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PubMed2006

Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support?

BACKGROUND: Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. METHOD: Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. RESULTS: Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups. CONCLUSIONS: After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care.

Adult↗
PubMed2002

ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period.

The physiologic and morphologic changes of pregnancy may interfere with the ability to engage safely in some forms of physical activity. A woman's overall health, including obstetric and medical risks, should be evaluated before prescribing an exercise program. Generally, participation in a wide range of recreational activities appears to be safe during pregnancy; however, each sport should be reviewed individually for its potential risk, and activities with a high risk of abdominal trauma should be avoided during pregnancy. Scuba diving also should be avoided throughout pregnancy because the fetus is at an increased risk for decompression sickness during this activity. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.

Exercise↗
PubMed1985

Neonatal phenobarbital imprinting of hepatic microsomal enzymes in adult rats: modulation by neonatal testosterone presence.

The influence of neonatal androgen status on the ability of neonatally administered phenobarbital (PB) to program increases in adult rat hepatic microsomal enzyme activities was investigated. Male and female rat pups were injected with 30 mg/kg PB or 0.9% saline on Days 1 to 5 postpartum. Males were further divided into either neonatally castrated or sham-operated groups. Females were subdivided into groups receiving either 0.5 mg testosterone propionate or 50 microliters corn oil on Days 1, 3, and 5 postpartum. Various hepatic microsomal cytochrome P-450 system and glucuronyltransferase activities were determined at 140 days of age. Our results indicate that PB imprints both males and females. P-450 reductase, ethoxycoumarin O-deethylase, and testosterone glucuronyltransferase activities were increased to a greater degree in females than in males. These same activities were increased by neonatal PB to a greater degree in castrated males compared to sham-operated males and were increased to a lesser degree in neonatally testosterone-treated females compared to female corn oil controls. It therefore appears that neonatal testosterone presence not only alters the patterns of enzyme activity but also diminishes the response of certain activities to PB programming.

Animals↗
PubMedDate not supplied

Attitudes and perceptions related to smoking among pregnant and postpartum women in a low-income, multiethnic setting.

PURPOSE: The purpose of this study was to gain insight into attitudes and perceptions about smoking during pregnancy, passive smoke exposure, barriers to quitting, and program preferences among women in a low-income, ethnically diverse setting. DESIGN: Nine focus group discussions were conducted with African-American, Native American, and white women. Discussions were moderated by local residents who shared the same ethnic background as group participants. SETTING: Discussions were held in neighborhood centers and clinics in an urban area. SUBJECTS: A total of 57 women participated. Moderators recruited participants from within their social networks and from neighborhood programs. The informal process of recruitment did not allow calculation of response rates. MEASURES: A series of open-ended questions with selected probes was used to guide the conversation. RESULTS: Participants were aware that smoking during pregnancy is harmful and were concerned to varying degrees about their smoking behavior. Most women who smoked took active steps to reduce the risks. Actions were frequently accompanied by beliefs that rationalized moderate levels of smoking. While concerned, women were uncertain about what constituted harmful, passive smoke exposure. Personal barriers to quitting included being around others who smoked, feelings of stress and boredom, addiction, and not believing smoking is dangerous enough. Participants tended to value pregnancy-related advice from female friends and relatives over advice from professionals. CONCLUSIONS: Results suggest that many women respond to warnings about smoking during pregnancy, but actions are not necessarily measured in quit rates. Misconceptions about the risks may help to rationalize continued smoking. Subjects lacked knowledge about how best to reduce the risks of passive smoke. Educational efforts may be effective when directed at networks of women who share information. The nature of qualitative data collection prevents extrapolation of these results to a larger population.

Adolescent↗
PubMed1992

A new defense: the maternity waiver program.

The Maternity Waiver Program is a freedom of choice waiver granted by the Health Care Financing Administration. A freedom-of-choice waiver allows certain sections of the Social Security Act to be waived, specifically statewide effectiveness; duration, amount and scope of benefits; and freedom of choice. The waiver allows the state to direct women to whom they can receive prenatal care. By restricting statewideness, the state can set up the program on a county by county basis. By waiving amount, duration and scope, the state can provide additional services to women in waiver counties that are not offered in nonwaiver counties (e.g., home visits). And by waiving freedom-of-choice, the state can set up a primary provider network which ensures that women have access to quality and comprehensive maternity services which are coordinated from the initial encounter through the postpartum period. The end result is a healthier birth outcome.

Alabama↗
PubMed2003

Exercise during pregnancy and the postpartum period.

The physiologic and morphologic changes of pregnancy may interfere with the ability to engage safely in some forms of physical activity. A woman's overall health, including obstetric and medical risks, should be evaluated before prescribing an exercise program. Generally, participation in a wide range of recreational activities appears to be safe during pregnancy; however, each sport should be reviewed individually for its potential risk, and activities with a high risk of falling or those with a high risk of abdominal trauma should be avoided during pregnancy. Scuba diving also should be avoided throughout pregnancy because the fetus is at an increased risk for decompression sickness during this activity. In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.

Exercise↗
PubMed2002

[The role of leptin in human reproduction].

The article reviews the current literature about leptin, a hormone produced mainly in the adipose tissue, in terms of its role in reproduction. The structure of leptin, its biological activity as well as its influence on secretion of their hormones has been discussed. The leptin concentrations during the ovulatory cycle, pregnancy puerperium and assisted reproduction have been presented. It has been suggested that leptin may have an advantageous effect not only on oocyte and zygote development in the early stages, but also on the process of implantation and therefore its evaluation may be useful for the clinical determination of embryo quality in IVF-ET program.

Adipose Tissue↗
PubMed1996

[Minilaparotomy tubal ligation in the immediate post-partum after vaginal delivery. A retrospective analysis of 253 cases in the maternity service of the Yaounde University Hospital Center (Cameroon)].

The authors report the results of a retrospective study of 253 cases of tubal ligation collected between January 1985 and December 1989 in the maternity unit of the Yaounde Teaching hospital. The tubal ligations were done through minilaparotomy with local anesthesia using the technique of Pomeroy. The frequency of tubal ligation evaluated at 3,8 per cent did not change during the period of this study. The authors note that the majority of patients in this study wished a tubal ligation only when they have 5 or more surviving children. We had no post-operative death, but our complication rate of 1,6 % can be improved upon by paying more attention to operative details. The authors conclude that because of poorly equipped medical infrastructures in the context of developing countries tubal ligation through minilaparotomy should be promoted as a contraceptive method in family planning programs.

Adult↗
PubMed2006

[Adjustment of the hepatitis-B vaccination scheme for newborns born to hepatitis-B virus carriers as of 1 January 2006].

Timely administration of hepatitis-B immunoglobulin postpartum combined with hepatitis-B vaccination will prevent the majority of vertical hepatitis-B virus transmissions. As of January 2006, the Dutch hepatitis-B vaccination scheme for newborns born to HBsAg positive mothers has been modified. Previously, the first vaccination was given at the age of 2 months. Newborns will now receive their first hepatitis-B vaccination preferably immediately following the administration of hepatitis-B immunoglobulin, within 2 hours after birth, or otherwise within 48 hours after birth. Booster vaccinations are scheduled at the ages of 2, 4 and 11 months, which are standard vaccination times in the Dutch national vaccination programme. The vaccination scheme for the other target-group of infants at increased risk of hepatitis-B virus infection has remained unchanged. As before, these infants will be vaccinated at 2, 4 and 11 months. It is also intended to measure the efficacy of vaccination by determining the anti-HBs antibodies 6 weeks after the last vaccination, at the age of 13 to 14 months. With this modification of the vaccination scheme, the Minister of Health follows the advice of the Health Council of the Netherlands. The goal is to increase the efficacy of hepatitis-B prevention in newborns born to HBsAg positive mothers.

Adult↗
PubMed2004

Hormonal induction of ovulation and artificial insemination in suckled beef cows under nutritional stress.

The objective was to develop a program for inducing estrus (followed by insemination) of suckled beef cows under nutritional stress (poor body condition). A total of 123 cows, from 60 to 75 days postpartum, were classified according to their body condition score (BCS; range from 1 to 5, in increments of 0.5) and allocated into two groups. On Day 0 (without regard to stage of the estrous cycle), cows (n = 59) in the hormone induction (HI) treatment group were given an intravaginal device (IVD) containing 250 mg of medroxiprogesterone acetate (MAP) and an i.m. injection of 2.5 mg estradiol benzoate (EB). On Day 6, these cows were given 500 IU eCG i.m. and calves were weaned for 96 h. The IVD were removed on Day 7. Cows detected in estrus by 45 h after IVD removal were inseminated 12 h after standing estrus; cows not in estrus by 45 h after IVD removal received an i.m. injection of 100 microg gonadorelin (GnRH) and were inseminated 16-18 h later. In the control group (C), cows (n = 64) only had their calves weaned at Day 6 (for 96 h), with estrus detection and AI from Days 6 to 11. Overall, the BCS ranged from 2.0 to 3.0. In the treatment group, estrus and pregnancy rates in cows with BCS 2.0 (20 and 30%, respectively) was lower (P < 0.05) than those with BCS 3.0 (50 and 66.6%, respectively), but did not differ (P > 0.05) from BCS 2.5 (23.3 and 47.6%). In C group, only 2 of 66 cows were detected in estrus and bred (neither was pregnant). In conclusion, the program for induction of ovulation using MAP, EB, eCG and GnRH increased the pregnancy rate in beef cows in poor body condition, enabling AI to be done in a 63-h interval.

Administration, Intravaginal↗
PubMed1999

Cow level sampling factors affecting analysis and interpretation of milk urea concentrations in 2 dairy herds.

The goals of this study were to determine the influence of the variations among udder quarters, the somatic cell count, the time of sampling during the day, sample conservation, and centrifugation on milk urea (UREA) concentrations, and to propose a sample collection procedure for herds that are not on a Dairy Herd Improvement (DHI) program. Forty cows from 2 herds with different feeding practices were randomly selected. The quarter sampled and the somatic cell count did not significantly influence UREA concentrations. Milk urea concentrations were highest in the morning. The diurnal pattern was not influenced by intrinsic factors like parity, days postpartum, or daily milk yield. The UREA concentrations were significantly higher after refrigeration for one week (mean UREA change = +0.41 +/- 0.24 mmol/L, P = 0.0001) and freezing for one month (mean UREA change = +1.52 +/- 1.25 mmol/L, P = 0.0001). Urea concentrations were slightly higher in lactoserum than in whole milk (mean UREA difference = +0.17 +/- 0.24 mmol/L, P = 0.0001). Although this study included only 2 herds and does not allow extrapolation, differences were found in the diurnal pattern of UREA in these 2 herds, which possibly reflect differences in feeding strategy. With consideration of these results, a 6-point sampling procedure for herds that are not on a DHI program is proposed.

Animals↗
PubMed2004

Factors related to postpartum depressive symptoms in low-income women.

OBJECTIVE: This study examined the relationship of depressive symptoms to psychosocial and lifestyle variables in postpartum women. DESIGN: The Mothers' Overweight Management Study (MOMS) was a randomized, weight-gain prevention trial. Baseline data are presented on the Beck Depression Inventory (BDI), Perceived Stress Scale, Social Support Questionnaire, smoking status, body weight, waist circumference, and step counts. SUBJECTS/SETTING: The study was conducted at the Special Supplemental Feeding Program for Women, Infants, and Children (WIC). Women (N = 151) had to be over the age of 18 years and have a child under two years of age to participate. RESULTS: Fifty-one percent of the women (mean age = 27 years; mean of 30 weeks postpartum) reported depressive symptoms (27% mild, 21% moderate, and 3% severe). Overall, stress scores were high (Mean = 27.2) and activity levels low (Mean steps = 5984). Mean body mass index was 30.2. Neither body weight nor steps walked were related to depressive symptoms in the bivariate or regression analyses. However, stress and social support were related to symptoms. Women without symptoms reported significantly less stress than the mild and moderate/ severe symptom groups (Means = 23.4, 29.6, and 32.7, respectively, p <.001). Mean social support satisfaction was significantly higher for non-depressed women compared to women in the moderate/severe symptom range (Means = 5.9 and 4.7 respectively, p <.001). Stress and current smoking status explained 46% of the variance in depressive symptoms. CONCLUSIONS: These data emphasize the need for stress management and other tools such as increasing activity levels to prevent or lessen depressive symptoms.

Adaptation, Psychological↗
PubMedDate not supplied

Recognition of and response to postpartum hemorrhage in rural northern India.

This study describes the results of a Morbidity and Performance Assessment (MAP) conducted to provide insight into the medical factors contributing to maternal and newborn morbidity and mortality in a rural district of northern India, and to use these insights to develop a locally appropriate, community-based safe motherhood program The MAP study was based on verbal autopsy method. Five hundred ninety-nine women (or in the case of 9 maternal deaths, a family member) participated in the study. This article describes a subsample of women who reported signs or symptoms suggesting excessive bleeding (n = 159). Findings include a poor knowledge of danger signs; poor problem recognition during labor, birth, and the immediate postpartum period; and a low level of health seeking that was consistent with poor recognition. Maternal sociodemographic characteristics, antenatal care use, and knowledge of danger signs were generally not associated with problem recognition and health seeking. The case fatality rate was 4%. These findings suggest an urgent need to understand the phenomenon of problem recognition and to integrate this into the design of interventions to reduce delays in health seeking.

Adolescent↗
PubMed1998

Prenatal and perinatal factors associated with breast-feeding initiation among inner-city Puerto Rican women.

OBJECTIVE: To identify factors associated with the initiation of breast-feeding in a predominantly Puerto Rican population living in inner-city Hartford, Conn. DESIGN: Retrospective study of 144 Latino women (mean +/- standard deviation age = 26.3 +/- 5.7 years) with children at least 1 year old but younger than 6 years old (mean +/- standard deviation age = 3.0 +/- 1.2 years) at the time of the survey. Women were recruited from agencies sponsoring health programs for mothers and children. They were interviewed in their homes (69%) or at the Hispanic Health Council, Hartford, Conn (31%). SUBJECTS/SETTING: Low-income Latino women who had at least 1 preschooler at the time of the interview. The women lived in inner-city Hartford, and the overwhelming majority were Puerto Rican and received welfare assistance and food stamps. Seventy-eight percent of the women chose to be interviewed in Spanish; the other 22% were interviewed in English. STATISTICAL ANALYSES: Explanatory variables that related to breast-feeding initiation (P < or = .2) in bivariate chi 2 analyses were entered into a multivariate logistic regression model that was reduced using backward stepwise elimination procedures. RESULTS: Multivariate analyses indicated that breast-feeding the previous child, shorter length of maternal residence in the United States, not receiving prenatal bottle-feeding advice, more recent birth, and higher birth weight were positively associated with breast-feeding initiation. A major reason for choosing not to breast-feed was that women felt socially uncomfortable doing it. APPLICATIONS: Breast-feeding initiation was more likely in Latino women who received prenatal breast-feeding counselling and postpartum support. Mothers of low-birth-weight infants and women breast-feeding for the first time may need additional help. These findings can be used by programs like the Special Supplemental Nutrition Program for Women, Infants, and Children to increase breast-feeding initiation.

Breast Feeding↗
PubMedDate not supplied

Postpartum home visits by maternity nursing students.

Fewer babies are being born; hospital postpartum days are being shortened; and many families are choosing home births: These facts have prompted nursing educators to seek maternity experiences for students outside the hospital setting. At the university where the student-visit program was implemented, faculty appreciated the need for follow-up home care and focused on more than the experiences in prenatal clinics and the acute-care setting. Rather than turning the family over to another community service or colleague when indicated, second and third home visits are being considered. These additional visits would assure a greater opportunity for primary prevention in the care of the total family. Hospital management and home-care maternity nurses have found that postpartum visits have decreased the need for parents to return to the emergency room or the hospital. Problems have been anticipated or assessed and nursing intervention provided on the home visit. This service gradually is becoming available to more families, with both physical and psychosocial needs being considered. It is hoped that it soon will be provided to all families. Postpartum families, nurses, and nursing students benefit from follow-up postpartum visits in the home. The families are assisted in their parenting roles and nurses gain satisfaction in providing continuity of care.

Adaptation, Psychological↗
PubMedDate not supplied

A program of IUD insertions by paraprofessionals and physicians in the Philippines.

A program of IUD insertions by paramedics and physicians was undertaken at the José Fabella Memorial Hospital. Both Lippes C and D were inserted in the postpartum and interval periods. Results show that paramedics can safely and effectively perform IUD insertions, although there are indications of a need to periodically monitor, and perhaps retrain, personnel, be they paramedic or physician, in the techniques of IUD insertion.

Adult↗
PubMed1989

Effects of continuous intrapartum professional support on childbirth outcomes.

The purpose of this stratified randomized trial was to determine the physical and psychological effects of continuous, one-to-one professional support on childbirth outcomes. Data were gathered during prenatal and postpartum interviews with, and from the medical records of, 103 low-risk women. All subjects had attended one of two types of prenatal education programs, were accompanied by husbands or partners during labor, and had vaginal deliveries. Subjects in the experimental group were less likely to have medication for pain relief and less likely to have episiotomies. Three variables were found to predict perceived control during childbirth--expectations of control, the presence of a continuous professional caregiver, and pain medication usage. The results demonstrate the importance of the traditional nursing support role during childbirth.

Adult↗
PubMed1998

A randomized controlled trial of pelvic floor muscle exercises to treat postnatal urinary incontinence.

A randomized controlled trial was carried out to evaluate the extent to which a program of reinforced pelvic floor muscle exercises (PFME) reduces urinary incontinence 1 year after delivery. Two hundred and thirty women who were incontinent 3 months postpartum were randomized to either a control group doing standard postnatal pelvic floor muscle exercises (n = 117) or to an intervention group (n = 113) who saw a physiotherapist for instruction at approximately 3, 4, 6 and 9 months postpartum. Results collected 12 months after delivery included prevalence and frequency of incontinence and PFME, sexual satisfaction, perineometry measurements and pad tests. Twenty-six (22%) of the control group and 59 (52%) of the intervention group withdrew before the final assessment. The prevalence of incontinence was significantly less in the intervention group than in the control group (50% versus 76%, P=0.0003), and this group also did significantly more PFME. There were no significant differences between the groups as regards sexual satisfaction, perineometry measurements or pad test results.

Exercise Therapy↗