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The knowledge, attitudes and practices of rural women in southern Nigeria are at least as important as the availability of modern obstetric care in the fight against haemorrhage in pregnancy. Community-based interventions taking this into account are necessary if the considerable mortality associated with the condition is to be significantly reduced.
Postnatal depression (PND) is a serious and debilitating condition that is recognized as being disruptive to women's lives at a time when they are already under stress adapting to the demands that a new baby creates. What has not always been fully acknowledged is that PND is linked with elevated levels of depression in male partners. In this article, the authors report on men's experiences of PND and of participation in a 6-week group treatment program specifically designed for male partners. The men experienced their partners' PND as overwhelming, isolating, stigmatizing, and frustrating. Coping with PND was assisted by participation in the men's group. Men reported lowered levels of depression and stress, and higher levels of social support, as a result of their participation. The men valued highly the opportunity to share experiences with peers, to hear strategies for engaging in their relationship, and to gain factual information.
This review summarises data on the relationship between the duration of postnatal hospital stay and neonatal outcome for term and preterm infants. Almost all of the data available derive from observational studies and should thus be interpreted with caution. For term infants, several studies found an increase in readmission rates in infants discharged early; in one of these studies, hospital discharge at less than 30 hours post partum was associated with an increase of neonatal mortality by almost four times. These risks may be reduced by establishing a rigorous follow-up program including home visits, for example, by a midwife. Disadvantages concerning mother-infant interaction or breast feeding success have not yet been demonstrated. For preterm infants, two randomised studies showed substantial cost savings due to an early discharge program involving home visits and telephone contacts, while there was no increase in the rate of readmissions or other complications. Translated into the German setting, these data suggest a way of reducing the length of hospital stay for both term and preterm neonates and their mothers without compromising their outcome, a goal that may become even more relevant with the imminent introduction of a reimbursement system based on diagnosis-related groups (DRGs).
Uterine health is often compromised in cattle because postpartum contamination of the uterine lumen by bacteria is ubiquitous, and pathogenic bacteria frequently persist causing clinical disease. The subfertility associated with uterine infection involves perturbation of the hypothalamus, pituitary and ovary, in addition to the direct effects on the uterus, and appears to persist even after clinical resolution of the disease. Absorption of bacterial components from the uterus can prevent the follicular phase LH surge and ovulation. In addition, the first postpartum dominant follicle has a slower growth rate and secretes less estradiol at the end of the growth phase. There are also localised ovarian effects of high uterine bacterial growth density, because fewer first dominant follicles are selected in the ovary ipsilateral than contralateral to the previously gravid uterine horn. Thus, it is important to diagnose and treat uterine disease promptly and effectively. Examination of the contents of the vagina for the presence of pus is the most useful method for diagnosis of endometritis. The character and odor of the vaginal mucus can be scored and this endometritis score is correlated with the growth density of pathogenic bacteria in the uterus, and is prognostic for the likely success of treatment. The challenge for the future is to design prevention and control programs to reduce the incidence of disease, and understand how the immune and endocrine systems are integrated.
OBJECTIVE: To measure patient satisfaction with pregnancy and newborn care. STUDY DESIGN: To develop our survey, we reviewed domains of care that had been identified by national groups working to develop measures of satisfaction with care. Within these domains of care, items pertinent to pregnancy and newborn care were written, reviewed, and pilot tested in focus groups of women who had recently delivered a baby. A 24-item survey instrument was the result of this process. PATIENTS AND METHODS: We sent our survey to 2337 female members of the Southern California Kaiser Permanente Medical Care Program approximately 8 weeks after they had delivered a baby. The demographic and clinical characteristics of the respondents were compared with those of the nonrespondents. RESULTS: A total of 1017 women (44%) completed and returned the survey. Eighty-eight percent of the women who responded were very or somewhat satisfied with the care they received during their pregnancy and the newborn period. Women who responded differed from those who did not respond on infant birthweight, maternal age and education, and other variables. The results of our survey were forwarded to local quality managers and physicians. CONCLUSION: Satisfaction with care is an important measure of quality of care. Many changes in the delivery system were made in response to the information provided by survey respondents, including offering alternative appointment times and scheduling postpartum appointments before hospital discharge. Our survey instrument, which assesses satisfaction with pregnancy and newborn care, might be useful for other health maintenance organizations for identifying areas where improvement in care is needed.
BACKGROUND: We wished to determine the incidence of nosocomial infections in the mother and the newborn during the early postpartum period. MATERIAL AND METHODS: Over a three-month period, the same investigator collected 50 different clinical and microbiological, standardized data related to infectious diseases in parturients and their newborns. RESULTS: Data were collected on 804 deliveries. The overall rate of nosocomial infection was 2.9% (23/804). For vaginal deliveries, the rate was 1.9% (12/615) and for deliveries by Cesarean section, the rate was 5.8% (11/189). Of 745 newborns followed until discharge from hospital, 0.7% (5/745) had a nosocomial infection. CONCLUSION: These results are in line with previously published rates of nosocomial infections, which varied between 0.2% to 2.3% for vaginal deliveries, 1.6% to 18.9% for Cesarean section, and 0.2 to 4% in newborns. Regular surveys of the incidence or the prevalence of nosocomial infections are necessary to monitor the effectiveness of educational programs, aimed to reduce hospital acquired infections.
The limited empirical data available on maternal health problems among Mexican immigrant women in the United States suggest that they underutilize health services, especially general preventive care. Research conducted among legal and undocumented women in the Mexican immigrant population in San Diego, California, support these findings. Among undocumented mothers, 11.5% of their births in the U.S. occurred with no prenatal care or care sought in the third trimester, which is much higher than Mexican women legally in the country (3.6%) and the general San Diego maternal population (3.8%). When we examine births which occurred within the last five years by immigration status, we find that women legally in the country have a much higher rate of cesarean delivery of both undocumented women and women in the general San Diego maternal population. Undocumented women in our sample were much less likely than their legal counterparts to return for postpartum examinations for themselves, to seek neonatal care for their infants, and to have had Pap examinations or carry out breast self-examinations.
We evaluate the cost consequence of a voluntary early obstetrical discharge programme in a military teaching hospital. The study involved a control group of routine obstetrical discharge patients with uncomplicated vaginal delivery from March 1 to August 31, 1994 and the study group of early obstetrical discharge (24-48 hours) patients with uncomplicated vaginal delivery from March 1 to August 31, 1996. There were 1,042 total control patients with routine vaginal delivery totalling 2,668 hospital days with a mean number of hospital days of 2.56 per patient. The study group of early obstetrical discharge patients with uncomplicated vaginal delivery encompassed 1,050 patients with 1,965 hospital days with mean hospital days of 1.87 per patient (p < 0.05) without an increase in postpartum clinic or emergency room visits. The total cost of admissions (cost calculation of $1,221 per hospital day) fell from $3,257,628 in the routine discharge group to $2,399,625 in the early discharge cohort showing a total cost savings of $858,003 over the 6-months study period. The average cost per obstetrical admission for routine vaginal delivery fell from $3,126 per day to $2,285 per day without an increase in the postpartum paediatric adverse outcomes. Maternal postpartum readmission rates were statistically significantly increased (p < 0.05) in the study group at 0.6% with an OR[2.32(2.17, 6.92)] but all readmissions fell outside the 48-hour early discharge window. This programme showed significant cost savings without concomitant increase in paediatric or maternal adverse outcomes.
It is now possible to virtually normalize ambient blood glucose levels in insulin-dependent diabetic women during pregnancy. Successful programs have been developed that utilize home blood glucose monitoring, physiologic delivery of insulin, and quantitation of caloric intake carefully matched to insulin dosage. The results of establishing normoglycemia throughout gestation appear to be a normalization of mortality and morbidity for both infant and mother. Pregnancy provides a need for continuous upward adjustment of insulin dose concomitant with the ongoing fetal and hormonal changes associated with gestation.
Caprine arthritis-encephalitis virus was isolated from goat milk and transmitted most efficiently to kids through both milk and colostrum. In addition, it appeared that transmissions through other secretions of the doe occurred, but were less important than transmission in milk and colostrum. Intrauterine infection may have occurred in 2 of 32 cesarean-derived goats, but postpartum horizontal transmission could not be ruled out. Transmission by the aerosol route was not demonstrated, and even short-term direct contact between virus-infected bucks and virus-free does during breeding did not result in transmission. Prolonged direct contact for over 12 months between weaned cesarean-derived goats and virus-infected goats was necessary before horizontal transmission could be demonstrated under nondairy conditions. However, when uninfected does were milked with infected does, a high percentage became infected in less than 10 months. Heat inactivation (56 C) reduced approximately 10(5) median tissue culture infective doses of caprine arthritis-encephalitis virus to below titratable levels, and virus was not transmitted to kids fed virus-infected colostrum that had been heated at 56 C for 1 hour. A program of eradication is discussed in which kids are removed from their dams at birth, fed safe sources of colostrum and milk, and isolated from other goats until weaning.
The natural history of alloimmunization to the PlA1 platelet antigen is uncertain. We followed 50 PlA1-negative pregnant women during pregnancy and for 6 months post-partum in order to determine this natural history. The cohort of PlA1-negative women was obtained by PlA1 typing 5000 women. Three PlA1-negative women formed anti-PlA1 antibodies during this prospective study, two in pregnancy and one in the immediate post-partum period. All three PlA1 antibody producers were HLA-DR3 positive, a histocompatibility phenotype that is strongly associated with alloimmunization to the PlA1 antigen. One of the three infants delivered to these mothers was thrombocytopenic (platelet count 9 x 10(9)/l). The remaining two infants had normal platelet counts at birth (160 and 174 x 10(9)/l). The HLA-A1, -B8, -DR3 and -DRw52 phenotype frequencies in the group of PlA1-negative women who did not form PlA1 antibodies (n = 47) was similar to that found in their husbands, and that expected in a normal Caucasian population. From our data we estimate that alloimmunization to the PlA1 antigen occurs in approximately one out of every 1000 pregnancies in a Caucasian population. It is important to recognize that not all pregnancies in which a mother has formed PlA1 alloantibodies will result in the delivery of a thrombocytopenic infant. These findings are relevant to programs designed to either prevent alloimmunization to the PlA1 antigen (through passive administration of anti-PlA1 immunoglobulin to at-risk PlA1-negative mothers), or to identify women at risk of delivery of thrombocytopenic infants (by antenatal screening to detect women alloimmunized to the PlA1 antigen).
AIM: The attempt to estimate the influence of physical exercises for course of delivery and confinement. MATERIAL AND METHODS: The investigations were conducted at hospitals in following cities and towns: Bielsko--Biala, Nowy Targ, Sucha Beskidzka and in Gliwice. The efficiency of School of Birth program was studied. The 384 women with random chosen and the natural deliveries were examined. The interviews, analysis of hospitals cards and School of Birth specifications were studied. The estimations of efficiency of newborn children in Apgar scale and psychological and physical state of health of the women after delivers conducted by doctors were taken into consideration.
BACKGROUND: The aim of the study was to evaluate prenatal and postpartal sonographic investigations to diagnose congenital uropathies. PATIENTS/METHODS: The Mainz birth defect monitoring system, the "Mainzer Model", was launched in 1990. Over a period of five years (1/90 to 1/95) 19,028 newborns underwent postpartal sonographic examination. Anamnestic data including prepartal sonographic examination were collected. According to a defined ultrasound criteria list, ultrasound findings were considered normal in 94.8% of the neonates, 4.4% were defined as requiring a follow-up examination and 0.8% were pathological. In the current study we analyzed patients with pathological findings with their pre- and postpartal sonographic investigations as well as their clinical data (urinary tract infections, operative procedures). RESULTS: In the study group prenatal ultrasonography showed evidence of severe anomalies only in 51 fetuses (32.9%). Surgical correction was required in 39 cases. 20 (51%) have been diagnosed prenatally. 28 patients presented with urinary tract infections. Out of this group only 11 patients have been detected by prenatal ultrasound. CONCLUSION: In conclusion, postnatal ultrasound is more effective to diagnose anomalies of the urinary tract. To prevent complications i.e. urinary tract infections a neonatal screening program would be valuable.
OBJECTIVE: This study aimed to: (1) Assess the community utility of a screening tool to identify families with child abuse or neglect risk factors in the immediate postnatal period (2) Determine the social validity and effectiveness of a home visiting program using community child health nurses and offering social work services for identified families, and (3) Identify factors in the immediate postnatal period associated with the child's environment that predict poor adjustment to the parenting role. METHOD: A randomized controlled trial using a cohort of 181 families was undertaken to evaluate the impact of a home visiting program. Mothers were recruited in the immediate postnatal period and allocated either into the home visiting program or into a comparison group. The research design required self-identification into the study by providing positive responses to a range of risk factors. A repeated measures design was used to test parenting stress and maternal depression from the immediate postnatal period to 12-month follow-up and physical child abuse potential to 18-month follow-up. To test whether measures taken in the immediate postnatal period were predictive for poor adjustment to the parenting role, a linear regression model was used. RESULTS: The screening procedure was shown to have utility in the context of recruitment to a research trial and mothers were willing to accept the home visiting program examined by this study from the immediate postnatal period. From as early as 6 weeks the program demonstrated ability to impact positively on maternal, infant, family, and home environment variables (testing 90 randomly allocated intervention vs. 91 comparison families). At follow-up, parental adjustment variables were not significantly different between groups (testing the remaining 68 (75.5%) intervention vs. 70 (76.9%) comparison families) and home environment assessment scores had converged. Predictive analysis of factors measured in the immediate postnatal period revealed an absence of any predictive value to demographic characteristics, which secondary prevention efforts typically target. CONCLUSIONS: Follow-up evaluation did not demonstrate a positive impact on parenting stress, parenting competence, or quality of the home environment confirming the need to test early program success on longer term outcomes. Further, thestudy not only demonstrated that there was a relationship between maternal, family and environmental factors identified in the immediate postnatal period. and adjustment to the parenting role, but also challenged demographic targeting for child abuse and neglect risk. At the same time, the immediate postnatal period presented an exciting window of opportunity to access high-risk families who may otherwise have become marginalized from traditional services.
The authors used a transcendental phenomenological approach to describe adolescent mothers' satisfactory and unsatisfactory inpatient postpartum nursing care experiences. They analyzed data from 14 in-depth interviews and found that adolescent mothers' satisfaction is dependent on their perceptions of the nurse's ability to place them "at ease." Nursing care qualities that contributed to satisfactory experiences included nurses' sharing information about themselves, being calm, demonstrating confidence in mothers, speaking to adolescent and adult mothers in the same way, and anticipating unstated needs. Nursing care was perceived to be unsatisfactory when it was too serious, limited to the job required, or different from care to adult mothers, or when nurses failed to recognize individual needs. In extreme cases, unsatisfactory experiences hindered development of an effective nurse-client relationship. These findings illustrate the value of qualitative inquiry for understanding patients' satisfaction with care, can be used for self-reflection, and have implications for nursing education programs.
A substantial proportion of disease and death in the US could be prevented if tobacco use was curtailed or eliminated. Low birth weight, pregnancy complications, and infant morbidity are but a few of the adverse outcomes experienced by pregnant and postpartum women and infants that result from cigarette smoking. Pregnancy may be an ideal time to intervene with smoking women. On learning of their pregnancy, many women reduce or quit smoking on their own. For those who do not quit, interventions during the childbearing year could provide additional incentive and support for complete cessation. Successful clinic-based interventions share similar characteristics and tailoring cessation messages to client populations may enhance the effectiveness of interventions. Assessing a smoker's degree of addiction and tailoring counseling for cessation according to the patient's readiness might enhance current clinical practices. Even with the most effective individual counseling, it is increasingly evident that additional strategies are needed to achieve population-wide reductions in smoking and its related health conditions. Examples of these efforts are increased taxation on cigarettes, community-based anti-tobacco programs, and increasing the number of smoke-free environments. Thus, in addition to clinic-based efforts, health professionals might take an active role in supporting the broad range of programmatic, legislative, and advocacy efforts.
AIMS AND OBJECTIVES: To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months. BACKGROUND: Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published. DESIGN: A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after. METHODS: Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design. RESULTS: Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant. CONCLUSIONS: Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings. RELEVANCE TO CLINICAL PRACTICE: An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care.
Information concerning a subject of interest to the health community may be gathered through simple, low-cost minisurveys. Data were gathered on postpartum breast-feeding in one community in 1974, 1979, and 1984. This community mirrored national trends and offered additional information on areas of programmatic interest; findings also confirmed the hypothesis that education and national trends over time had statistically significant relationships with the choice to breast-feed. Of special note is the finding that the level of knowledge concerning infant feeding is closely linked to the choice to breast-feed, as is the relationship between the primary influence of another woman and the choice to breast-feed. With level of education controlled for, both associated variables remained significant for women with lower levels of education, the group least likely to select breast-feeding. This would suggest the probable advantage of breast-feeding promotion based on woman-to-woman contact during preconception and antepartum periods; such a program might be particularly effective with women of lower educational levels.