation. The angle of maternal recline, a variable central to BN but hitherto ignored in the skin-to-skin and SUPC literature, is unrelated to dress level. This commentary develops a postural argument to increase understanding of the potential role played by the maternal body slope to reduce the risk of idiopathic SUPC.

A triple risk model for unexplained late stillbirth.

BackgroundThe triple risk model for sudden infant death syndrome (SIDS) has been useful in understanding its pathogenesis. Risk factors for late stillbirth are well established, especially relating to maternal and fetal wellbeing.DiscussionWe propose a similar triple risk model for unexplained late stillbirth. The model proposed by us results from the interplay of three groups of factors: (1) maternal factors (such as maternal age, obesity, smoking), (2) fetal and placental factors (such as intrauterine growth retardation, placental insufficiency), and (3) a stressor (such as venocaval compression from maternal supine sleep position, sleep disordered breathing). We argue that the risk factors within each group in themselves may be insufficient to cause the death, but when they interrelate may produce a lethal combination.SummaryUnexplained late stillbirth occurs when a fetus who is somehow vulnerable dies as a result of encountering a stressor and/or maternal condition in a combination which is lethal for them.