Breast-feeding patterns and correlates in Shaanxi, China.
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Agriculture↗
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Which teen mothers choose Norplant?
PURPOSE: The objective of this study was to determine if there are sociodemographic differences between adolescent mothers who choose to use Norplant after delivery and those who do not. We hypothesized that those adolescent mothers who are at highest risk for repeat adolescent pregnancy are least likely to select Norplant as a postpartum contraceptive. METHODS: We prospectively compared the prevalence of epidemiologic risk factors for repeat adolescent pregnancy in a group of 187 consecutively delivered 13-18-year-olds who were enrolled in a comprehensive, multidisciplinary, adolescent-oriented maternity program. The study subjects were interviewed at delivery; 100 subsequently had a Norplant inserted (Norplant users). Student's t-tests and chi-square analyses were used to compare Norplant users and refusers. RESULTS: We found no statistically significant differences between Norplant users and refusers with regard to: age, race, Medicaid, or marital or school status. Compared to Norplant refusers, Norplant users were less likely to be primiparous (79% compared to 90%; p = .04) and more likely to have poor school grades (20% compared to 7%; p = .001). Norplant users were more likely to state that they had had trouble remembering to use contraceptives in the past (32% compared to 14%; p = .005). CONCLUSIONS: These data do not support the study hypothesis and are encouraging because they suggest that Norplant may reduce repeat pregnancy among adolescent parents.
Adolescent↗
Using a breastfeeding prevalence survey to identify a population for targeted programs.
Often, efforts to improve overall population health require identifying and targeting programs to specific high-risk populations. Breastfeeding is an example. In order to determine initiation and duration rates among various groups in the City of Toronto, a random sample of 434 mothers with infants at four months of age was surveyed to determine the prevalence of breastfeeding and major impacts on its duration. The study found that, overall, 83% of mothers initiated breastfeeding at birth. The greatest rate of decline occurred during the first month. At four months postpartum, 57% of mothers continued to breastfeed, including 35% who were exclusively breastfeeding and 22% who were supplementing breast milk with formula. Breastfeeding duration was related to a number of factors, including information and support, parity, education, use of formula supplements and country of birth. Specific groups are identified for targeted programs, and a number of strategies are proposed.
Adult↗
A psychological theory of child abuse.
This paper presents a detailed study of two patients hospitalized in a closed psychiatric unit on which the treatment program emphasized dynamically oriented individual psychotherapy and family therapy. The first patient was hospitalized following physical abuse of her four-year-old daughter, while the second was hospitalized for a postpartum depression eight weeks following the birth of her first child, a girl. Although the presenting pictures in these two patients were markedly different, the psychodynamic patterns were so similar that a detailed comparison of the two cases seems to offer useful insight into some of the psychological causes of child abuse.
Adult↗
Continuous labor support from labor attendant for primiparous women: a meta-analysis.
OBJECTIVE: To evaluate the available literature on the effects of continuous labor support among primiparous women. DATA SOURCES: We did a Medline search using the keywords "labor support," "doula," and "monitrice." Papers published in English from 1965 to May 1995 were eligible for this review. We also cross-checked all the references in the selected reports. METHODS OF STUDY SELECTION: We identified seven randomized clinical trials published during that period; four of these were eligible for our meta-analysis. DATA EXTRACTION AND SYNTHESIS: Meta-analysis of four studies conducted among young, low-income, primiparous women who gave birth on a busy labor floor in the absence of a companion suggested that continuous labor support by a labor attendant shortens the duration of labor by 2.8 hours (95% confidence interval [CI] 2.2-3.4), doubles spontaneous vaginal birth (relative risk [RR] 2.01, 95% CI 1.5-2.7) and halves the frequency of oxytocin use (RR 0.44, 95% CI 0.4-0.7), forceps use (RR 0.46, 95% CI 0.3-0.7), and cesarean delivery rate (RR 0.54, 95% CI 0.4-0.7). Women with labor support also reported higher satisfaction and a better postpartum course. CONCLUSION: Labor support may have important positive effects on obstetric outcomes among young, disadvantaged women. Further studies on benefit relative to cost are needed before a broad-scale program is advocated.
Delivery, Obstetric↗
Trends in pregnancy weight gain within and outside ranges recommended by the Institute of Medicine in a WIC population.
OBJECTIVES: To examine the proportion of women with a pregnancy weight gain below, within, and above ranges recommended by the Institute of Medicine from 1990 to 1996. METHODS: Our study population included women attending Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics in five states who delivered a liveborn singleton infant at term (N = 120,531). Pregnancy weight gain was self-reported at the postpartum visit. RESULTS: Only 34% of women gained weight within recommended ranges and there was little change in this proportion from 1990 to 1996. The proportion of women gaining less than their recommended weight decreased from 23.4% to 22.0%, and the proportion gaining more than recommended increased from 41.5% to 43.7% during the study period. Stratified analyses revealed similar trends within all race-ethnicity, age, parity, trimester of WIC initiation, and trimester of prenatal care initiation strata and among women in low, average, and high prepregnancy body mass index categories. There was no change in the weight gain distribution among obese women. Absolute and relative increases in the proportion of women gaining more weight than recommended were greatest among women who were underweight, Asian or Native American, less than 20 years of age, multiparous, and who initiated WIC and prenatal care in the third trimester. CONCLUSIONS: Pregnancy weight gain increased among this population of WIC participants from 1990 to 1996.
Adolescent↗
Enhancing early discharge with home follow-up: a pilot project.
Although early hospital discharge of mothers and infants reduces health care costs, it also decreases the opportunities for women to learn the mothering role with the help of health care providers. This article describes the development of a program in which hospital staff nurses provide follow-up care to new mothers and their infants in the home. In addition, it compares the nonroutine health care expenditures in the postpartum period of mother-infant dyads receiving this service and of dyads who did not.
Adolescent↗
Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey.
OBJECTIVE: In the third quarter of 2001, the National Immunization Survey (NIS) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding. Using the data from the 2002 NIS, this study estimates breastfeeding rates in the United States by characteristics of the child, mother, or family. METHODS: The NIS uses random-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations and then validates the information through a mail survey of the health care providers who gave the vaccinations. In 2002, approximately 3500 households from the NIS were randomized to 1 of the 3 rotating topical modules that covered breastfeeding. RESULTS: More than two thirds (71.4%) of the children had ever been breastfed. At 3 months, 42.5% of infants were exclusively breastfed, and 51.5% were breastfed to some extent. At 6 months, these rates dropped to 13.3% and 35.1%, respectively. At 1 year, 16.1% of infants were receiving some breast milk. Non-Hispanic black children had the lowest breastfeeding rates. Breastfeeding rates also varied by participation in day care or the Women, Infants, and Children program, socioeconomic status, and geographic area of residence. CONCLUSIONS: Although the rate of breastfeeding initiation in the United States is near the national goal of 75%, at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50% and 25%, respectively. In addition, rates of exclusive breastfeeding are low. Strenuous public health efforts are needed to improve breastfeeding behaviors, particularly among non-Hispanic black women and socioeconomically disadvantaged groups.
Black or African American↗
A village would be nice but...it takes a long-acting contraceptive to prevent repeat adolescent pregnancies.
OBJECTIVE: To determine which components of a comprehensive, multidisciplinary, adolescent-oriented maternity program help teenage mothers delay subsequent pregnancies. DESIGN/SETTING/PATIENTS: A cohort of 373 participants in a comprehensive, multidisciplinary, adolescent-oriented maternity program was studied. INTERVENTION: The program was designed to prevent rapid subsequent pregnancies directly by simplifying access to contraceptives and indirectly by discouraging school drop-out and encouraging the pursuit of careers incompatible with closely spaced childbearing. Parents and children were seen together; nine visits were scheduled during the first postpartum year and four visits during the second year. MAIN OUTCOME MEASURE: Repeat adolescent pregnancy. RESULTS: The repeat pregnancy rate was 14% at 1 year and 35% at 2 years. Teenage mothers who became pregnant exhibited significantly more repeat pregnancy risk factors but were as compliant with clinic visits as their nonpregnant peers. The contraceptive choices the teenagers made during the puerperium had the most profound effect on their subsequent fertility. A logistic regression analysis identified failure to use Norplant during the puerperium as the strongest predictor of repeat pregnancy during the first 2 postpartum years (relative risk [RR]=8.89; 95% confidence interval [CI]=2.80-28.50). Exhibiting nine or more repeat pregnancy risk factors (RR=2.37; 95% CI=1.38-4.06) and not using Depo-Provera during the puerperium (RR=2.30; 95% CI=1.60-3.29) also predicted repeat conception, but clinic visits and return to school postpartum did not. CONCLUSIONS: Using a long-acting hormonal contraceptive during the puerperium was associated with pregnancy prevention during the first 2 postpartum years, but frequent clinic visits, contact with supportive healthcare and social service providers, and return to school were not.
Adolescent↗
Teen-focused care versus adult-focused care for the high-risk pregnant adolescent: an outcomes evaluation.
The purpose of this retrospective, matched-case comparison study was to compare outcomes and cost-effectiveness of comprehensive, interdisciplinary teen-centered prenatal care clinics (Young Women's Clinic & Teen Pregnancy and Parenting Clinic) with "traditional" adult-centered obstetric services (University of Washington Medical Center & Group Health Cooperative) in a university medical center and a staff-model HMO. The sample (n = 106) included 27 index teens from Young Women's Clinic and matched cases from the other three clinics, matched on nine risk variables. Findings showed that teen-clinic clients missed fewer appointments (0.96 vs. 2.29, p < 0.05), were more likely to be enrolled in the supplemental Medicaid program First Steps (p < 0.001) and WIC (p < 0.01), were more likely to have vaginal deliveries (90% vs. 75%, p < 0.05) and higher birth weight infants (3330 vs. 3084 g, p < 0.05), and were more likely to attend 2-week (p < 0.001) and 6-week postpartum exams (p < 0.05). Postpartum data were missing for the majority of adult-clinic subjects; teen-clinic postpartum outcomes included high contraception rates (87.5%), breastfeeding (62%), school return postpartum (63%), and long-term follow-up. Costs were lower for teen clinics based on outcomes; cost savings related to preterm labor were similar.
Adolescent↗
Telephone support for pregnant smokers who want to stop smoking.
This article describes a statewide, proactive telephone peer-support system to help low-income pregnant women stop smoking. From October 1994 to December 2000, 948 pregnant smokers attending the Women, Infants, Children program accepted an offer to receive support by telephone from a woman ex-smoker who called weekly, biweekly, and then monthly to provide guidance, encouragement, and reinforcement for smoking cessation. This free service, funded by the Vermont Department of Health, resulted in 25% self-reported abstinence at last telephone contact when women never reached for telephone support were counted as smokers, and self-reported abstinence during pregnancy of 20% among participants who returned for their postpartum Women, Infants, Children visit. These findings suggest that proactive telephone peer support is a viable way to help pregnant women stop smoking during pregnancy.
Female↗
The fertility impact of spousal separation.
The impact of spousal separation on marital fertility in a natural fertility context is investigated. REPMOD, a procedure for computer simulation of reproductive processes, is employed. A given length of separation affects fertility more, the less it overlaps with time during which the woman is not at risk of conception. Thus the "efficiency" of separation as a constraint on fertility increases as its duration increases, the duration of postpartum amenorrhea decreases, and fecundability decreases. Effects of spousal separation in actual situations can be estimated using results of these simulations as inputs.
Birth Intervals↗
Pre-pubertal and postpartum anestrus in tropical Zebu cattle.
Bos indicus breeds, commonly known as Zebu cattle, have spread from their center of origin in Western Asia into large areas of Asia (including the Asia-Pacific basin), Africa, South and Central America (including the Caribbean islands). The original Zebu genotype, however, has been modified by planned and unplanned cross-breeding programs involving many native and Bos taurus breeds in their new habitats. Though accurate estimates are not available, more than half of the world's cattle population includes a proportion of B. indicus germ plasma. B. indicus native breeds have developed by natural selection over centuries for their ability to survive in rough, harsh tropical environments. Most of these non-described breeds still exhibit high fertility, in terms of calving rates, and disease resistance but they grow very slowly and take well over 3 years to reach puberty and produce only a few liters of milk over a short lactation period. Selection has been carried out in some areas and distinct Zebu breeds have been developed that have moderately high growth rate and milk production. However, they are slow breeders and have extended pre-pubertal and postpartum anestrous periods, compared to their temperate counterparts exposed to similar environment and management. The reproductive biology of B. indicus is similar to that of B. taurus. Most of the proven management, nutritional, hormonal and biotechnological interventions developed through experimentation with B. taurus breeds are equally applicable to B. indicus and their crosses. Zebu breeds predominate in most tropical countries where the majority of the human population lives. If meat and milk production are to be increased in the tropics, Zebu cow productivity, in terms of number of calves produced per lifetime or per unit area of land, must be increased and the time from birth to slaughter must be reduced. This goal could be achieved either by selection within local Zebu populations or through planned cross-breeding with B. taurus breeds. Because the productive and reproductive potentials of Zebu cattle are relatively low, worthwhile gains could only be achieved by selection over many generations. This would require substantial investment in labor, feed and drugs that may not be economic since the return from such investment is relatively low. However, many studies have shown that cross-breeding with B. taurus, which combines additive, dominance and epistatic effects of the two genotypes, ensures high productive and reproductive performance. Therefore, planned cross-breeding with suitable B. taurus breeds, although demanding additional investment in labor, feed and drugs, will still be economic because the return far exceeds the costs.
Anestrus↗
[The Brazilian Ministry of Health's Program for Humanization of Prenatal and Childbirth Care: preliminary results].
This article evaluates the implementation of the Brazilian Ministry of Health's Program for Humanization of Prenatal and Childbirth Care using data generated by the SISPRENATAL/DATASUS database from the Unified National Health System. From its beginning in June 2000 until December 2002, 3,983 municipalities joined the Program, and 71% of participating municipalities (3,183) reported their health care activities, constituting a database with 720,871 women. Nearly 20% of the women had six or more prenatal visits, and approximately half of them had the postpartum follow-up visit and required lab tests performed in 2002. In addition, 41% of the women had been vaccinated against tetanus. The number of HIV antibody tests was twice that of syphilis during the two-year period. Only a small percentage of women (2% in 2001 and 5% in 2002) received the entire set of prenatal and childbirth care services. The low percentages attest to the need for permanent evaluation aimed at improving quality of care and guaranteeing both high-quality maternal and perinatal results and the inalienable right of women to safe care and well-being during pregnancy and delivery.
Brazil↗
Is the lactational amenorrhea method a part of natural family planning? Biology and policy.
The lactational amenorrhea method is a natural method of family planning for women who breastfeed their infants. The underlying physiology results in a natural suppression of ovulation, and the concomitant amenorrhea, induced by exclusive (or almost exclusive) breastfeeding. This in addition to the infant's age of 6 months or less and specific feeding pattern are the parameters used to identify the possible return of fertility. The lactational amenorrhea method provides at least 98% protection against pregnancy. Data from a recent multicenter study of breastfeeding support the use of the lactational amenorrhea method as a natural family planning method. The lactational amenorrhea method can be incorporated into natural family planning programs and teaching.
Amenorrhea↗
"Mad for Fitness": an exercise group to combat a high incidence of postnatal depression.
Health visitors working in a socially and economically deprived area of the Wirral, Merseyside wanted to find innovative ways to address the high incidence of postnatal depression in their caseloads. Believing that exercise may have a beneficial effect on depression, they set up a project to make fitness activities more affordable and available to their client base. After an initial survey of local mothers had indicated support, a pilot "swim, gym and crèche" scheme was set up in a Leisure Centre in partnership with other agencies. The response from the pilot group was positive and suggested that the participants were benefiting mentally and physically from the exercise and the social aspects of the group. Parents began to take a greater part in running the group and funding was obtained to continue the scheme. Further evaluation is in progress and there are plans to replicate the scheme in other areas of the local Primary Care Trust.
Attitude to Health↗
Rh immunization in Manitoba: progress in prevention and management.
For two decades the perinatal mortality caused by erythroblastosis has been decreasing in Manitoba. The improved management of Rh-immunized pregnancies has lowered the death rate among affected infants from 10.8% to 3.4%, while the prevention of Rh immunization has reduced its incidence from 9.1 to 2.2 per 1000 total births. In its first 6 years and 8 months Manitoba's antenatal prophylaxis program, in which immunoglobulin is administered to Rh-negative women at 28 weeks' gestation, reduced the incidence of Rh immunization during pregnancy by 93%. In combination with post-abortion and postpartum prophylaxis the antenatal treatment has provided a protection rate of 98.6% among primigravidas at risk. Further improvements are expected.
Erythroblastosis, Fetal↗
Depression screening in the pregnant soldier wellness program.
OBJECTIVES: The purpose of this study was to determine the prevalence of depression among active-duty low-risk pregnant women using the Edinburgh Postnatal Depression Scale. Rates for depression have been reported to be as high as 13% during pregnancy and 12 to 22% postpartum, with postpartum suicidal ideation at nearly 7%. METHODS: From April 2002 through March 2003, 82 women receiving prenatal care at Madigan Army Medical Center completed screening questionnaires during pregnancy and/or postpartum visits. RESULTS: A total of 97 questionnaires were administered (71 antepartum and 26 postpartum). During pregnancy, 24% of individuals screened scored positive. During the postpartum, 19% scored positive. A total of 15 women were screened twice during the study period. One woman was screened twice during pregnancy and the remaining 14 were screened once antepartum and once postpartum. Suicidal ideation was present in 11% of those screened during pregnancy and in 15% postpartum. CONCLUSIONS: Active-duty women appear to have a higher rate of depression and suicidal ideation compared with rates in nonmilitary populations; perhaps such screening should become a standard practice.
Depression↗