Mothers In Labor Research Articles

Comparison of HIV-1 Mother-to-Child Transmission After Single-Dose Nevirapine Prophylaxis Among African Women With Subtypes A, C, and D

The HIVNET 012 trial in Uganda showed that mother-to-child transmission (MTCT) of HIV-1 can be prevented by providing pregnant women and their infants with a single dose (SD) of the antiretroviral drug nevirapine (NVP). Safety and efficacy of 1- or 2-dose NVP prophylaxis for prevention of MTCT have been documented in other studies. We have shown that NVP resistance emerges in some women after SD NVP prophylaxis and that the portion of women with NVP resistance is influenced by HIV-1 subtype. At 6 to 8 weeks after SD NVP NVP resistance was more common in women with subtype C (69.2%) than in women with subtype D (36.1% P < 0.0001) or subtype A (19.4% P < 0.0001).4 Selection of NVP-resistant HIV-1 variants in women after NVP dosing could theoretically lower the efficacy of NVP prophylaxis for prevention of HIV transmission by breast-feeding in the first few weeks after birth. In the HIVNET 012 trial most women were infected with HIV-1 subtype A or D. Risk of MTCT was slightly (but not statistically) higher in women with subtype D. In this report we combined data from the HIVNET 012 and NVAZ trials to compare the risk of MTCT in women with subtype C to the risk of MTCT in women with subtypes A and D in the setting of SD NVP prophylaxis. (excerpt)

Maternal antenatal profile and immediate neonatal outcome in VLBW and ELBW babies

To evaluate the antenatal profile of the mother and the immediate neonatal morbidity and mortality till discharge. The study was a retrospective analysis of 92 patients of preterm labour who delivered babies weighing A total of 92 mothers in preterm labour at 26 to 34 weeks were admitted and subsequently delivered 70 VLBW babies (< 1500 gms) and 36 ELBW babies (< 1000 gms) including 8 pairs of twins and 3 triplets pregnancies. Majority of the patients (93.4%) were booked. Amongst the various high risk factors for preterm labour, anaemia during pregnancy (32.6%), bacterial vaginosis (26%), gestational hypertension (18.4%) and pervious history of preterm labour (18.4%) were common associations. Calcium channel blocker (Depin) tocolysis was effective in postponing labour from 48 hours to more than 2 weeks. The cesarean section rate was very high (67.3%) in our study. The commoner neonatal complications in both VLBW and ELBW babies were RDS, neonatal jaundice and sepsis. Features of IUGR were seen in both the groups (22.8% in VLBW and 22.2% in ELBW babies). The neonatal mortality rate till discharge was 15.7% in VLBW group and 33.3% in ELBW group. The morality rate was highest in 26 to 30 weeks gestation babies and in babies weighing < 800 gms. Antenatal profile of preterm labour in our series showed a number of high risk factors. The identification of common high risk factors is important for appropriate prenatal care. A better neonatal survival rate was possible due to timely intervention, appropriate management and NICU care facility available in our tertiary care centre.

Defining normal birth would help midwives and mothers

Does any first time mother understand what to expect from birth? To me the concept of normal birth was both what I expected and what I was prepared to abandon at the first sign of a problem. I started out with all the right ideas. I didn't go to hospital until my contractions were five minutes apart and when I arrived I was 8cm dilated and went straight to the delivery suite. As my labour progressed I used entonox for pain relief, laughed like a lunatic and, significantly I think, lay on my back because that's what I seemed to be expected to do. I wonder how many new mothers in labour do what they think is expected of them? It is after all the most convenient position to be in when your waters need to be broken, the easiest way to monitor heartbeat, the most straightforward access to the fetal scalp if a blood test is required, and the best position to be in when you are wheeled out for an emergency caesarean. When, in my second pregnancy, at term, a consultant came in, looked me up and down and told me there was no way I could deliver a baby by any other means than caesarean it did not occur to me to question his extraordinarily confident judgement.

The Connection between Maternal Employment and Childhood Obesity: Inspecting the Mechanisms

This paper investigates the channels through which maternal employment affects childhood obesity. We use time diaries and interview responses from the Child Development Supplement of the Panel Study of Income Dynamics which combine information on children's time allocation and mother's labor force participation. Our empirical strategy involves estimating the effect of children's activities and meal routines on BMI, estimating the effect of maternal employment on these activities and routines and then combining these two estimates. We find that maternal employment affects child weight through two main mechanisms - supervision and nutrition, however, the particular channels vary by mother's education.

Midwifery in Scotland 3: intranatal practices

This article, the third in the series exploring midwifery in Scotland from 1916-1983, with the help of examples from oral history testimonies, examines some aspects of midwives' practice in the care of mothers in labour. It explores the extent to which midwives were able to fulfil their role as autonomous practitioners as specified in the 1915 Midwives (Scotland) Act. This includes discussion on: who delivered the babies; the shift during the time-period from an estimated 95% home births to 99.5% hospital births, along with increasing medicalisation of childbirth. This took the normality out of many births and had a negative impact on midwifery. The subsequent change in midwife/mother relationships and the requirement for midwives to follow hospital policy and protocol will also be discussed.

Epidural analgesia

Since 1990, there has been a huge change in the way regional analgesia is provided to mothers in labour. The main changes have been to improve the reliability of regional analgesia while reducing the side effect of motor block. This contribution covers the induction and maintenance of analgesia, and mobilization with a regional block during labour.

Reducing perinatal mortality among Indigenous babies in Queensland: should the first priority be better primary health care or better access to hospital care during confinement?

BackgroundThe perinatal mortality rate among Indigenous Australians is still double that of the rest of the community. The aim of our study was to estimate the extent to which increased risk of low birthweight and preterm birth among Indigenous babies in Queensland account for their continuing mortality excess. If a large proportion of excess deaths can be explained by the unfavourable birthweight and gestational age distribution of Indigenous babies, then that would suggest that priority should be given to implementing primary health care interventions to reduce the risk of low birthweight and preterm birth (eg, interventions to reduce maternal smoking or genitourinary infections). Conversely, if only a small proportion is explained by birthweight and gestational age, then other strategies might need to be considered such as improving access to high-quality hospital care around the time of confinement.MethodologyPopulation-based, descriptive study of perinatal mortality rates among Indigenous and non-Indigenous babies, in Queensland, stratified by birthweight and gestational age.ResultsIndigenous babies are twice as likely to die as their non-Indigenous counterparts (rate ratio1998–2002: 2.01; 95%ci 1.77, 2.28). However, within separate strata of birth weight and gestational age, Indigenous and non-Indigenous rates are similar. The Mantel-Haenszel rate ratio adjusted for birth weight and gestational age was 1.13 (0.99, 1.28). This means that most of the excess mortality in Indigenous babies is largely due to their unfavourable birth weight and gestational-age distributions. If Indigenous babies had the same birth weight and gestational age distribution as their non-Indigenous counterparts, then the relative disparity would be reduced by 87% and 20 fewer Indigenous babies would die in Queensland each year.ConclusionOur results suggest that Indigenous mothers at high risk of poor outcome (for example those Indigenous mothers in preterm labour) have good access to high quality medical care around the time of confinement. The main reason Indigenous babies have a high risk of death is because they are born too early and too small. Thus, to reduce the relative excess of deaths among Indigenous babies, priority should be given to primary health care initiatives aimed at reducing the prevalence of low birth weight and preterm birth.

Pharmacology Review

After completing this article, readers should be able to: 1. Describe the pharmacologic and physiologic factors that affect transplacental transfer of drugs to the fetus. 2. Anticipate and manage the neonatal respiratory depressant effects of magnesium and opioid analgesics administered to mothers during labor. 3. Identify several drugs commonly used in the immediate antepartum period that can be expected to have no significant effects on neonatal resuscitation. Resuscitation of the neonate in the delivery room is among the most commonly encountered emergencies in neonatal medicine. Standardized approaches to neonatal resuscitation, as defined within the Neonatal Resuscitation Program, have made management of infants who fail to negotiate the transition from fetal to extrauterine life more effective and less stressful for the responsible clinicians. Uncertainty about the potential effects of medications administered to the mother prior to delivery of a depressed neonate may lead to unnecessary anxiety or even errors in management during resuscitation and stabilization of the infant. The purpose of this review is to summarize current knowledge of the effects of maternal medications on neonatal resuscitation, so resuscitators can appropriately anticipate and manage potential adverse neonatal effects or confidently anticipate the absence of such effects. It has been said that “essentially all pharmacologic agents are transferred to the fetus, with possible toxic fetal effects.” (Plonait and Nau, 2004) However, the speed and extent of this transfer has important implications for the significance of effects on the fetus. Drugs that are transferred slowly may not reach the fetus in significant amounts between the time of administration to a mother in labor and delivery of the baby, and drugs that are transferred only in insignificant quantities have little or no effect on fetal physiology. An understanding of the principles that govern transplacental drug transfer can provide a helpful framework for anticipating the potential impact of …

Gender Equality and Fertility in Sweden

SUMMARY In Sweden, the birth or adoption of a child is accompanied by the right to more than one year of paid parental leave that can be shared between parents. This article examines the relationship between the father's and the mother's respective use of such leave and the continued childbearing of a couple. Our investigation is based on longitudinal information on registered parental leave use and childbearing of all intact unions in Sweden during 1988-99. We analyze our data by means of event-history analysis. We expected an extended paternal involvement in leave-taking to be positively associated with continued childbearing, since it makes family building more compatible with the mother's labor force participation. In addition, such commitment to childrearing from the father's side is likely to signal his greater interest for continued family building. Around 85% of fathers take some leave but in most cases for a brief time. We find a positive effect of a father's taking moderately long leave on a couple's second- and third-birth propensity, but no such effect of a father's taking very long parental leave.

COMBINED SPINAL EPIDURAL ANALGESIA IN LABOUR

The combined spinal epidural (CSE) as an anaesthetic technique for providing analgesia for labour and anaesthesia for operative delivery has gained in popularity over the last ten years. Essentially the CSE consists of identification of the epidural space and insertion of an epidural catheter plus the initial intentional placement of an intrathecal dose of opioid, local anaesthetic or both, all as a single procedure. Theoretically the technique combines the advantages of the speed of onset and the reliability of block achieved by subarachnoid anaesthesia with the flexibility provided by the presence of an epidural catheter and avoids their individual disadvantages. The complications that may be encountered are those attributable to subarachnoid and epidural anaesthesia individually but some are unique to the CSE technique. The CSE technique is also applicable to other situations in obstetrics where a block is initiated by subarachnoid anaesthesia and its continuation is facilitated by the presence of an epidural catheter, either to maintain anaesthesia for prolonged procedures or for post operative pain control. The CSE's popularity has been ensured by the fact that it has allowed rapid onset analgesia with minimal motor blockade to be provided routinely for mothers in labour.

Analgesia in labour: induction and maintenance

Since 1990, there has been a huge change in the way regional analgesia is provided to mothers in labour. The main changes have been to improve the reliability of regional analgesia, while reducing motor block. In the UK, most anaesthetists initiate analgesia by the epidural route. There is growing support for the initial injection to be subarachnoid followed by epidural top-ups, using the technique of combined spinal-epidural (CSE). The place of low-dose CSE compared with the low-dose epidural for initiating analgesia is hotly debated. Opioids should be added to bupivacaine to initiate and maintain labour analgesia because they enhance analgesia and improve maternal satisfaction, there is also less motor block and a reduction of instrumental vaginal delivery for delay in the second stage of labour. The common bupivacaine/opioid solutions used for initiating and maintaining epidural analgesia are listed. Until the mid 1990s, the mainstay of initiating and maintaining analgesia in labour was intermittent doses of bupivacaine. The use of dilute solutions of bupivacaine and opioids given as a continuous infusion has become popular because it reduces the incidence of motor block. There has been a slow move away from low-dose infusions to low-dose top-ups and the use of patient-controlled epidural analgesia. Mothers have welcomed the reduction in motor block with the newer techniques and some choose to mobilize. The safety of mothers who get out of bed with an epidural has to be considered, but limited mobilization is often welcomed.

Decomposing the effects of children's health on mother's labor supply: is it time or money?

In this paper, I explore how children's health influences the wages and work hours of their mother. Some children have illnesses that require expensive medicine or treatment, but demand little parental time. Others require extraordinary amounts of time; and still others require care at unpredictable times of the day. I construct a theoretical model of mother's labor supply that explicitly incorporates the financial and time costs associated with the presence of unhealthy children. The model predicts that children with time-intensive illnesses and those with unpredictable illnesses negatively influence mother's labor supply, whereas children with illnesses with a strong financial component have a positive effect on mother's labor supply. In order to empirically test this, I organize a focus group of doctors to categorize illnesses and disabilities by the type of resources they require. Using the 1997 PSID Child Development Supplement, I estimate the effects of these requirements on mother's decision to work and work hours. After controlling for the financial burden of the illness, single mothers work fewer hours if their child has a time-intensive illness and married mothers are less likely to work and work fewer hours if their child has a severe condition with an unpredictable time component. These findings are consistent with the theoretical model and highlight the need to decompose the effects of child health on mother's work status. Model specifications that aggregate across illnesses are incapable of disentangling these effects and may therefore underestimate the welfare costs of having a sick child in the family.

Do Mothers Work to Support Ailing Husbands?

This paper analyzes the role of a spouse's poor health in forming the mother's labor force participation decision. The data are drawn from the 1996 Survey of Income and Program Participation (SIPP), which follows individuals for four years. This paper uses a medical expenditure approach to measuring health. Because SIPP is a panel dataset, changes in health and labor force participation can be observed. This paper finds an increase of 8% in the wife's labor force participation when the health of the spouse falls from excellent to poor. This result of the changes in the mother's labor force participation is consistent with previous literature, indicating that this new health measure performed well.

HIV - Positive Women In Labour Room In Jos, Nigeria

Background : Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are commonly encountered by health practitioners in Nigeria. Unfortunately, the HIV positive status does not limit the fertility of a woman. Healthy looking women, infected with HIV are not uncommon in the antenatal clinic and the labour room. Objective: The objective of this study was to determine trend of HIV-positive pregnant women presenting in the labour room. To determine how many staff were infected. Proffer suggestions on how to minimize the spread if found to be rising in pregnant mothers in labour. Also, to draw the attention of attending physicians, midwives and hospital authorities to the need for urgent protection from infection with the viruses. Methods: This retrospective study was conducted from January 1998 to December 2003. The information was obtained from 159 patient records of the labour room of the Jos University Teaching Hospital, Jos, Nigeria. The HIV status was already confirmed antenatally. Record of HIV-positive patients were retrieved and analyzed. The record of staff at risk was also determined. Results: During the period under review, January 1998 to December 2003, 15,282 deliveries took place and 159 HIV-positive women were admitted into the maternity unit of the Jos University Teaching Hospital for labour and delivery. The study showed that from 2 cases reported in 1998, the proportion of patients with HIV had been on the increase. The incidence has risen astronomically from 0.1% to the present figure of 1.9%, or 32 per 1,673 deliveries in 2003. The age range of the patients was from 18 to 36 years with a mean of 26.4 years. All patients were married. Conclusion: The number of HIV positive patients seen and managed for labour and delivery is rapidly increasing. Labour rooms need to be better equipped with preventive measures in order to protect the lives of the personnel performing their obligatory responsibilities in this all-important part of a hospital. Key words: - Human Immunodefiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), labour room, Nevirapine, Jos-Nigeria. Highland Medical Research Journal Vol.2(2) 2004: 47-54

Pre-School Enrollment: An Analysis by Immigrant Generation

There has been minimal research on the pre-school enrollment of immigrant children. Using 1990 U.S. Census data, this paper investigates pre-school enrollment of child immigrants, those who immigrated as children and the U.S. born children of immigrants. The analysis is conducted using probit analysis. Pre-school enrollment is found to vary systematically with parental characteristics (income and education), immigrant generation, number of siblings, mother's labor supply and country of origin. Among the foreign-born, differences in pre-school enrollment are analyzed by country of origin. Among the U.S.-born children of immigrants pre-school enrollment is greatest among those with both parents foreign born.

An observational study using audio-video recording to assess care given to vaginal examinations during labour

Vaginal examinations are intimate and potentially embarrassing experiences, particularly so during childbirth, where they are a common procedure. Few investigations of vaginal examination procedures in labour have been undertaken, yet it carries risk of emotional trauma and infection, a potentially avoidable cause of perinatal mortality. As part of our ongoing investigation of care in labour we undertook a detailed analysis of vaginal examinations during labour. Informed consent was obtained for observation of direct care of 20 mothers in labour by audio-video recording, within a single delivery room. A protocol was developed from professional guidelines to assess quality of care during vaginal examinations with emphasis on dignity, hygiene, contamination and communication. Experienced clinicians performed the examinations. On average a vaginal examination was undertaken every 2 hours with a total of 59 examinations (minimum one to maximum eight) during 123 hours of labour. Table I summarises the findings. No vaginal examination conformed to the ‘ideal’ model. Mothers were exposed unnecessarily during the procedure, with only 11 examiners using simple measures to maintain the mother's dignity. There was a lack of basic hygiene standards, with contamination of the room post-examination. Points will be illustrated with video clips.

Inhibitory effects of hCG on uterine smooth muscle contractility and relationship between serum hCG concentration and onset of labour in the human

In order to investigate the role of hCG in the onset of human labour, uterine smooth muscles were exposed to 500 000 IU of hCG in an organ bath for 3 hours and challenged with 10 mU of syntocinon. After a period of 1 hour, another dose of 10 mU of syntocinon was added to the bath. Contractile activity (frequency × amplitude) were computed. The experiment was repeated with the addition of 105 m indomethacin in the bath. Serum values of hCG from mothers in spontaneous labour at gestational ages from 34 to 42 weeks were compared. In 10 women, serum values of hCG of paired samples obtained at 34 weeks and at spontaneous onset of labour after 38 weeks were compared. 500 000 IU/l of hCG inhibits human uterine activity by 65% in vitro. The inhibitory effect was on the frequency rather than amplitude of contraction. In the presence of hCG, 10 mU/l of syntocinon was able to reinitiate normal uterine contractility, but this not in the presence of 105 m indomethacin. The maternal serum concentration of hCG was lower in mothers with ongoing pregnancy compared with mothers in spontaneous labours at all gestational ages.

Deliveries in maternity homes in Norway: results from a 2-year prospective study.

The study aims to report the short-term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway. A 2-year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum. The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection. Midwives and general practitioners working in the districts can identify a low-risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor.

Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants

Objective: The purpose of this study was to determine whether the use of antenatal magnesium sulfate prevents adverse outcomes (neonatal intraventricular hemorrhage, periventricular leucomalacia, death, and cerebral palsy). Study Design: In a controlled trial, we randomized mothers in preterm labor to magnesium sulfate, “other” tocolytic, or placebo. At delivery, umbilical cord blood was collected for the later determination of serum ionized magnesium levels. Neonatal cranial ultrasound scans were obtained periodically for the diagnosis of intraventricular hemorrhage and periventricular leucomalacia. Among survivors, the diagnosis of cerebral palsy was made at age 18 months. Results: Children with adverse outcomes had higher umbilical cord magnesium levels at delivery. In regression models that controlled for confounders, which included very low birth weight, magnesium remained a significant risk factor (adjusted odds ratio, 3.7; 95% CI, 1.1-11.9; P =.03). Conclusion: Contrary to original hypotheses, this randomized trial found that the use of antenatal magnesium sulfate was associated with worse, not better, perinatal outcome in a dose-response fashion. (Am J Obstet Gynecol 2002;186:1111-8.)

Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour

The pharmacokinetics of remifentanil suggests that it may be suitable for analgesia during labour. In an open pilot study, 36 women requesting meperidine for analgesia were recruited early in labour and randomized to receive either meperidine i.m. or remifentanil given as patient-controlled analgesia (PCA). Pain severity, sedation and anxiety were assessed with visual analogue scales and overall effective analgesia was assessed by the woman and midwife. The pain scores were lower in the remifentanil group: median pain score at 60 min was 72 mm for meperidine and 48 mm for remifentanil (P=0.004) and median maximum pain score during the first 2 h was 82.5 mm for the meperidine group and 66.5 mm for the remifentanil group (P=0.009). Both the midwives' and the women's assessments of overall effective analgesia were higher in the remifentanil group [Likert scale (5 = excellent to 1 = poor): chi2=12.10, P=0.002 for mothers' assessment; chi2=12.80, P=0.002 for midwives' assessment]. In this pilot study, remifentanil by PCA gave better pain relief to mothers in labour than intramuscular meperidine. However, remifentanil is a potent respiratory depressant and adequate continuous monitoring is necessary.