Preparation For Birth Research Articles

Vécu de l’accouchement par le couple primipare : étude qualitative

Objective The aim of this research was to study childbirth experience for the primiparae couple. Patients and methods Thirty-three couples were interviewed two days after the birth in maternities. Results For mothers, the presence of their husbands is a support whereas men mentioned a feeling of helplessness. Discussion and conclusion These results point out the need to accompany mothers and fathers during birth preparation to make this experience to be the most satisfying for both members of couple.

Birth preparedness and complication readiness among women in Adigrat town, north Ethiopia

Abstract Background: Avoidable mortality and morbidity remains a formidable challenge in many developing countries like Ethiopia. Pregnancy related complications can not be reliably predicted and it is necessary to design strategies to overcome those problems when they arise. Objective: To assess knowledge and practices with respect to birth preparedness and complication readiness and factors associated with their practices among women who gave birth in the last 12 months preceding the survey in Adigrat Town, Tigray Regional State, Ethiopia. Method: A cross-sectional community-based study was conducted in September and October 2006. A total of 538 women who gave birth in the last 12 months preceding the survey were randomly selected for interview. Results: Data were obtained from 534 mothers, yielding a response rate 99.3%. Taking into account place of delivery identification, means of transportation and saving money, about 22% of the respondents were prepared for birth and its complications. In multivariate analysis, preparation for birth and its complication was higher among literate mothers (OR= 2.11, 95% CI= 1.17, 3.80), married women (OR= 5.69, 95% CI= 1.67, 19.38), women with parity range of 2 to 4 (OR= 2.53, 95% CI= 1.17, 5.44), women with history of still birth (OR= 4.41, 95% CI= 1.68, 11.59) and those who were advised about birth preparedness during their antenatal care follow up (OR= 2.65, 95% CI= 1.66, 4.23). Conclusion: The study identified poor comprehensive knowledge and practices of preparation for birth and its complication in the area. Community education about preparation for birth and its complication and empowerment of women through expansion of educational opportunities are important steps in improving birth preparedness and consequently the effects of pregnancy related complications. Antenatal care clinics should give due emphasis to preparation for birth and its complication and provide information and education to all pregnant women. [Ethiop.J.Health Dev. 2007;22(1):14-20]

Homebirths in a modern setting – a cautionary tale

In Western societies, homebirth instead of facility delivery pinpoints the essence of obstetrics: supporting and overseeing an uncomplicated delivery and providing timely intervention for a complic...

Expression Profiles of the Mouse Lung Identify a Molecular Signature of Time-to-Birth

A greater understanding of the regulatory processes contributing to lung development could help ameliorate morbidity and mortality in premature infants and identify individuals at risk for congenital and/or chronic lung diseases. Genomics technologies have provided rich gene expression datasets for the developing lung that enable systems biology approaches for identifying large-scale molecular signatures within this complex phenomenon. Here, we applied unsupervised principal component analysis on two developing lung datasets and identified common dominant transcriptomic signatures. Of particular interest, we identify an overlying biological program we term "time-to-birth," which describes the distance in age from the day of birth. We identify groups of genes contributing to the time-to-birth molecular signature. Statistically overrepresented are genes involved in oxygen and gas transport activity, as expected for a transition to air breathing, as well as host defense function. In addition, we identify genes with expression patterns associated with the initiation of alveolar formation. Finally, we present validation of gene expression patterns across the two datasets, and independent validation of select genes by qPCR and immunohistochemistry. These data contribute to our understanding of genetic components contributing to large-scale biological processes and may be useful, particularly in animal models of abnormal lung development, to predict the state of organ development or preparation for birth.

A tool to measure fathers' attitudes and needs in relation to birth

The aim was to develop a scale—the Birth Participation Scale (BPS)—which midwives can use to measure fathers' attitudes and needs in relation to birth participation. The objectives were to use the BPS to: detect whether fathers genuinely want to be present at the birth; identify localized perceptions and fears fathers may have about birth participation; and ascertain whether being present at the birth was a rewarding experience. A quantitative survey was carried out with data collected from York District Hospital Maternity Unit (UK). The participants were a stratified sample of first-time (n= 42) and second-time fathers (n= 36). Measurements and findings: the BPS was issued at two observation points: prior to birth participation and post birth participation. Difference in scores between conditions assessed the fathers' attitudes towards birth participation in a positive or negative direction. Scores post birth showed a small shift in attitude in a positive direction for first-time (p= 0.01) and second-time fathers (p= 0.02) with only 4% finding birth partnering more difficult than they had anticipated. Key conclusions are that midwives are facilitating the majority of fathers towards a positive birth experience. Implications for practice are that the BPS may prove useful for: identifying whether fathers genuinely want to be present at the birth; ascertaining fathers' personal concerns in relation to birth participation; and tailoring birth preparation to meet fathers individualized needs.

β-Endorphin concentration in colostrums of Burkinabe and Sicilian women

Objective Endorphins (EPs) present in human colostrum may be relevant for immediate postnatal fetal adaptation because this compound is involved in stress response and adaptation mechanisms. Endorphin levels in human colostrum are two-fold greater than corresponding maternal plasma levels; however, the high endorphin levels in human milk decrease as lactation continues. The aim of this study was to determine the β-EP concentration in colostrums of women residing in Burkina Faso and Sicily. In addition, we investigated the source of potential differences in β-EP levels between these populations, especially ethnic sources of these deviations. Methods The concentration of β-EP was determined in the colostrum from the first 3 d subsequent to delivery by an enzyme immunoassay as immunoreactive material (IRM). Results The production of β-EP in the colostrum was significantly higher in Burkinabe mothers (0.83 ± 0.04 ng/mL) than in Sicilian mothers (0.31 ± 0.02 ng/mL) at 24 h after delivery. Colostrum levels of β-EP declined progressively during the first 3 d after delivery in both populations (0.64 ± 0.1 and 0.28 ± 0.015 ng/mL, respectively, at 72 h). The level of β-EP-IRM correlated significantly with pain and psychological involvement during and after delivery. In addition, the correlation between β-EP-IRM and length of stage II of labor was significant ( P < 0.0001) in the colostrums of Sicilian mothers who received ergot derivatives, episiorrhaphy, and child birth preparation. The correlation between β-EP-IRM and length of stage II was less significant ( P < 0.001) in the colostrums of Burkinabe mothers who received neither ergot derivatives nor child birth preparation. Conclusion During the first 3 d after labor the β-EP-IRM concentration in the colostrums of Burkinabe mothers differs from that of Sicilians. In addition, because Burkinabe women produce a larger volume of colostrum, their newborns receive, during the first days of life, a larger absolute amount of β-EP-IRM, likely resulting in better postnatal fetal adaptation.

Metabolismo del glutatión y desarrollo posnatal del pulmón de la rata

Significant changes in lung antioxidants occur in preparation for birth. Little is known about physiological regulation of antioxidants in the postnatal period. To study the glutathione system in the lungs during postnatal development. In the lungs of 7, 15, 21, 50 and 70 days old Sprague-Dawley rats we measured total and oxidized glutathione content as well as the activity of the limiting enzyme in glutathione synthesis (y-GCS) and of the enzymes glutathione peroxidase (GPx) and glutathione reducíase (GRd). Between 7 and 15 days the activities of GPx and GRd increase 32% and 26%, respectively (p <0.001). Whereas GPx activity remains high throughout the rest of the study period, GRd activity decreases progressively reaching adulthood values at 7 days. y-GCS activity shows a gradual increase that reaches significance at 50 days when it doubles values observed at 7 days (p <0.05). A significant correlation was found between GPx and GRd activities over the entire period (r =0.62, p <0.0001). Strength of the correlation is age dependent due to the differences in time course of the enzyme changes. Whereas total GSH does not change, oxidized glutathione decreases from 7% at 7 and 15 days to 4% later on (p <0.01). The activity of several enzymes involved in glutathione metabolism increases during postnatal development of the rat lung. Interpretation of lung responses to injurious agents needs to be done taking into consideration the physiological regulation of antioxidants during postnatal development.

Women's expectations of maternity services: A community-based survey

Examining women's preferences for maternity care is overdue. Understanding women's preferences and re-orienting services to meet their expectations is critical to improving health outcomes. A self-report survey of a convenience community sample of 63 women visiting a Maternity Coalition/Association for Improvements in Maternity Services stall at a Mother and Baby Expo in 2003. Over 95% of women ranked birth safety, bonding with the baby, feeling in control during birth, and postnatal care as "very important". Over 85% of women rated educational preparation for birth, the relationship with their caregiver, prenatal care, and breastfeeding successfully as "very important". Avoiding labour pain was considered less important by more women than any other item. Around half the respondents preferred their birth care to be from a chosen midwife with access to medical backup (57.9%, n=37). Some women identified a lack of choice of care options with 45.9% (n=17) reporting "little" or "no" choice in birth care for their previous birth. Poor quality care was also identified with 57.9% (n=22) rating their postnatal care as "mediocre". Given assurance of equal safety and free care, 50% (n=31) of participants would prefer to give birth at a birth centre and 24.2% (15 out of 63) would prefer a homebirth. Factors associated with safety, control, continuity of care and successful mothering are perceived as important for many women. Some women perceived limited birth choices. More needs be done to align the provision of maternity services with women's preferred care options. Given the small self-select, non-representative sample, results should be interpreted with caution.

Juggling type 1 diabetes and pregnancy in rural Australia

Objective to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps. Design qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically. Setting The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals. Participants seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months. Findings rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants’ experiences were coloured by their limited access and interactions with expert health professionals. Conclusion women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals. Implications for practice national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.

Maternity services suffer again

The NHS continues to be in financial crisis and when cuts need to be made, someone is going to suffer. The latest disaster is the closure or curtailment of antenatal classes, as well as visits to maternity wards in a number of areas in England and Wales. The Department of Health expects the NHS to comply with the 2004 National Service Framework on maternity services, which says that good antenatal care should include access to parenting education and preparation for birth through classes, or other means. However the individual trusts must provide the funds. In some cases classes have been cut to just one and where antenatal classes have been closed down completely, trusts propose that midwives will make a long home visit to prepare women for the birth.

DNA Microarray Reveals Novel Genes Induced by Mechanical Forces in Fetal Lung Type II Epithelial Cells

Mechanical forces are essential for normal fetal lung development. However, the cellular and molecular mechanisms regulating this process are still poorly defined. In this study, we used oligonucleotide microarrays to investigate gene expression in cultured embryonic d 19 rat fetal lung type II epithelial cells exposed to a level of mechanical strain similar to the developing lung. Significance Analysis of Microarrays (SAM) identified 92 genes differentially expressed by strain. Interestingly, several members of the solute carrier family of amino acid transporter (Slc7a1, Slc7a3, Slc6a9, and tumor-associated protein 1) genes involved in amino acid synthesis (Phgdh, Psat1, Psph, Cars, and Asns), as well as the amiloride-sensitive epithelial sodium channel gene (Scnn1a) were up-regulated by the application of force. These results were confirmed by quantitative real-time PCR (qRT-PCR). Thus, this study identifies genes induced by strain that may be important for amino acid signaling pathways and protein synthesis in fetal type II cells. In addition, these data suggest that mechanical forces may contribute to facilitate lung fluid reabsorption in preparation for birth. Taken together, the present investigation provides further insights into how mechanical forces may modulate fetal lung development.

The impact of including husbands in antenatal health education services on maternal health practices in urban Nepal: results from a randomized controlled trial

Observational studies suggest that including men in reproductive health interventions can enhance positive health outcomes. A randomized controlled trial was designed to test the impact of involving male partners in antenatal health education on maternal health care utilization and birth preparedness in urban Nepal. In total, 442 women seeking antenatal services during second trimester of pregnancy were randomized into three groups: women who received education with their husbands, women who received education alone and women who received no education. The education intervention consisted of two 35-min health education sessions. Women were followed until after delivery. Women who received education with husbands were more likely to attend a post-partum visit than women who received education alone [RR = 1.25, 95% CI = (1.01, 1.54)] or no education [RR = 1.29, 95% CI = (1.04, 1.60)]. Women who received education with their husbands were also nearly twice as likely as control group women to report making >3 birth preparations [RR = 1.99, 95% CI = (1.10, 3.59)]. Study groups were similar with respect to attending the recommended number of antenatal care checkups, delivering in a health institution or having a skilled provider at birth. These data provide evidence that educating pregnant women and their male partners yields a greater net impact on maternal health behaviors compared with educating women alone.

A comparison of labour and birth experiences of women delivering in a birthing centre and at home in the Netherlands

to compare the labour and birth experiences of women who delivered at home without complications with the experiences of women who delivered in a birth centre without complications. a descriptive study using postal questionnaires at 1-6 months after birth of a consecutive sample of postpartum women. women were recruited from one birth centre and three midwifery practices in an urban area of the Netherlands between September and December 2003. 193 women; 129 delivered at home and 64 delivered in the birth centre. the home-birth group perceived less pain (mean score home birth 6.291, birth-centre birth 6.977), desired less pain-relieving medication (home birth 7.9%, birth-centre birth 21.9%), believed they knew their midwife better (home birth 36%, birth-centre birth 10% 'knew her well'), and rated their birth setting 'higher' than the birth-centre group (mean score home birth 4.70, birth-centre birth 4.01). Furthermore, the birth-centre group emphasised safety, having medical help available, and convenience, whereas the home-birth group placed more importance on the home being trustworthy and dependable, having their own place and belongings, and feeling comfortable and relaxed. having an understanding of a woman's labour and delivery experience allows health-care providers to continue to improve the quality of maternity care. The environment can have a positive effect on a woman's birth experience; recommendations have been proposed that can be applied to all pregnant and labouring women. identification and understanding of the factors in the environment that make the labour and birth experience more positive should be incorporated into the education and preparation for an upcoming birth.

A cohort study of the incidence and risk factors for negative behavior changes in children after general anesthesia

Hospitalization and anesthesia can have a substantial psychological impact on children, which may be manifested by negative behavioral change. The primary aims of this study were to estimate the incidence of negative behavior change postanesthesia in a large cohort of children, and to identify the possible risk factors. One thousand two hundred and fifty children aged from 3 to 12 years scheduled for anesthesia for a variety of procedures were enrolled. The absolute version of the Vernon Post Hospitalization Behavior Questionnaire (PHBQ) was used to assess behavior change at 3 and 30 days postanesthesia. Deterioration in seven or more items of behavior was defined to be a significant negative behavior change. Demographic data, anesthesia details, type and extent of preparation, details of procedure and length of hospitalization were recorded. Child temperament, child anxiety and parental anxiety were also measured. Twenty-four percent of children had significant negative behavior change at day 3 and 16% at day 30. After logistic regression, factors associated with significant negative behavior change at 3 days were increased parental state anxiety, younger age, overnight admission, lower birth order and preparation via having a discussion with the anesthetist. At day 30, longer hospitalization, younger age, reading the anesthesia preparation book and a previous difficult anesthesia experience were associated with significant negative behavior change. Also at day 30, reading the anesthesia preparation book was strongly associated with negative behavior change in children having short procedures, but not longer procedures. However, at both 3 and 30 days, the amount of variability explained by factors included in the models was low. Significant negative behavior change can occur in children after anesthesia. It is difficult to precisely predict in which children this will occur, however, some individual, family and procedural variables are associated with significant negative behavior change. If used, preparation should be considered according to level of surgical complexity.

Be prepared, expect the unexpected and above all, communicate

Expectant parents entertain great hopes for the birth experience, but the actual event may turn out to be very different. Freelance writer Jane Bainbridge discusses realistic preparations for birth.

Acupuncture for Birth Preparation and Delivery: How Investigating Mechanisms of Action Can Generate Research

Acupuncture has become an accepted and validated part of Western mainstream medicine and is increasingly used by clinicians, midwives, and acupuncturists for reproductive care, induction of labor, and analgesia. Most studies of the effects of obstetrical acupuncture are descriptive, many in foreign languages. Only a few have evaluated efficacy. Results suggest that acupuncture ripens the cervix, initiates labor, reduces labor pain, and shortens the first stage of labor. There is some evidence suggesting that certain acupuncture points have very specific effects on the fetus and uterus, which may be mediated through the hypopituitary-thalamic axis or by local neurovascular stimulation. The substantial maternal hormonal changes occurring just before and during labor offer a unique opportunity to clarify the mechanisms of action of acupuncture. Using a conceptual model based on possible mechanisms of action of the use of acupuncture in obstetrics, the authors propose specific research questions into the physiology of acupuncture administered before and at parturition.

Enema Prior to Labor: A Controversial Routine in Taiwan

While taking an enema to induce labor is a controversial issue worldwide, in Taiwan it remains a routine procedure in many hospitals in preparation for birth. Episiotomy is also a prevalent procedure performed during the birthing process. Some physicians believe that enemas help reduce the risk of feces contamination of the episiotomy incision and, therefore, are justified as a routine procedure. This study compared the neonatal infection rates, times to appearance of fetal head, times to first post-labor bowel movement, and rates of episiotomy dehiscence of women receiving a pre-labor enema against those who did not. A total of 534 women classified with low-risk pregnancies were recruited from a medical center in central Taiwan and assigned randomly into one of two groups for a six-month period. The first group (264 subjects) received routine enema procedures prior to delivery in the first 6 months. The second group (270 subjects) did not receive enemas. Study results revealed no significant difference between enema and non-enema groups in terms of infection rates in mothers or infants or in terms of average time to fetal head appearance. While labor duration was the same for the two groups in the first and third stages of labor, the enema group experienced a relatively shorter second stage. No significant difference was observed in times to first post-labor bowel movement or episiotomy dehiscence rates. The results of this study indicate that the administration of enemas as a routine practice prior to labor is not substantiated by medical necessity. However, limitations of the research design suggest that a randomized clinical trial be adopted in the future to explore further the scientific validity of study results.

Enema Prior to Labor: A Controversial Routine in Taiwan

While taking an enema to induce labor is a controversial issue worldwide, in Taiwan it remains a routine procedure in many hospitals in preparation for birth. Episiotomy is also a prevalent procedure performed during the birthing process. Some physicians believe that enemas help reduce the risk of feces contamination of the episiotomy incision and, therefore, are justified as a routine procedure. This study compared the neonatal infection rates, times to appearance of fetal head, times to first post-labor bowel movement, and rates of episiotomy dehiscence of women receiving a pre-labor enema against those who did not. A total of 534 women classified with low-risk pregnancies were recruited from a medical center in central Taiwan and assigned randomly into one of two groups for a six-month period. The first group (264 subjects) received routine enema procedures prior to delivery in the first 6 months. The second group (270 subjects) did not receive enemas. Study results revealed no significant difference between enema and non-enema groups in terms of infection rates in mothers or infants or in terms of average time to fetal head appearance. While labor duration was the same for the two groups in the first and third stages of labor, the enema group experienced a relatively shorter second stage. No significant difference was observed in times to first post-labor bowel movement or episiotomy dehiscence rates. The results of this study indicate that the administration of enemas as a routine practice prior to labor is not substantiated by medical necessity. However, limitations of the research design suggest that a randomized clinical trial be adopted in the future to explore further the scientific validity of study results.

Breastfeeding duration is determined by only a few factors

According to a representative German study prepared between 1996 and 1998 (SuSe-Study) 90% of the mothers were willing to breastfeed, but only 33% (10%) of the babies were exclusively breastfed up to 4 (6) months of age. Bearing in mind that the period currently recommended for breastfeeding is 6 months, this discrepancy highlights the need for action to identify the causes. The present study investigates the behavioural pattern of mothers 4-5 months after delivery. The investigation was carried out as a cross-sectional study of mothers who intended to breastfeed their babies (n = 52). All mothers delivered in a hospital, with maximum medical care, and were interviewed later by telephone using a semi-standardised questionnaire. The differences between actual breastfeeding mothers (BF, n = 30) and non-breastfeeding mothers (not BF, n = 22) were identified. The factors influencing decision-making were determined. Significant differences between the two groups tested (BF and not BF) were identified as the perception of the simplicity of breastfeeding, planned pregnancy, marital status, as well as participation at birth preparation classes. If only factors known prior to birth are applied, the decision to breastfeed can be correctly forecast as being 81%. In order to allocate consulting resources more effectively, appropriate concepts need to be developed and promoted. If the present results could be verified by a study with a larger sample, the practical use for resource optimisation in breastfeeding consultations would be very beneficial.

Teenage Maternity: A Study from Seven City Hospitals in Taipei

To assess adolescent pregnancy for demographic characteristics, obstetric morbidity, and birth outcome in Taipei City Hospitals. Registry data for 9,630 singleton births at 20 weeks or more of gestation at seven city hospitals in Taipei between January 2002 and June 2003 were studied. Mothers were divided into three groups by age: under 20 ( n = 133 births; 1.4%); 20-34 ( n = 8,035; 83.4%), and over 34 ( n = 1,462; 15.2%). The overall registration rate was about 95%. Data were analyzed by Chi-squared, logistic regression, and ANOVA tests. Education attainment in the teenage group was lower and the proportion who were single, had first parity, sought prenatal care after first trimester, and smoked were significantly higher. Obstetric complications were more common in this group in terms of antenatal anemia and precipitate labor, with adjusted odds ratios (ORs) of 2.2 (1.2-4.0) and 3.0 (1.5-6.2), but not in the frequency of prolonged labor, postpartum hemorrhage, abruptio placenta, or hypertensive disorder. However, rates were higher for stillbirth (adjusted OR, 2.8; 1.0-8.2) and small for gestational age (crude OR, 1.9; 1.2-3.2), resulting in the lowest mean birth weight of infants. No significant differences were demonstrated in frequency of prematurity, Apgar score, congenital anomalies, intensive care unit admission, or neonatal death. Teenage maternity is associated with general characteristics of social disadvantage and suboptimal outcome. We recommend education classes, focusing on the nutritional aspects of anemia correction, smoking cessation, and adequate preparation for birth. In addition, an integrated program is required, with social workers recruited to enhance family support.