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PubMed1988

The infant mortality rate, life expectancy at birth, and a linear index of mortality as measures of general health status.

The infant mortality rate is not a good indicator of overall mortality or health status. Based on new empirical life tables from the UN Population Division, it can only predict life expectancy with 95% confidence to within a 14-year range. Two infant mortality rates must be nearly 80 units apart to be 95% confident that life expectancy in the two communities is different. Life expectancy itself is not an ideal general measure of mortality, because it implicitly weights deaths at different ages in an inconsistent fashion. A measure of potential years of life lost is preferable because it is ethically more consistent.

Adolescent↗
PubMed1996

The complexity of labor pain: experiences of 278 women.

All women giving birth over a period of 2 weeks in a major city of Sweden, except non-Swedish speaking women and those with elective Caesarean sections, were asked about their experience of pain 2 days after the birth. The sensory (pain intensity) and effective (negative or positive experience) dimensions of pain, as well as need for pain relief during labor were explored. The 278 women who returned completed questionnaires (91%) reported high levels of pain, 41% worst imaginable pain, in spite of wide use of pharmacological pain relief. Only 9% had no analgesia. Pain was not an entirely negative experience, 28% assessing it as more positive than negative, suggesting that coping with pain is a rewarding experience for some women. More than 30 different explanatory variables were included in regression analysis to explain the variation in pain intensity and pain attitude scores, but only five contributed to the respective model. Most of the variables explaining pain intensity, namely anxiety during labor, expected pain, expected birth experience, midwife support and duration of labor, differed from the variables explaining attitude to pain. These were pain intensity, anxiety, expected birth experience physical well-being during pregnancy and emergency Caesarean section. The explanatory values were relatively low, especially for the model explaining pain intensity (R2 = 15%). The findings are discussed in the light of the different character and meaning of childbirth pain compared with pain related to disease.

Adolescent↗
PubMed2000

Process indicators for safe motherhood programmes: their application and implications as derived from hospital data in Nepal.

Measuring maternal mortality ratios is fraught with problems and underestimates. Therefore process indicators have been proposed for monitoring the availability and use of obstetrics services. We report the results of process indicators for measuring the availability, use and quality of obstetric care in five districts in Nepal between 1997 and 1998. The number of comprehensive essential obstetric care (EOC) facilities was adequate for four of the five districts, but none had a minimum acceptable level of basic EOC facilities as set by UNICEF et al. The proportion of expected births in hospital was 21.5% in Rupandehi and < 5% in Baglung, Kailali, Okhaldunga and Surkhet. The minimum acceptable level is 15%. The 'met need' for obstetric care which pertains to the proportion of all women with direct obstetric complications that are treated in hospital was 14.9% in Rupandehi and < 5% in the other four districts, against the required minimum of 15%. The caesarean section rate calculated of all expected births in the population varied between 0.2% and 1.4%. The case fatality rate was 4.0% in Rupandehi Zonal Hospital. Analysis of these indicators clearly identified tremendous underuse of maternity services which has stimulated national policy discussions in Nepal with ensuing safe motherhood interventions and monitoring strategies.

Adult↗
PubMed2006

Age at menarche: Influences of prenatal and postnatal growth.

OBJECTIVE: The objective of this study was to determine the influence of birth weight and postnatal weight gain on age at menarche. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study where girls from the West Australian Pregnancy (Raine) Cohort Study were followed prospectively from fetal life (18 wk of pregnancy) to adolescence (12-14 yr). MAIN OUTCOME MEASURE: Age at menarche was the main outcome measure. RESULTS: Growth status at birth was judged by expected birth weight ratio (EBW; a ratio of observed infant's birth weight over median birth weight appropriate for maternal age, weight, height, parity, infant sex, and gestational age). Postnatal growth status was judged by body mass index (BMI). Both EBW (P = 0.020) and BMI in childhood (8 yr of age) (P < 0.001) were associated with age at menarche. Menarche occurred earlier in girls with lower EBW and higher BMI. CONCLUSIONS: We have demonstrated for the first time that both birth weight and weight gain in childhood are associated with age at menarche. Weight gain before birth and subsequent weight gain up to the age of 8 yr were found to have opposing influences on the timing of menarche. Lower EBW combined with higher BMI during childhood predicted early age at menarche, and this relationship existed across normal birth weight and BMI ranges.

Adolescent↗
PubMed2005

The childbirth expectations of a self-selected cohort of Western Australian women.

OBJECTIVES: to explore and describe the labour and birth expectations of a cohort of Western Australian women, and to identify the factors that influence these expectations. DESIGN: a qualitative study using an explorative descriptive design and techniques associated with constant comparison. Data were collected from tape-recorded telephone interviews. SETTING: : Perth, Western Australia. PARTICIPANTS: two hundred and two women who were pregnant or who had birthed within the last 12 months. FINDINGS: five major themes were identified. Three of the five themes reflected a positive outlook on birth. These were labelled, 'owning and believing in birth as a natural event', 'satisfaction with the birth process and outcome' and 'involvement and participation in the birthing experience'. The remaining two themes 'birth is a negative event' and 'birth is a medical event' encapsulated the women's statements that described childbirth as a potential negative and unaffirming experience. Particularly influential on the formation of childbirth expectations were the public and private discourses of childbirth, especially those related to books and magazines, and the stories of mothers and sisters. Professional discourses, women's own history, and factors such as age and life-style choices also influenced decisions and contributed to how women perceived their experiences. IMPLICATIONS FOR PRACTICE: the findings of the study challenge the anecdotal evidence that many contemporary western women willingly and knowingly choose or expect birth to be a medicalised event. Although midwives and other maternity healthcare providers need to help women develop realistic expectations, there is also a need to examine the influence of healthcare professionals in perpetuating a technical approach to birth. The findings do, however, confirm that some women are anxious, scared and frightened of the childbirth experience. It is essential that research continues to focus on developing strategies to assist women confront and deal with these fears.

Attitude to Health↗
PubMed1985

Neonatal characteristics of maltreated infants and children.

We compared selected neonatal characteristics of 40 children who were abused and neglected (34) or who failed to thrive (six) and 40 nonabused, thriving children individually matched by hospital of birth, gender, mother's welfare status, race, and age at which abuse or failure to thrive was manifested. The populations were preponderantly lower-class, black, and male. The following characteristics were overrepresented in the study population: birth order second or later, low birth weight, admitted to neonatal intensive care unit, and discharged from hospital after mother. The higher incidence of full-term infants who were small for gestational age for the study population (20%) than for the control population (3%) was of borderline significance. The lower distribution of birth weights in relation to expected birth weights for the full-term study subjects, however, was highly significant.

Black or African American↗
PubMed1999

Heredity for hypertension influences intra-uterine growth and the relation between fetal growth and adult blood pressure.

OBJECTIVE: To study whether heredity for hypertension influences intra-uterine growth and the relationship between fetal growth and adult blood pressure. DESIGN: Five-year prospective follow-up study with retrospective collection of data on size at birth and gestational age from obstetric records. SETTING: Centre of preventive medicine in Malmo, Sweden. SUBJECTS: Thirty normotensive men with and 27 without heredity for hypertension were investigated in 1990, and the majority (n = 28 and n = 20, respectively) in 1995 also. MAIN OUTCOME MEASURES: Two measures of intra-uterine growth were compared between the groups and related to adult systolic blood pressure: the birth weight deviation from the expected birth weight based on ultrasonically derived intra-uterine growth curves, and the degree of thinness at birth (ponderal index = weight/length3). RESULTS: The birth weight deviation in men with heredity for hypertension differed significantly from that in men without such heredity (%) (-6.9+/-12.0 versus +7.3+/-18.4; P = 0.002). Ponderal index was somewhat lower in the men with than in those without heredity for hypertension, but the difference did not reach statistical significance (kg/m3) (25.9+/-2.6 versus 27.0+/-2.2; P = 0.08). In the group with heredity for hypertension, systolic blood pressure correlated inversely with ponderal index both in 1990 (r = -0.44; P = 0.01) and 1995 (r = -0.49; P = 0.009), and the 5-year increase in systolic blood pressure correlated inversely with the birth weight deviation (r = -0.38; P = 0.04). No such correlations were found in the group without heredity for hypertension. CONCLUSION: Our results suggest that genetic factors contributing to the development of hypertension may influence intra-uterine growth.

Adult↗
PubMed1991

Searching: expectant fathers' experiences during labor and birth.

When expectant fathers are present and view labor and birth as a couple experience, they are co-laboring in one of three roles: coach, teammate, or witness. Within these roles are various degrees and types of engagement. Men in the role of coach experience high degrees of physical and mental engagement. Teammates fluctuate between high and low degrees of physical and mental engagement, and witnesses remain at low degrees of engagement until the second stage of labor, when they experience high degrees of mental engagement. The expectant fathers' experience is influenced by the labor guides' activities of gatekeeping, leading, and informing. Men either maintain or redefine their role during labor and birth. Men who experience a sense of not belonging or who are uncomfortable with their role will redefine their role by using the strategy of searching for place. Searching for place involves the steps of identifying an alternative role, engaging in the new role, testing the role, and evaluating the effectiveness of the alternative role. Men who experience a sense of belonging in their new role will maintain this role. May posed the question, "Is it time to fire the coach?" This theory, which requires further testing and validation, does address May's question. Perhaps it is not time to fire the coach, as May indicated, but it is time to provide couples with options in the role expectant fathers play during labor and birth. This theory can guide nurses in relatively risk-free interventions for the expectant father. Nurses can assist expectant fathers in finding a place in labor and birth that will enhance a mutually satisfying birthing experience.

Adult↗
PubMed1991

Indirect fertility analysis in painters exposed to ethylene glycol ethers: sensitivity and specificity.

Semen analysis has proven useful in the clinical diagnosis of infertility and is the most widely used method of monitoring the effects of occupational exposure on male fertility. Collection and analysis of semen samples in a field setting, however, require a highly motivated population and excellent technical resources, limiting the widespread application of the method. Techniques of monitoring male worker fertility using questionnaires to avoid some of the difficulties of semen analysis have been developed. These methods compare the rate of observed births for wives of workers with expected birth rates derived either from U.S. fertility tables or from unexposed workers. The present study compares the sensitivity of this questionnaire method with that of semen analysis in an evaluation of reproductive function in men exposed to ethylene glycol ethers. The reproductive function of 74 married painters exposed to ethylene glycol ethers was compared with that of 51 married controls employed at a shipyard. The groups differed in sperm count, but the questionnaire method showed no effect of exposure on fertility. This analysis suggests that the questionnaire assessment of fertility is less sensitive than semen analysis as a screening tool for male reproductive function.

Adult↗