Maternal Care Center Research Articles

The Lived Experience of First-Time Expectant Fathers Whose Spouses Are Tocolyzed in Hospital

The purpose of this study is to explore the experiences of first-time expectant fathers whose spouses undergo tocolysis in the hospital. The study was conducted by the descriptive phenomenological method. On the basis of the qualitative method, the data were subjected to Colaizzi's content analysis by means of the constant comparison method. Data were collected through one-on-one interviews with six expectant fathers. The findings revealed that the experiences of the fathers could be summarized under the following five themes: being confused and absent-minded in an awkward situation, facing difficulty and attempting to identify solutions, breaking through the dilemma, looking forward to being a father, and looking back with complicated feelings. The findings of this study should provide nursing staff in charge of family- centered maternity care with information about how tocolysis influences the families of first-born babies. They should also contribute to improvements in nursing quality.

Prenatal views of baby and parenthood: Association with sociodemographic and pregnancy factors

The aim of the present study was to explore whether sociodemographic and pregnancy factors are associated with the content of prenatal maternal representations about the child and maternity. The study was designed as a questionnaire-based, anonymous, cross-sectional study. Participants were 391 pregnant women in routine follow-up visits enrolled from 14 maternity care centers in Southwestern Finland. Measures consisted of self-report questionnaires for background data and adjective lists (i.e., semantic differentials) regarding the mother's prenatal view of this child, herself, child's father, and own mother-as-mother. Of the nine background factors explored in this study, two factors had significant associations with the content of prenatal representations: a number of children under 7 years of age in the household and (b) planning of the current pregnancy. Prenatal maternal representations about the child, self, partner, and own mother were more negative in content, especially if the mother already had two to three children under 7 years of age, if this pregnancy was not planned, or both. Background factors which did not have significant associations with the content of any prenatal representations included social class, previous abortions, duration of gestation, and somatic problems in this pregnancy. The results are important considering the previous research findings on the role of prenatal representations for the quality of postnatal maternal interactive behavior with the child, intergenerational transmission of attachment security, and developmental outcome of the child later, even in school age. The factors found in this study to have significance for the content of prenatal representations are routinely asked in all maternity care practice and do not need any arrangements to be explored. The results suggest that professionals working in maternity care should pay more attention to the subgroups of pregnant women with many small children in the family and/or whose pregnancy is unplanned. Their need for support in the relationship with this particular child should be especially attended to.

Jordanian women: Perceptions and practices of first‐time pregnancy

A woman's child-bearing encounter is an experience that reflects the cultural beliefs and practices of the society. The purpose of this study was to describe the perceptions and practices of urban, low socioeconomic, Jordanian women (aged 18-30 years) in relation to their pregnancy career. An opportunistic sample consisting of 67 Muslim first-time pregnant women who followed up antenatal care at two maternity-care centres in East Amman was selected. A qualitative approach, including ethnographic semistructured interview, participant observation data from the households and clinics and oblique interviewing in random conversations initiated by the primigravidae, was conducted over 18 months. Women gave elaborative accounts of their pregnancy and childbirth expectations in narrative, phenomenological forms. Qualitative data analysis was performed concurrently with data collection, revealing the essential themes of immediacy of pregnancy; familial support and changing networks, especially for the after-birth period; fear of pain and medical interventions, all emphasizing the traditional and religious perceptions and practices in a familial context.

P06.11: The role of ultrasound assessment in predicting intrauterine fetal demise after fetoscopic laser photocoagulation for twin–twin transfusion syndrome

K. Ishii1, K. Tanaka1, T. Murakoshi2, H. Sago3, S. Hayashi3, M. Nakata4 1The Department of Obstetrics and Gynecology Niigata University Graduate School of Medical and Dental Sciences, Japan, 2Division of Perinatology, Fetal Diagnosis and Therapy, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Japan, 3Division of Fetal Medicine, National Center for Child Health and Development, Japan, 4Perinatal Care Center, Yamaguchi University Hospital, Japan

Periodontal disease awareness among pregnant women and its relationship with socio‐demographic variables

Certain conditions may have an affect on gingival status and may aggravate pre-existing disease, especially in persons with poor oral hygiene. Pregnancy is one of these conditions. In addition, there is evidence in the literature suggesting an association between periodontal diseases in pregnant women and giving birth to premature, low-birth infants. The purpose of this study was to evaluate the degree of periodontal health knowledge, and awareness, among pregnant women in Jordan. This was carried out by cross-sectional survey using self-administered, structured questionnaires distributed at six maternity care centres in Irbid City. Questionnaire items addressed personal and socio-demographic variables and periodontal health awareness and knowledge of pregnant women. Women (n = 300) were randomly chosen from attendants to these centres. Of the 300 questionnaires distributed, only 275 pregnant women ages 16-45 years with a mean of 29 year responded and were included in the study. Data were analysed by chi-squared test with the level of significance set at (P < 0.05). About one-third of the participants had secondary level of education; it appeared that a minority of the pregnant women had knowledge or ability to identify dental plaque (16.4%) and its harmful effects (22.5%), while most of them (88%) were aware that bleeding gums indicated the presence of periodontal disease. The differences in the responses to knowledge questions were only significant for question number one (What is plaque?) among different educational levels and groups. This study revealed that (71.6%) of the pregnant women knew the main cause of gum disease; however 56% of them do not believe that frequency of teeth brushing should be increased during pregnancy and only 5.1% believed there might be a relationship between gum diseases and premature labour. Knowledge and awareness for pregnant women about their teeth and gingival condition is generally poor. Pregnant women need accurate information about their teeth and oral health. Simple educational preventive programmes on oral self-care and disease prevention before and during pregnancy should be provided to improve oral health.

Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial

Objectives To compare the efficacy of standard treatment, standard treatment plus acupuncture, and standard treatment plus stabilising exercises for pelvic girdle pain during pregnancy.Design Randomised single blind controlled trial.Settings East...

Breastfeeding, very long polyunsaturated fatty acids (PUFA) and IQ at 6½ years of age

Breastfeeding seems to be favorable for cognitive development. Could levels of polyunsaturated fatty acids (PUFA) explain this? Pregnant mothers were recruited consecutively at maternity care centres. PUFA were analysed in colostrum and breast milk at 1 and 3 mo. The product-precursor ratios of n-6+n-3 PUFA were examined as measures of activity in respective steps in the fatty acid metabolic chain. Also, the quotient between DHA and AA was analysed. The children were tested with the full WISC-III at 6.5 y. First, the influence of length of breastfeeding was analysed by multiple regression together with relevant cofactors (except for PUFA). In the best models, 46% of the variation in total IQ was explained. Length of breastfeeding contributed significantly to total IQ (beta = 0.228, p = 0.021), verbal IQ (beta = 0.204, p = 0.040) and performance IQ (beta = 0.210, p = 0.056). There were no significant single correlations between PUFA and measures of cognitive development. However, in multiple regression analysis of colostrum, significant beta-coefficients were found for steps 4+5 in the fatty acid metabolic chain (beta = 0.559, p = 0.002). If length of breastfeeding and gestation week were added to steps 4+5, this three-factor model could explain 67% of the variation of total IQ. Introducing length of breastfeeding and gestation week together with the quotient DHA/AA (beta = 0.510, p < 0.001) yielded a three-factor model, which explained 76% of the variation in total IQ. Our findings could be interpreted as supporting the importance of high levels of PUFA for cognitive development. However, the sample is small and the results must be interpreted with caution.

Breastfeeding, very long polyunsaturated fatty acids (PUFA) and IQ at 6/4 years of age

Aim: Breastfeeding seems to be favorable for cognitive development. Could levels of polyunsaturated fatty acids (PUFA) explain this?Methods: Pregnant mothers were recruited consecutively at maternity care centres. PUFA were analysed in colostrum and breast milk at 1 and 3 mo. The product‐precursor ratios of n‐6+n‐3 PUFA were examined as measures of activity in respective steps in the fatty acid metabolic chain. Also, the quotient between DHA and AA was analysed. The children were tested with the full WISC‐III at 6.5 y. Results: First, the influence of length of breastfeeding was analysed by multiple regression together with relevant cofactors (except for PUFA). In the best models, 46% of the variation in total IQ was explained. Length of breastfeeding contributed significantly to total IQ (beta = 0.228, p= 0.021), verbal IQ (beta = 0.204, p= 0.040) and performance IQ (beta = 0.210, p= 0.056). There were no significant single correlations between PUFA and measures of cognitive development. However, in multiple regression analysis of colostrum, significant beta‐coefficients were found for steps 4+5 in the fatty acid metabolic chain (beta = 0.559, p= 0.002). If length of breastfeeding and gestation week were added to steps 4+5, this three‐factor model could explain 67% of the variation of total IQ. Introducing length of breastfeeding and gestation week together with the quotient DHA/AA (beta = 0.510, p &gt; 0.001) yielded a three‐factor model, which explained 76% of the variation in total IQ. Conclusion: Our findings could be interpreted as supporting the importance of high levels of PUFA for cognitive development. However, the sample is small and the results must be interpreted with caution.

Book Review: Family Centered Maternity Care

Book Review: Family Centered Maternity Care

Natural birthing lessons from Nepal

The legacy of an outdated medical model approach to intrapartum care is still apparent in most of the developing world. Rather than trying to avoid the issue of the Western responsibility for this situation, we might do well to consider what we could learn from the history of medical and cultural colonialism. With an awareness of these issues, the author set up the Nepal Midwives Initiative in 2000. This article describes her efforts to reintroduce the option of natural active birth to urban maternity care centres.

Prenatal maternal representations: Mothers at psychosocial risk

AbstractThe aim of the study was to explore differences in the content of prenatal mental representations between a risk group (n = 84) and a low‐risk group (n = 296) of pregnant women, enrolled from maternity care centers in southwestern Finland. The method used was semantic differentials of IRMAG (Interview of Maternal Representations During Pregnancy). The risk group was defined by means of questionnaire screens that concerned chemical dependency, depression, difficulties in social environment, and low social support. The ratings on all target subjects, i.e., child, self, partner, self‐as‐mother and own mother‐as‐mother, were significantly more negative in the risk group. The representation profiles of the groups differed: especially the ratings of partner and own mother‐as‐mother were more consistently and strongly negative among the risk mothers. © 2001 Michigan Association for Infant Mental Health.

Genetic screening in maternity care: preventive aims and voluntary choices

This paper analyses a prenatal genetic screening programme for three gene defects, conducted at maternity care centres in Eastern Finland in 1995 and 1996. What is special in this case is that the screening ended sooner than was planned. This paper investigates how the genetic screening programme was launched, the problems it encountered and the circumstances of its closure. The present analysis focuses on the co‐existence of, and tensions between, the two major objectives of the project: preventing disability and increasing mothers’ choices. The tensions between these two objectives were highlighted at maternity care centres. The public health nurses working at these centres were confused about whether or not they should offer autonomous consumer choice or guidance to mothers to behave in responsible and health‐conscious ways. The nurses’ confusion was intensified because the goal of prevention was identified with financial savings for the municipality, which the nurses thought was an inappropriate reason for abortions.

Creating a patient classification system: one birth center's experience in the triage process.

Adequate nurse staffing is crucial to the provision of quality maternity care in the rapidly changing health care market including the triage of obstetric patients. The mandate for cost-efficient services must be balanced by the triage of health team members who are essential to safe and effective operations in the inpatient perinatal setting. The transformation of traditional perinatal units to single-site maternity care centers requires the development of creative staffing designs that permit the expeditious allocation of human resources in a cost-effective manner. Creating an acuity-based patient classification system for a single-site unit is a challenging task. The authors describe the process of creating a patient classification system when a new unit, The Birth Center, was opened at San Francisco General Hospital Medical Center. The unit combined the staff and patient populations of a labor and delivery unit with an antepartum-postpartum-gynecology unit and included a triage room for evaluation of pregnant clients. The two units had different modalities for budget and staffing. An activity study was conducted to determine unit and staff activities. A patient classification system was created for the single-site maternity unit, which allowed for acuity-driven staffing.

On what grounds do women participate in prenatal screening?

Along with the rapid biomedical development of prenatal screening tests, target groups' attitudes and decision-making about, and the acceptance of, screening procedures have come into focus. To understand users' decision-making, it is essential to understand users' knowledge and perceptions of a procedure. The aim of this study was to examine Finnish women's knowledge and perceptions of, and stated reasons to participate in, two prenatal screening tests: serum screening and mid-trimester ultrasound screening. Subjects (n=1035) for the serum screening survey were catered for in the maternity care centres of two Finnish towns, where serum screening is available for all pregnant women. After one reminder, 88 per cent returned the questionnaire. Subjects (n=497) for the mid-trimester ultrasound screening survey were catered for in the obstetrical and gynaecological outpatient clinic of the city hospital of another town; the response rate was 85 per cent. Women's perceptions of the studied prenatal screening tests, serum screening and mid-trimester ultrasound screening, differed significantly, even though both are used to detect fetal malformations. Serum screening was far more often perceived to be connected with finding diseases or abnormalities than ultrasound screening. Another interesting finding was that the stated reasons for screening in general and the subjective reasons for participation were different. Reassurance was the personal reason most often mentioned in both the serum screening and the ultrasound group. Almost all women had the most superficial knowledge about serum screening; they knew whether it had been offered and that it is done to screen for Down syndrome. The greatest gaps in knowledge concerned the sensitivity of serum screening, its use in screening for congenital nephrosis, and diagnostic tests and their risks. Knowledge was poorer among women without a high school education. When counselling women about prenatal screening tests, more emphasis should be given to the sensitivity of serum screening, all of its screening uses, and the possible diagnostic tests and their risks. The fact that ultrasound screening can detect conditions which may lead to the possibility of a selective abortion should also be explained more fully.

PER UNA STORIA DELLE SCIENZE DELL'INFANZIA: LE FONTI DELL'ISTITUTO DEGLI INNOCENTI DI FIRENZE*

Abstracttitle SUMMARY /title This text is the description of an investigation. At the same time it is an interpretative essay and detailed description of still unexplored archival material, currently being catalogued. It also describes photographs, scientific instruments and books, all belonging to one of the oldest and most important institutions for childhood. The focus is on the nineteenth and twentieth centuries, a decisive and yet too little studied period at the origins of pediatrics. During this period the Istituto degli Innocenti experienced an extraordinary transformation from being a place of charity to being a centre for maternity and infant care in the modern sense, where pioneering activities took place relating to scientific research, sanitary care, medical experimentation and training, as well as to specialised nursing, prevention and divulgation.

Preinduction cervical ripening: A comparison of intracervical prostaglandin E 2 gel versus the Foley catheter

OBJECTIVE: Both prostaglandin E 2 gel and an intracervical balloon catheter have been shown to be effective for cervical ripening. The purpose of this study is to compare the efficacy of intracervical prostaglandin E 2 gel with an intracervical Foley catheter for preinduction cervical ripening. STUDY DESIGN: A randomized, prospective study was conducted in the Maternity Care Center at the Foothills Hospital at Calgary, Alberta, Canada. Patients with a Bishop score ≤4 and meeting inclusion and exclusion criteria were included. Thirty patients were randomized to receive prostaglandin E 2 gel and 36 to receive an intracervical Foley catheter on the evening before induction. Induction then proceeded thue following morning by the preferred method of the attending physician. RESULTS: The groups were comparable with respect to maternal age, parity, gestational age, reason for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (4.1 ± 0.4 and 4.8 ± 0.5, respectively, p < 0.001); however, there was no significant difference between the groups There was no significant difference in side effect profile, intrapartum complications, or delivery mode. Six cesarean sections (17.6%) were performed in the Foley group and seven (25%) in the prostaglandin E 2 gel group (not significant). The induction-to-delivery interval was 16.0 ± 1.7 hours in the Foley group and 21.5 ± 3.2 hours in the prostaglandin E 2 gel group ( p = 0.014). Apgar scores, cord gases, and neonatal birth weight showed no difference between the group. CONCLUSION: This study has shown that for preinduction cervical ripening there is no difference in efficacy between intracervical prostaglandin E 2 gel or an intracervical Foley catheter.

Granny midwives in Mississippi: career and birthing practices.

In this study career and birthing practices of Mississippi granny midwives who held permits and practiced in the early 1980's are reported. Leininger's (1978, 1985) mini ethnonursing method was used as the primary research approach. Although other authors have studied granny midwives in the South using alternate research methods such as Mongeau (1973) in North Carolina using analysis of historical documents and field research; Campbell (1946) in Georgia using field study research; Kroska (1985) in Alabama using mini-ethnography, to date no one has systematically studied granny midwives and their practices in Mississippi. Patterns and themes from verbatim and record analysis data indicate that the Mississippi granny midwives were practitioners who were called by God to practice. The majority had a mother or aunt who had also been a midwife. They used an oligopolistic market approach combined with altruism and care. They practiced family centered maternity care while using three practice modalities of folk, professional and motherwit for enacting their practice. Although their practice was externally regimented, they practiced in an autonomous way as their individual judgment dictated.

Samsun Bölgesi’nde Çocukluk Çağı Akut Zehirlenme Vakalarının Değerlendirilmesi

SUMMARY Acute intoxications in children in Samsun 773 cases of intoxication of various causes seen at Samsun Maternal and Child Care center and Samsun State Hospital between March 1985 and March 1987 were evaluated. Incidence was higher in boys and 1-4 years of age. Drugs were the most common cause for intoxications. 73.60 percent of patients were hospitalized and 0.90 percent of patients died. Results were compared with to other districts. Suggestions were made to lower the incidence, mortality and morbidity of intoxications. OZET Samsun Dogum ve Cocuk Hastanesi ve Devlet Hastanesi acil poliklinigine Mart 1985 - Mart 1987 tarihleri arasinda zehirlenme nedeniyle basvuran 773 hasta incelendi. Erkek cocuklarda daha sik oldugu gorulen zehirlen¬melere en cok 1-4 yas grubunda rastlandi. Zehirlenme nedenleri arasinda ilâclar (% 54.08), bunlarin arasinda da aneljezikler (% 24.40) ilk sirada geliyordu. Hastalarin % 73.60'i yatirilarak tedavi edildi ve zehirlenmeler¬den olum orani % 0.90 bulundu. Sonuclar diger bolgelerdeki calismalar Ile karsilastirilarak morbidite ve mortalitenin azaltilmasi icin dusunulen oneriler sunuldu.

Parental Response to Family Centered Maternity Care and to the Implementation of Sibling Visits

Parental Response to Family Centered Maternity Care and to the Implementation of Sibling Visits

Family Centered Maternity Care: Its Relationship to Perinatal Regionalization and Neonatal Intensive Care

For several months prior to birth a major portion of a family's attention, conversation, thought, and often worry, is directed toward the idea of a new child. This prolonged attention and anticipation contribute to making childbirth an emotionally charged experience. In psychological terms, it is therefore a critical period of peak motivation for learning, and a time to peak susceptibility to reinforcement. Theory, reason, and scientific evidence indicate thng with childbirth and early postpartum experiences, can significantly affect subsequent parental behaviors, the child's central environment influence. Evidence strongly suggests that these parental attitudes and behaviors so crucial to the child's ultimate well-being are learned rather than derived instinctually, and therefore they are malleable and can be taught, directed, and corrected. Through education and reinforcement it is possible to encourage parental behaviors and child interactions which are products of feelings of control, competence, accomplishment, understanding, and caring. Similarly we can recognize and work toward replacing attitudes, feelings, and behaviors that express fear, worry, and insecurity about the child. Over the past 50 years major changes have occurred in the practice of obstetrics and newborn pediatrics. Other major changes will necessarily occur as we move toward perinatal regionalization. Changes instigated solely on physiologic data can have unrecognized collateral effects on the psychological component of the childbirth experience. All concerned health care personnel, especially obstetricians and pediatricians, can insist that the importance of desirable mother-father-child interactions be recognized and that practices fostering them be afforded a high priority. I would like to endorse a comment from a recent article by Richmond concerning the advent of behavioral pediatrics by adding that behavioral obstetrics is also "an idea whose time has arrived".