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PubMed1998

Counseling and motivational videotapes increase duration of breast-feeding in African-American WIC participants who initiate breast-feeding.

OBJECTIVE: To evaluate the relative effects introducing motivational videotapes and/or peer counseling in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics serving African-American women have on breast-feeding duration. DESIGN: Experimental intervention study. Pregnant women were enrolled at or before 24 weeks gestation and were followed up until postpartum week 16. Women were interviewed at enrollment, 7 to 10 days, 8 weeks, and 16 weeks postpartum. SUNJECTS/SETTING: One hundred fifteen African-American WIC participants who initiated breast-feeding and who had been enrolled in 1 of 4 clinics. INTERVENTION: Two-by-two factorial design, in which 4 clinics were randomly assigned to receive either no intervention, a motivational video package intervention, a peer-counseling intervention, or both interventions. MAIN OUTCOME MEASURES: Breast-feeding duration in weeks and relative risk ratios for breast-feeding cessation before 16 weeks postpartum. STATISTICAL ANALYSIS PERFORMED: Contingency table analysis, including chi2 tests and log-rank tests; multivariate analysis using Cox proportional hazards regression analysis. RESULTS: A higher proportion of women were breast-feeding at 8 and 16 weeks postpartum in the intervention clinics than in the control clinic. The proportion of women reporting breast-feeding declined at 8 and 16 weeks postpartum, but the rate of decline was slower in the 3 intervention clinics than in the control clinic. Being younger than 19 years of age or older than 25 years of age, having a male infant, and returning to work or school all negatively affected breastfeeding duration, whereas previous breast-feeding experience positively influenced breast-feeding duration. APPLICATIONS/CONCLUSIONS: WIC-based peer counselor support and motivational videos can positively affect the duration of breast-feeding among African-American women. WIC nutritionists and other health professionals in contact with this population should expand their efforts toward promoting increased duration of breast-feeding.

Black or African American↗
PubMed1982

Breast-feeding and family planning: a review of the relationships between breast-feeding and family planning.

A number of interrelated factors must be considered when breast-feeding is introduced as a concern for family planning programs: the number of pregnancies and births experienced, age at each pregnancy and birth, duration of the intervals between conceptions, lactation including duration and type, health and nutritional services available to meet the demands of pregnancy, delivery, and postpartum care. The dietary intake of the mother and her health and disease status have an effect on the duration of breast-feeding, and lactation has an effect on her ovulation and birth spacing. Those at particularly high risk include adolescent girls, older grand-multipara women, and families living in poverty. An historical relationship between the reduction in infant and childhood mortality and the falling off of births can be documented. The straightforward benefits on nutritional status of breast-fed infants, the conjunction with the antibody protection afforded by breast milk, served to reduce infant mortality and indirectly served to reduce birth rates. In addition, the prolongation of postpartum anovulatory cycles in breast-feeding women, coupled with sexual mores that postpone sexual relations while a women is breast-feeding in certain groups, will serve to prolong the interbirth intervals. Populations where breast-feeding is customary have been shown to have fewer births than populations where the women do not breast-fed and where infants are artificially fed.

Age Factors↗
PubMed2004

Evaluation of a lactation intervention program to encourage breastfeeding: a longitudinal study.

The purpose of this study was to evaluate the implementation of a change to the breastfeeding policy in seven hospitals in accordance with the 'Ten Steps to Successful Breastfeeding' issued by the World Health Organization and the United Nations Children's Fund and to assess the impact of hospital practices on breastfeeding. A 3-year quasi-experimental pre-post test design was conducted in 12 hospitals. The subjects were composed of 4614 lactating women in both experimental and control groups. The research instruments included the Baby-Friendly hospital Initiative training programs and questionnaires on breastfeeding duration, knowledge, attitude, and demographic data. Breastfeeding rates (including exclusive breastfeeding, mixed breastfeeding, and overall breastfeeding rates) of the experimental and control groups were measured and compared at four different times, during the hospital stay and at 2 weeks, 1 and 2 months postpartum. The results indicated that the exclusive and overall breastfeeding rates of the experimental group were higher than those of the control group (p < 0.001); moreover, the breastfeeding rates generally exhibited an increasing trend year by year ((p < 0.001). The results also showed that the experimental group scored higher in breastfeeding knowledge than the control group as did positive attitudes toward breastfeeding (t > 1.96, p < 0.05) with scores increasing year by year. The results also showed that higher scores reflected better knowledge in breastfeeding, and, in turn, a longer duration of breastfeeding.

Adolescent↗
PubMedDate not supplied

Prevalence of smoking associated with pregnancy in three Southern Ontario Health Units.

OBJECTIVES: The objectives of this study were to determine the prevalence of pregnancy-associated smoking among women residing in three Southern Ontario Health Units and to examine potential risk factors for smoking during pregnancy, using an existing data collection mechanism. METHODS: During May 2001, questions about pregnancy-associated smoking were asked during the telephone follow-up of postpartum women living in the three health units in Southern Ontario; this follow-up is routinely conducted by public health nurses. Sociodemographic data were also obtained. Data from 1,134 women were analyzed concerning smoking before and after the occurrence of the pregnancy was known, during each trimester, and immediately postpartum. RESULTS: The rates of smoking before and after the pregnancy was known, in the first, second, and third trimesters, and immediately postpartum were 17.8%, 10.4%, 9.6%, 8.7%, 8.1%, and 7.9%, respectively. For all six estimates of smoking, Canadian-born women had rates 2.5 to 4 times higher than those of women born outside Canada. Age less than 25 years and lower educational attainment were also independent risk factors for smoking during pregnancy. CONCLUSIONS: The Ontario Tobacco Strategy goal of eliminating smoking in pregnancy has not yet been realized. Ongoing smoking cessation programs among pregnant women are needed as part of a comprehensive strategy to reduce the overall prevalence of smoking. In planning such programs, particular attention should be paid to the needs of women who are Canadian-born, have lower educational attainment, and are under the age of 25.

Adult↗
PubMed1978

Second trimester abortion with 5% intraamniotic saline--a pilot study.

The risk of hypernatremia and related postabortion complications resulting from the intraamniotic administration of a 20-25% hypertonic saline solution, a widely used procedure all over the world, prompted this trial of 5% saline. Midtrimester abortion was induced in 150 women with a 5% saline solution administered intraamniotically at the National Medical College, Calcutta, India, from August 1974 to October 1975. The abortion was complete within 48 hours in 90% of the cases. All the fetuses were delivered dead. In one case, hysterotomy was performed because of severe bleeding. The immediate complication rate was 36% (12% serious). The follow-up complication rate was 2%. One patient died on the seventh postabortal day due to severe, uncontrolled septicemia. The authors conclude that because this procedure is simple and low cost and because it reduces the risk of hypernatremia it should be a welcome addition to service programs in developing countries.

Abortion, Induced↗
PubMedDate not supplied

Lack of preparedness: experiences of first-time mothers.

PURPOSE: To examine the experiences of first-time mothers following discharge from the hospital after vaginal delivery. STUDY DESIGN AND METHOD: Qualitative, grounded theory. In-depth interviews were conducted with participants guided by open-ended semistructured questions. All interviews took place in the participants' homes within 4 weeks of delivery and were tape-recorded. Data collection and analysis occurred simultaneously. Open coding and selective coding were utilized to identify and refine concepts. Participants were primiparous, drawn from an urban location in the northeastern United States, English-speaking, and 18 to 35 years of age. RESULTS: Following the dramatic changes of pregnancy and delivery, the women in this study returned home feeling unprepared to care for themselves and their babies. Because of their lack of preparedness at a time of increased responsibility and vulnerability, they were overwhelmed. Exhausted, feeling unwell and isolated, they struggled to adapt to new role expectations. Propelled into information seeking by their lack of knowledge, they were further hampered by conflicting and fragmented advice. Family and friends were the primary sources for information for the majority of these new mothers, not healthcare professionals or services. CLINICAL IMPLICATIONS: Insight into the experiences of first-time mothers provides a framework for additional research and the development of programs and resources that will address their unique needs.

Adolescent↗
PubMed1996

"Sylvia Frumkin" has a baby: a case study for policymakers.

"Sylvia Frumkin" was a pseudonym given to a 32-year-old woman with chronic mental illness described by Susan Sheehan in her books Is There No Place on Earth for Me? This paper presents the case of "Gloria Morrison," a patient similar to Ms. Frumkin, who is also a mother. Issues raised by the case in three areas are discussed. Issues for the service delivery system include developing better assessment, prediction, and reduction of the risk that a parent's mental illness may pose to a child's safety and well-being; targeting supportive and educational interventions to relatives and foster parents caring for children of severely mentally ill patients; and tailoring programs and services to the needs of such patients and their children. Clinical treatment issues include offering treatment options through agencies other than the department of social services; developing protocols for the care of severely mentally ill pregnant and postpartum women; focusing on issues of loss; and providing parenting skills training. Issues in the area of family support include increasing providers' awareness of family burden and alleviating conflicts between the family and patient.

Child↗
PubMed2005

Mode of infant feeding and HIV infection in children in a program for prevention of mother-to-child transmission in Uganda.

OBJECTIVE: To evaluate the impact of different modalities of infant feeding on HIV transmission in children in a prevention of mother-to-child transmission (PMTCT) program in an urban hospital in Uganda. METHODS: HIV-infected pregnant women in the PMTCT program at St Francis Hospital Nsambya, Kampala were offered the chance to participate in the study. Short-course antiretroviral regimens were provided and formula feeding offered free of charge for women choosing not to breastfeed. Mother-infant pairs were followed until 6 months postpartum. HIV status in children was assessed at week 6 and month 6. For the analyses, mother-infant pairs were classified into three groups according to the mode of infant feeding: exclusive formula feeding (EFF), exclusive breastfeeding (EBF) and mixed feeding (MF). RESULTS: A total of 306 children were enrolled. Transmission rates were 8.9% at week 6 (3.4% in the EFF group, 11.2% in the EBF group, 17.1% in the MF group) and 12.0% at month 6 (3.7% in the EFF group, 16.0% in the EBF group, and 20.4% in the MF group). The EBF and MF groups were associated with a significantly higher risk of HIV transmission than the EFF group. No significant risk difference was observed between the EBF and the MF groups. CONCLUSIONS: HIV transmission rates were significantly lower in formula-fed infants in comparison with both exclusively breastfed and mixed-fed infants. Transmission through breastfeeding seems to occur mainly in the first weeks after delivery.

Adult↗
PubMed2001

Adolescents at risk for mistreating their children. Part II: A home- and clinic-based prevention program.

OBJECTIVE: To determine if adding an intensive home visitation component to a comprehensive adolescent-oriented maternity program prevents child abuse and neglect. METHODS: We studied 171 participants in a comprehensive, adolescent-oriented maternity program who were deemed to be at high risk for child abuse and neglect. Half were randomly assigned to receive in-home parenting instruction. Major disruptions of primary care-giving by the adolescent mother were classified hierarchically as abuse, neglect, and abandonment. RESULTS: Compliance with home visits varied in relation to the support the teenage mothers received from their families and the fathers of their babies (p < .0001). There were no significant treatment group differences in the pattern of health care utilization, the rate of postpartum school return, repeat pregnancies, or child abuse and neglect. The incidence of maltreatment rose in tandem with the predicted risk status of the mother. Ultimately, 19% of the children were removed from their mother's custody. CONCLUSIONS: Prediction efforts were effective in identifying at-risk infants, but this intensive home- and clinic-based intervention did not alter the incidence of child maltreatment or maternal life course development. A parenting program that was more inclusive of the support network might be more popular with teenagers and therefore more effective. Our findings also emphasize the importance of including counseling specifically designed to prevent teenagers from abandoning their children.

Adolescent↗
PubMed1993

Effects of maternal aerobic fitness on cardiorespiratory responses to exercise.

We hypothesized that aerobically fit women who continued to exercise throughout pregnancy would have enhanced cardiorespiratory responses to exercise. Physically active (N = 10) and sedentary (N = 6) subjects were compared during steady-state (15 min) semi-recumbent cycle exercise performed at a given heart rate (HR; 140 b.min-1) twice during pregnancy (25 wk, 36 wk) and 12 wk postpartum. Indirect calorimetry was used to measure volumes and fractional concentrations of expired gases. Cardiac output was estimated via CO2 rebreathing. Data were analyzed with repeated measures ANOVA. Caloric expenditure during exercise was significantly (P < 0.001) greater in the physically active (7.2 kcal.min-1) compared with sedentary (4.7 kcal.min-1) subjects. Alveolar ventilation and cardiac output responses to exercise were proportionally greater (P < 0.001) in the aerobically fit subjects. Ventilatory equivalents for O2 and physiological dead space/tidal volume ratios were significantly (P < 0.01) lower in the physically active subjects during exercise. In contrast, ratings of perceived exertion during exercise did not differ between subject groups. It appears that a physically active woman's enhanced cardiorespiratory responses to acute exercise are maintained during pregnancy if she continues her aerobic fitness program throughout gestation.

Adult↗
PubMed1995

Studies on reproductive toxicity of iloprost in rats, rabbits and monkeys.

A reproduction toxicological test program was performed with the carbaprostacyclin derivative iloprost, an analogue to the endogenous prostacyclin PGI2, in order to detect possible effects on fertility and reproductive performance, on preimplantational, embryonal and fetal development, on delivery as well as on lactation and postpartum development. While in humans iloprost is administered as an i.v. infusion for 6 h/day, it was administered i.v. to rats, rabbits and monkeys by continuous infusion with a subcutaneously implanted pump. No influence on mating or reproductive parameters was found after treatment of male or female rats during the premating phase up to day 7 post coitum (p.c.). Embryonal and fetal development were not remarkably impaired in rabbits or monkeys after treatment throughout the period of organogenesis. The only remarkable observations in the embryotoxicity and peri-/postnatal studies in the rat were defects on the digits (reductions of phalangeal structures) in single individuals. These malformations were interpreted as resulting from a compound-related hypotonia with subsequent change in the regional blood flow and the consequence of temporary impairments of placental blood supply leading to hypoxia in the affected structures.

Animals↗
PubMed2005

Is advice to stop smoking from a midwife stressful for pregnant women who smoke? Data from a randomized controlled trial.

BACKGROUND: There are no randomized trials examining whether intensive advice to pregnant smokers is more stressful than standard care. METHOD: Nine hundred eighteen U.K. women currently smoking on commencing antenatal care were randomized into three arms. Women in Arm A received one episode of brief advice to stop smoking. Women in Arm B were assessed for stage of change and worked through an exercise in self-help manuals on three occasions. Women in Arm C used a 20-min interactive computer program three times in addition to the intervention women in Arm B received. Stress was assessed by the change in score on the Perceived Stress Scale (PSS) from baseline to 30 weeks gestation, the month before delivery, and 10 days postpartum. RESULTS: There were small and not significant differences in the changes in PSS between the arms at all outcome times. There was no evidence that the importance women attached to pleasing their midwife by stopping, having failed to quit, or nulliparity modified the effect of intensive advice on change in stress levels. CONCLUSIONS.: Intensive advice to stop smoking was not associated with increases in stress. Advice and support for pregnant women to stop smoking should be given without fear of causing stress.

Delivery of Health Care↗
PubMed1989

Battering during pregnancy: tip of an iceberg revealed.

Physical abuse of women is pervasive with one in three women experiencing battering. Battering occurs during pregnancy with women reporting blows to the pregnant abdomen, injuries to the breast and genitals, and sexual assault. A recent study in a large metropolitan area documented one in twelve pregnant women to have been physically battered during the present pregnancy. Among the women battered, 87% had been physically abused prior to pregnancy and 29% reported the abuse increased after becoming pregnant. Health care providers did not assess any of the women for abuse. When pregnancy outcome was analyzed in another study of 589 postpartum women, battered women were four times more likely to deliver a low-birthweight infant. This paper discusses the etiology of battering, prevalence of battering during pregnancy and pregnancy outcomes of battered women. A community-wide primary prevention program is presented that has linked the health care provider with law enforcement and shelters for battered women to interrupt the cycle of violence and promote the health and safety of pregnant women.

Adolescent↗
PubMed2000

[An epidemiological investigation of anotia and microtia in China during 1988-1992].

OBJECTIVE: To investigate the epidemiological characteristics of cases with anotia and microtia in China. METHOD: The birth defect monitoring program was undertaken by a hospital-based monitoring method in 443-588 hospitals from 30 provinces, cities and autonomous regions across China. Data including intrauterine death and stillbirth from 28 weeks of gestation to a period of 7 days postpartum were collected between 1988 and 1992. RESULTS: A total of 3,246,408 births was monitored from 1988 to 1992, in which 453 cases had anotia and microtia. The average incidence was 1.40 per 10,000 during the five-year period. The decreased tendency of incidence was noted during the period (chi 2 = 5.5588, P < 0.05). The incidence in the urban area was significantly higher than that in the rural area. There was no sex difference in the incidence of anotia and microtia. The incidence varied among 30 provinces with highest incidence in Xinjiang province (2.08 per 10,000 births) and lowest in the Inner Mongolia Autonomous Region (0.33 per 10,000 births). In cases with the defects of anotia and microtia, 60.4% were accompanied with other congenital malformations. The proportion of multiple malformations with microtia and anotia was significantly higher than that of isolated case (chi 2 = 36.9277, P < 0.01). The highest incidence of concurrent malformations was anophthalmia or microphthalmia (13.1%), followed by facial cleft (12.6%), neural tube defects (10.0%), limb reduction defects (9.6%) and polydactyly (5.4%). There were also 3.5% cardiac defects. CONCLUSIONS: The prevalence of anotia and microtia varied among provinces across China. The high proportions of cases with anotia and microtia had multiple malformations. Therefore, careful examination of other malformations in patients with anotia and microtia is necessary.

Abnormalities, Multiple↗