Preparation For Birth Research Articles

Preparation for parenthood: a concept analysis

Objective: This article reviewed the literature and critically analysed the concept of preparation for parenthood. The analysis is mainly of a discursive nature with some theoretical underpinnings. Background: Preparation for parenthood is a concept that is generally used within psychology, sociology and health professional practice especially midwifery, in terms of preparation for birth and parenthood sessions. However, parents often report feeling unprepared during this period. In order to ensure appropriate delivery of support and education during this time it is important to fully understand what preparation for parenthood really means by unravelling its component elements and understanding its contemporary relevance. Methods: A number of sources were searched using the keywords ‘preparation’ and ‘parenthood’. The concept analysis framework put forward by Walker and Avant was used to develop appropriate cases to further illustrate and explore meaning. Results: The literature search confirmed limited evidence with regards to an in-depth exploration of the concept and the separate elements that are related to each other. This investigation is the first of its kind considering the full range of meanings with regards to the concept and the contemporary evidence available. Law, gender, culture and spirituality all influence the concept and thus antecedents and consequences cannot always be applied to contexts which are fundamentally different. Conclusion: Preparation for parenthood is multi-faceted and changing, thus further research with regards to this concept is warranted. This analysis provides the groundwork for the development of measures that may be used within clinical practice.

Psycho-Social Predictors of Childbirth Fear in Pregnant Women: An Australian Study

Background: Around 20% of birthing women report high levels of childbirth fear. Fear potentially impacts women’s emotional health, preparation for birth, and birth outcomes. Evidence suggests that personal and external factors contribute to childbirth fear, however results vary. Aim: To identify pyscho-social factors associated with childbirth fear and possible antenatal predictors of childbirth fear according to women’s parity. Method: 1410 women in second trimester and attending one of three public hospitals in south-east Queensland were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Other measures included the Edinburgh Depression Scale (EPDS), Decisional Conflict Scale (DCS) and items from the EuroQol (EQ-5D) targeting Anxiety/Depression and Pain/Discomfort. In addition items measuring a previous mental health condition, social support and knowledge were used. Preferred mode of birth was also collected. Psycho-social factors were analysed to determine associations with childbirth fear. Multivariate analysis was used to determine predictors of fear. Results: Thirty-one percent (n = 190/604) of nulliparous and 18% (n = 143/782) of multiparous women reported high fear levels. Having a mental health history, desiring a caesarean section, reporting moderate to high pain during pregnancy, having a non-supportive partner and perceiving less childbirth knowledge than peers, were associated with childbirth fear. Standard multiple regression analyses by parity determined that depression, decisional conflict, low social support and less perceived knowledge predicted levels of childbirth fear. The model explained 32.4% of variance in childbirth fear for nulliparous and 29.4% for multiparous women. Conclusion: Psychosocial factors are significantly associated with childbirth fear. The identification of predictive psychosocial factors for childbirth fear indicates the importance of observing, assessing, and developing support strategies for women. Such strategies are required to decrease anxiety and depression for women during pregnancy, promote normal birth, and build social support to improve women’s feelings and positive expectations of birth.

Préparer la naissance : une affaire de genre

Preparing for childbirth : a gender affair What if birth preparations included preparing the gendered socialisation of the baby to be ? This article looks at the early processes involved in producing babies as gendered beings, and how they might already be put in place before birth, during pregnancy. Most couples expecting a child do not mobilise to welcome a baby that is “ neuter” in terms of gender, but a little girl or a little boy. Two aspects of this gendered preparation for childbirth are examined : getting the future baby’s “ wardrobe” together, and preparing the place where he or she will sleep. This mobilisation also includes a gendered role distribution for the parents : in both cases, the mother’s involvement is more noticeable. The article is based on semistructured interviews conducted in 2011 and 2012 with women who have higher-education qualifications, before or just after the birth of their second child.

A profile of midwifery in Paraguay

Objectivethe goal of this study was to provide a descriptive profile of midwifery in Paraguay. Designthe study involved three components: background research from official documents and key informant interviews to complete questionnaires, qualitative interviews with Paraguayan midwives and obstetricians, and participant observation. Data from official documents and questionnaires were tabulated using descriptive statistics. Individual interviews and small-group interviews of midwives, student midwives, and obstetricians were conducted in five health departments of Paraguay. Settingthe research took place in the capital of Paraguay, Asunción, and four additional health departments: Central, Cordillera, Guira, and Misiones. ParticipantsTwenty-two midwives, nine student midwives, nine obstetricians, and five leaders of professional health organisations in Paraguay participated in this study. Findingsthree salient themes were identified throughout the interviews. First was the understanding of the changing role of the midwife in the health system, particularly in and around the capital city of Asunción. Second, midwives and obstetricians both reported that women were not sufficiently prepared for labour and birth during the antenatal period. Limited antenatal education and childbirth classes existed and midwives felt that this was a major barrier to vaginal birth. Finally, access to midwife-provided antenatal care is perceived to be limited. A major barrier to accessing midwifery care for women in the capital is related to the midwives' changing role in practice. Obstetricians are now providing antenatal care more often than they used to, and in some public hospitals they also attend vaginal deliveries. Key conclusions and implicationslimiting the utilisation of midwives may well be a major contributor to the rising rates of caesarean sections. Women are not prepared for labour and birth in the antenatal period, or are scheduled for elective caesarean sections antenatal ly. Midwives are not fulfilling their potential to prepare women for labour and birth, despite their high-level professional training. Midwives have the potential to improve antenatal preparation for low-intervention birth. This transition in care provision would be a more effective use of human resources for both obstetricians and midwives.

Newborn Transition

The transition from intrauterine to extrauterine life is a complex adaptation. Although, in a sense, the entire time in utero is in preparation for this transition, there are many specific anatomic and physiologic changes that take place in the weeks and days leading up to labor that facilitate a healthy transition. Some, including increasing pulmonary vasculature and blood flow, are part of an ongoing process of maturation. Others, such as a reversal in the lung from secreting fluid to absorbing fluid and the secretion of pulmonary surfactant, are associated with the hormonal milieu that occurs when spontaneous labor is impending. Interventions such as elective cesarean birth or induction of labor may interfere with this preparation for birth. Postnatal interventions such as immediate clamping of the umbilical cord and oropharyngeal suction may also compromise the normal process of newborn transition. This article reviews the physiology of the fetal to newborn transition and explores interventions that may facilitate or hinder the optimal process.

Antenatal education and the birthing experience of Brazilian women: a qualitative study

BackgroundInformation is still scarce on the birthing experience of women who participate in antenatal systematic education programs. The objective of the study was to report the experience of labor as described by nulliparous women who participated and who did not in a systematic Birth Preparation Program (BPP).MethodA qualitative study was conducted with eleven women who participated in a BPP and ten women attending routine prenatal care selected through purposeful sampling. The BPP consisted of systematized antenatal group meetings structured to provide physical exercise and information on pain prevention during pregnancy, the role of the pelvic floor muscles, the physiology of labor, and pain relief techniques. A single, semi-structured interview was conducted with each participant. All interviews were recorded, transcribed verbatim and thematic analyses performed. The relevant themes were organized in the following categories of analysis: control of labor, positions adopted during labor, and satisfaction with labor.ResultsWomen who participated in the systematic educational activities of the BPP reported they maintained self-control during labor and used breathing exercises, exercises on the ball, massage, baths and vertical positions to control pain. Also they reported satisfaction with their birthing experience. Women who did not participate in systematic educational activities referred to difficulties in maintaining control during labor and almost half of them reported lack of control. Also they were more likely to report dissatisfaction with labor.ConclusionsWomen who participated in the BPP reported self-control during labor and used non-pharmacological techniques to control pain and facilitate labor and expressed satisfaction with the birthing experience.

Group-based antenatal birth and parent preparation for improving birth outcomes and parenting resources: Study protocol for a randomised trial

ObjectivesTo examine the efficacy and cost-effectiveness of group based antenatal education for improving childbirth and parenting resources compared to auditorium based education. MethodsParticipants: 2350 Danish pregnant women and their partners ⩾18years old, recruited before 20+0 gestational weeks.Population-based individually randomised superiority trial with two parallel arms: Four sessions of birth and parent preparation in small groups (experimental group); two lectures in an auditorium (control group).Data is collected by (1) questionnaires at baseline (≈18weeks of gestation), 37weeks of gestation, 9weeks-, 6months-, and 1year post-partum, (2) the hospital obstetric database, (3) national registers. Primary outcome: use of epidural analgesia. Secondary outcomes: stress, parenting alliance; explorative outcomes: depressive symptoms, use of health care services, self-efficacy, well-being, family break-ups.Analyses will be intention-to-treat as well as per protocol. Process evaluation will be conducted using questionnaires and qualitative interviews. The incremental societal cost of the intervention will be computed and compared to the measured outcomes in a cost-effectiveness analysis. ConclusionTo the best of our knowledge this is the largest well-designed randomised trial of its kind to date. The trial will bring much-needed evidence for decision makers of the content and form of antenatal education.

Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial

BackgroundAntenatal preparation programmes are recommended worldwide to promote a healthy pregnancy and greater autonomy during labor and delivery, prevent physical discomfort and high levels of anxiety. The objective of this study was to evaluate effectiveness and safety of a birth preparation programme to minimize lumbopelvic pain, urinary incontinence, anxiety, and increase physical activity during pregnancy as well as to compare its effects on perinatal outcomes comparing two groups of nulliparous women.MethodsA randomized controlled trial was conducted with 197 low risk nulliparous women aged 16 to 40 years, with gestational age ≥ 18 weeks. Participants were randomly allocated to participate in a birth preparation programme (BPP; n=97) or a control group (CG; n=100). The intervention was performed on the days of prenatal visits, and consisted of physical exercises, educational activities and instructions on exercises to be performed at home. The control group followed a routine of prenatal care. Primary outcomes were urinary incontinence, lumbopelvic pain, physical activity, and anxiety. Secondary outcomes were perinatal variables.ResultsThe risk of urinary incontinence in BPP participants was significantly lower at 30 weeks of pregnancy (BPP 42.7%, CG 62.2%; relative risk [RR] 0.69; 95% confidence interval [CI] 0.51-0.93) and at 36 weeks of pregnancy (BPP 41.2%, CG 68.4%; RR 0.60; 95%CI 0.45-0.81). Participation in the BPP encouraged women to exercise during pregnancy (p=0.009). No difference was found between the groups regarding to anxiety level, lumbopelvic pain, type or duration of delivery and weight or vitality of the newborn infant.ConclusionsThe BPP was effective in controlling urinary incontinence and to encourage the women to exercise during pregnancy with no adverse effects to pregnant women or the fetuses.Trial registrationClinicaltrials.gov, (NCT01155804)

Nonlinear optical microscopy and ultrasound imaging of human cervical structure

The cervix softens and shortens as its collagen microstructure rearranges in preparation for birth, but premature change may lead to premature birth. The global preterm birth rate has not decreased despite decades of research, likely because cervical microstructure is poorly understood. Our group has developed a multilevel approach to evaluating the human cervix. We are developing quantitative ultrasound (QUS) techniques for noninvasive interrogation of cervical microstructure and corroborating those results with high-resolution images of microstructure from second harmonic generation imaging (SHG) microscopy. We obtain ultrasound measurements from hysterectomy specimens, prepare the tissue for SHG, and stitch together several hundred images to create a comprehensive view of large areas of cervix. The images are analyzed for collagen orientation and alignment with curvelet transform, and registered with QUS data, facilitating multiscale analysis in which the micron-scale SHG images and millimeter-scale ultrasound data interpretation inform each other. This novel combination of modalities allows comprehensive characterization of cervical microstructure in high resolution. Through a detailed comparative study, we demonstrate that SHG imaging both corroborates the quantitative ultrasound measurements and provides further insight. Ultimately, a comprehensive understanding of specific microstructural cervical change in pregnancy should lead to novel approaches to the prevention of preterm birth.

First-Time Parents’ Perception of Antenatal Education in Sweden

Antenatal parent education is one part of the parenthood support program and is offered to all first-time parents in Sweden. The aim was to explore first-time parents’ experiences of antenatal education and its helpfulness in preparation for birth and early parenthood. Eight hundred ten first-time parents completed questionnaires. The antenatal education was a positive experience for 56% and 62% of women and men, respectively. Antenatal education was helpful during birth for 68% of women and 63% of men. Forty-seven percent of women and 44% of men found it helpful for early parenthood. High level of education was the only background variable associated with being satisfied with antenatal education. Satisfaction was lower than reported in previous studies and indicates room for change and improvement in antenatal parent education.

THE PECULIARITIES OF CHANGES IN THE STRUCTURE OF PSYCHOEMOTIONAL SPHERE IN WOMEN DURING THE GESTATION FLAVORS OF PREGNANCY

We examined the structure of psychoemotional sphere of 153 pregnant patients in different terms of pregnancy and 48 non-pregnant women. Our data demonstrated that first-term pregnancy is accompanied by a significant emotional stress. In second-term pregnancy those changes are more positive, at third-term pregnancy the level of the patients feels is significantly increased and the psychoemotional sphere is stabilized. Thereby the specific features of nervous system are influence the status of the pregnant women. Evidently pregnant patients with the high level of anxiety, introversion, psychotic and nevrotic characteristics are in need of the increased attention of the obstetric-gynecologic specialists, anaesthesiologists and psychologists to make correction of the psychoemotional sphere when preventive preparation of birth and the choice of anesthesia delivery.

Residency and Activation of Myeloid Cells During Remodeling of the Prepartum Murine Cervix1

Remodeling of the cervix is a critical early component of parturition and resembles an inflammatory process. Infiltration and activation of myeloid immune cells along with production of proinflammatory mediators and proteolytic enzymes are hypothesized to regulate cervical remodeling as pregnancy nears term. The present study standardized an approach to assess resident populations of immune cells and phenotypic markers of functional activities related to the mechanism of extracellular matrix degradation in the cervix in preparation for birth. Analysis of cells from the dispersed cervix of mice that were nonpregnant or pregnant (Days 15 and 18 postbreeding) by multicolor flow cytometry indicated increased total cell numbers with pregnancy as well as increased numbers of macrophages, the predominant myeloid cell, by Day 18, the day before birth. The number of activated macrophages involved in matrix metalloproteinase induction (CD147) and signaling for matrix adhesion (CD169) significantly increased by the day before birth. Expression of the adhesion markers CD54 and CD11b by macrophages decreased in the cervix by Day 18 versus that on Day 15 or in nonpregnant mice. The census of cells that expressed the migration marker CD62L was unaffected by pregnancy. The data suggest that remodeling of the cervix at term in mice is associated with recruitment and selective activation of macrophages that promote extracellular matrix degradation. Indices of immigration and activities by macrophages may thus serve as markers for local immune cell activity that is critical for ripening of the cervix in the final common mechanism for parturition at term.

P19.05: A rare case of infradiaphragmatic pulmonary sequestration

Objectives: Fetal lymphangiomas are uncommon congenital malformations of the lymphatic system that involve the skin and subcutaneous tissues. Lymphangiomas can occur anywhere in the skin and the mucous membranes.The aim of this study was to review the ultrasound findings in the prenatal diagnosis, the outcome and treatment of the NNL. Methods: We analyze our database with 1843 cases of congenital anomalies between 2003 to March of 2012. The definition for the prenatal diagnosis of the Lynphangiomas were cystic mass who involve the without vascular supply and include in the soft tissue. We exclude the nuchal localization. The diagnosis was confirmed after birth and each one was follow. The variables include in the analysis were the localization, associate malformations, postnatal outcome, treatment. Results: Thirteen cases were diagnosed with NNL. Postnatal assessment was obtained in all the cases. The anatomic localization was: fetal thorax 2 cases, axillar 3 cases, facial 2 cases, anterior neck 3 cases; 1 of them with a big mass with obstruction of the air way, arm 1 case, gluteus 1 case an 1 case with lymphangiomatosis. 2 (15%) died in the perinatal period 1 of them the lymfangiomatosis and the other the anterior neck with air way obstruction. 2 (15%) of the cases had spontaneous resolution the localization of this cases was arm and 1 case in the anterior neck. 9 cases require postnatal treatment with medical therapy with Bleomicin and surgical reduction. None were associated with chromosomal anomalies. None of them produced functional limitation. The facial lynphangiomas were related with aesthetic facial scarring sequelae. Conclusions: The prenatal diagnosis of the NNL require a sequential analysis of the localization, size, multiloculation and mass effect. The Involvement of the upper airways one of the prognostic factor the prenatal diagnosis allows the preparation for birth. In cases of lymphangiomatosis the prognosis is poor. As to its other locations lymphangiomas the prognosis are well but the the sequelae commitment to aesthetic or function must be taken into account when counseling parents.

The Human Microbiome Project

The Human Microbiome project (National Institute of Health, USA) has just been completed and information generated from this project was published on June 14, 2012 in Nature and PLoS journals. This project, which consists of a consortium of scientists from nearly 80 universities and scientific institutions, aims to reveal the myriad of microbial organisms residing in healthy humans and related research across various body habitats. The results published in Nature and PLoS journals are considered to be a major milestone in the history of biological success. The presence of more than 10,000 microbial species in human ecosystem reveals the massive contribution of these microbes in controlling various metabolic functions. While the human genome contains nearly 22,000 protein-coding genes, the human microbiome contributes nearly 8 million protein of these bacteria that inhabit the human body. The data has revealed some interesting information. Our body contains 100 trillion bacteria, and the gut is generally not packed with food but with microbes. It is also becoming apparent that the human microbiome contains more number of beneficial than harmful microbes, as the former keeps a check on pathogenic microbes. The potential benefits of the resident commensal microbes also include the control of obesity, brain development deriving nutrition, the ability of the human body to develop resistance towards pathogens and invoking immune response against infections. However, the diversity and distribution of the human microbiota varies systematically across body habitats. While some locations, like the gut, mouth and skin harbour more diverse communities, others show a deficient biogeographical localization of such communities in the human body. Likewise, it has been estimated that around 500–1000 species of bacteria inhabit the skin, where they have been studied to play a significant role in educating our immune system to respond to infections and injury, as well as to maintain homeostatic control of skin inflammation. Interestingly, researchers found that the bacterial species of the vaginal microbiome undergo a major shift in preparation for birth, and the passage of the child through the birth canal provides it with its first dose of microbes Major momentum to research in this field was provided when a deliberate alteration of these commensal bacterial populations (availability of germ-free systems) by way of antibiotic treatments was observed to not only increase the rate of allergic reactions, but also lead to many diseases. Further characterization of the factors that influence the diversity and distribution of these commensal bacteria may tie together the research done in the field of medicine to prevent infections, as well as provide a helping hand in therapeutics. As is rightly said, microbiota is indeed acting as ‘brothers in arms’ in the fight against infectious diseases by endowing us with traits essential for optimal immune responses. Even though the regulatory mechanism by way of which these bacteria face the pathogens is not well known till now, further ventures into this field will definitely illuminate newer ways to promote better human health and immunity to several infections. This microbiome data cannot be easily extrapolated to more diverse microbiomes of Indian population. Thus there is a need to initiate a parallel study of analyzing human microbiome from individuals from the Indian continent so as to deeply understand the relationship between an individual’s physiology and environmental microbiology.

P19.04: A rare case of congenital lobar emphysema mimicing cystic adenomatoid malformation prenatally

Objectives: Fetal lymphangiomas are uncommon congenital malformations of the lymphatic system that involve the skin and subcutaneous tissues. Lymphangiomas can occur anywhere in the skin and the mucous membranes.The aim of this study was to review the ultrasound findings in the prenatal diagnosis, the outcome and treatment of the NNL. Methods: We analyze our database with 1843 cases of congenital anomalies between 2003 to March of 2012. The definition for the prenatal diagnosis of the Lynphangiomas were cystic mass who involve the without vascular supply and include in the soft tissue. We exclude the nuchal localization. The diagnosis was confirmed after birth and each one was follow. The variables include in the analysis were the localization, associate malformations, postnatal outcome, treatment. Results: Thirteen cases were diagnosed with NNL. Postnatal assessment was obtained in all the cases. The anatomic localization was: fetal thorax 2 cases, axillar 3 cases, facial 2 cases, anterior neck 3 cases; 1 of them with a big mass with obstruction of the air way, arm 1 case, gluteus 1 case an 1 case with lymphangiomatosis. 2 (15%) died in the perinatal period 1 of them the lymfangiomatosis and the other the anterior neck with air way obstruction. 2 (15%) of the cases had spontaneous resolution the localization of this cases was arm and 1 case in the anterior neck. 9 cases require postnatal treatment with medical therapy with Bleomicin and surgical reduction. None were associated with chromosomal anomalies. None of them produced functional limitation. The facial lynphangiomas were related with aesthetic facial scarring sequelae. Conclusions: The prenatal diagnosis of the NNL require a sequential analysis of the localization, size, multiloculation and mass effect. The Involvement of the upper airways one of the prognostic factor the prenatal diagnosis allows the preparation for birth. In cases of lymphangiomatosis the prognosis is poor. As to its other locations lymphangiomas the prognosis are well but the the sequelae commitment to aesthetic or function must be taken into account when counseling parents.

Women's experiences of participation in a pregnancy and postnatal group incorporating yoga and facilitated group discussion: A qualitative evaluation

This paper reports on a small qualitative research study which explored women's experiences of participation in a pregnancy and postnatal group that incorporated yoga and facilitated discussion. The group is offered through a community based feminist non-government women's health Centre in Northern NSW Australia. The purpose of the research was to explore women's experiences of attending this pregnancy and postnatal group. An exploratory qualitative approach was used to explore women's experiences of attending the group. Fifteen women participated in individual, in-depth face-to-face interviews. Interviews were recorded and transcribed verbatim. Thematic analysis was undertaken to analyse the qualitative data. Six themes were developed, one with 3 subthemes. One theme was labelled as: 'the pregnancy and motherhood journey' and included 3 sub-themes which were labelled: 'preparation for birth', 'connecting with the baby' and 'sharing birth stories.' The other five themes were: 'feminine nurturing safe space', 'watching and learning the mothering', 'building mental health, well-being and connections', the "group like a rock and a seed' and 'different from mainstream'. This research adds to the overall body of knowledge about the value of yoga in pre and postnatal care. It demonstrates the value of sharing birth stories and the strong capacity women have to support one another, bringing benefits of emotional and social well-being, information, resources and support derived from group based models of care.

Personal experiences of water birth

Introduction. Water birth is one of the advanced methods of labour managing. Aim. The aim of this study is the assessment of the influence of water immersion on labour progress, condition of mother and newborn as well as the women’s reported contentment with childbirth. Material and methods. An anonymous survey of own design was used for the research. The gathered material was statistically analyzed using Satistica and Excel software. The research was conducted from October 2009 till March 2010 on 74 randomly chosen women, giving birth at The Regional Specialist Hospital in Wrocław. Results. The preparations for a traditional birth were carried out by the attending physician at the clinic (49%), while the ones for the water birth, by a midwife at a birth center (51%). In both groups the father was present in 86% of the cases. Seventy three per cent delivered during the first or second immersion. No instrumental procedures were required during the whole process of water birth and lower pain levels in comparison to the traditional method were reported. The water could have decreased the intensity of contractions and slowed the labor. The first stage of labor was reported as short by women who chose the water method (46%), while the second stage was reported as a long one by the same group of women (14%) and as a very long by women who chose the traditional method (5%). Compared to the traditional birth, episiotomy rates for a water birth are distinctively lower, as well as sex organ injuries – 27% in the former and 8% in the latter. There is no difference in the rate of complications in the third stage of labor between the test group and the control group. Compared to the control group no increase in perinatal bleeding was observed in the test group. Conclusions. After meeting adequate conditions water birth can serve as an alternative to traditional obstetrics.

Genome-wide analyses of Nkx2-1 binding to transcriptional target genes uncover novel regulatory patterns conserved in lung development and tumors.

The homeodomain transcription factor Nkx2-1 is essential for normal lung development and homeostasis. In lung tumors, it is considered a lineage survival oncogene and prognostic factor depending on its expression levels. The target genes directly bound by Nkx2-1, that could be the primary effectors of its functions in the different cellular contexts where it is expressed, are mostly unknown. In embryonic day 11.5 (E11.5) mouse lung, epithelial cells expressing Nkx2-1 are predominantly expanding, and in E19.5 prenatal lungs, Nkx2-1-expressing cells are predominantly differentiating in preparation for birth. To evaluate Nkx2-1 regulated networks in these two cell contexts, we analyzed genome-wide binding of Nkx2-1 to DNA regulatory regions by chromatin immunoprecipitation followed by tiling array analysis, and intersected these data to expression data sets. We further determined expression patterns of Nkx2-1 developmental target genes in human lung tumors and correlated their expression levels to that of endogenous NKX2-1. In these studies we uncovered differential Nkx2-1 regulated networks in early and late lung development, and a direct function of Nkx2-1 in regulation of the cell cycle by controlling the expression of proliferation-related genes. New targets, validated in Nkx2-1 shRNA transduced cell lines, include E2f3, Cyclin B1, Cyclin B2, and c-Met. Expression levels of Nkx2-1 direct target genes identified in mouse development significantly correlate or anti-correlate to the levels of endogenous NKX2-1 in a dosage-dependent manner in multiple human lung tumor expression data sets, supporting alternative roles for Nkx2-1 as a transcriptional activator or repressor, and direct regulator of cell cycle progression in development and tumors.

Choosing homebirth – The women's perspective

To describe the decision-making process and birth experience of ten women in Finland who had planned to have a home birth. The data were collected by means of in-depth interviews in 2008 and were analyzed using qualitative content analysis. Several reasons led to a decision to give birth at home. The main reasons were: previous birth experience, considering birth to be a natural process, increased autonomy, the home environment, intuition, the desire to choose the birth attendant, mistrust of the medical establishment and the opportunity to have the baby's siblings present at the birth. There were inhibiting and facilitating factors which influenced the women's decisions, and before making their decisions women sought out information about home birth. Home birth was an extremely positive experience and women highlighted their desire for the development of parent education to empower women in their preparations for birth. Full autonomy, the participation of family members, trust in one's ability to give birth and the absence of pharmacological pain relief were major contributors to the positive birth experience. The need for empowerment through parent education was highlighted in the interviews. To the women of this study home birth was very positive experience in which the autonomy was the important factor. According to this study maternity care services do not respond to women's individual wishes and services should be offer more alternatives and should be more empowering.

Prevalência e fatores condicionantes do aleitamento materno - Estudo ALMAT

PREVALENCE OF BREASTFEEDING AND ASSOCIATED FACTORS - ALMAT STUDY Objective: To determine the prevalence of breastfeeding at 6 months of age and to determine if the early cessation of breastfeeding is associated with maternal age, parity, education, employment status, smoking, alcohol consumption and knowledge of the benefits of breastfeeding. Study Type: Cross-sectional study. Location: USF Mais Saude and USF Lethes, Local Health Unit of Alto Minho. Population:Women giving birth in 2009 in these regions. Methods: Between September 1 and October 15, 2010, we conducted telephone interviews with 163 mothers (106 from USF Lethes and 57 from USF Mais Saude) selected from a list of the women giving birth in 2009 identified in the electronic medical record. The information was gathered using a questionnaire developed by the authors. The data collected were analyzed using descriptive and inferential statistics. Results: The prevalence of breastfeeding at 6 months was 36% (29% - 43%, CI 95%). The mean duration of breastfeeding was 5 months. The prevalence of breastfeeding was higher in older women. The prevalence of breastfeeding was high in women in lowest and highest level of education. It was lower in women who attended birth preparation classes. In a multivariate analysis, age was found to be a confounding variable, so these variables (education and pre-natal classes) were found not to be associated with breastfeeding. Conclusions: The prevalence of breastfeeding at 6 months of age in this population was found to be similar to that found in other studies, but lower than the goal by set by the World Health Organization. The association between breastfeeding and age is similar to that found in the literature. We believe that this study contributes to our knowledge of the factors associated with the prevalence of breastfeeding at 6 months of age in Portugal.