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PubMedDate not supplied

[Breastfeeding knowledge among post-partum women enrolled in a prenatal care program].

The purpose of this study was to evaluate knowledge of breastfeeding issues among post-partum women who had participated in a prenatal program at the Rio de Janeiro Federal University (UFRJ) Maternity Teaching Hospital. The sample totaled 135 post-partum women who answered a structured questionnaire with objective questions about practical and theoretical aspects of breastfeeding. The women had begun prenatal care at the 16th week of gestation on average, with an average of 8 medical consultations. Some 53.3% stated having received information about breastfeeding during prenatal care, and 22.2% stated that the information they remembered the best was that they should breastfeed for the first 6 months. Regarding the best moment for the first feeding, 50.4% identified it as immediately after delivery. Some 47.4% said breastfeeding protects the child from diseases. Thus, although the mothers demonstrated basic knowledge about breastfeeding, issues like the best moment for the first feeding, the importance of colostrum, and nutritional aspects for nursing mothers require further clarification during prenatal care and the immediate post-partum period.

Adult↗
PubMed1999

Women's perceptions of midwifery care: a longitudinal study to shape curriculum development.

BACKGROUND: Health and education services are increasingly expected to focus on the consumer. The perceptions of childbearing women should be incorporated into midwifery curricula, but often they are given minimal attention or not sought for this purpose. This study was designed to enable the views and experiences of local women to influence curriculum development in a large university in England. METHODS: A descriptive, longitudinal, qualitative study was conducted using semistructured and unstructured interviews with women, and data from their maternity records. Forty-one pregnant women were recruited and interviewed during pregnancy, in the early postpartum period in hospital, and in their homes 2 to 3 weeks after the birth. RESULTS: Themes were clustered into three categories: the characteristics and qualities of the caregivers, the individualized nature of care, and the clinical competence of the caregivers. Continuity of caregiver was desired but accepted as probably unrealistic by many. Developing a "special" trusting relationship with a female midwife was perceived as essential to promoting a positive childbirth experience. Clinical competence was expected and largely experienced. Negative feelings related to individual caregivers more than the type of care given. CONCLUSIONS: Most women had positive experiences, finding midwives and doctors with good knowledge, interpersonal skills, and abilities. Examples of poor communication skills and interprofessional conflict indicated a need to give priority to developing and assessing students' interpersonal skills. Evidence of interprofessional conflict acted as the catalyst to merge midwifery with the department of obstetrics in the university to enhance interprofessional learning.

Adult↗
PubMedDate not supplied

[Serum retinol in urban Mexican women during the perinatal period].

OBJECTIVE: To establish the prevalence of vitamin A deficiency during pregnancy and lactation in a group of urban Mexican women. MATERIAL AND METHODS: A group of pregnant women who attended a prenatal care program were invited to participate. Subjects had no added pathologies and were less than 20 weeks pregnant. Evaluations were performed 3 times during pregnancy until 24 weeks post-partum. Vitamin A levels were determined in serum by high performance liquid chromatography (HPLC). The cut-off point to consider retinol deficiency was < 1.05 mumol/L. RESULTS: During the 3 gestational evaluations, vitamin A levels were 2.34 +/- 0.70, 2.41 +/- 1.03 and 1.86 +/- 0.66 mumol/L, respectively, which shows a significant decrease. However, only 1/30 was situated below the accepted cut-off point to consider risk of deficiency, and none for deficiency. During post-partum, concentrations remained relatively constant, approximately 2.10 mumol/L. Lactation had no impact on serum retinol levels, while weight loss did. CONCLUSIONS: No cases of vitamin A deficiency were found in the studied population during the perinatal period. Maternal weight loss affects post-partum retinol levels.

Adult↗
PubMed2000

A systematic review to evaluate the effectiveness of interventions to promote the initiation of breastfeeding.

BACKGROUND: Human breastmilk provides complete nutrition for infants and helps protect against certain childhood diseases. Despite this, rates of initiation of breastfeeding in the UK remain low relative to other countries. In 'Our healthier nation' action report, the government has highlighted the promotion of breastfeeding in order to assist improvements in health and to reduce the health inequalities of mothers and children in the UK. OBJECTIVES: The primary aim of this systematic review was to evaluate existing evidence to identify which promotion programmes are effective at increasing the number of women who start to breastfeed. In addition, the review aimed to assess the impact of such programmes on the duration and/or exclusivity of breastfeeding and the intermediate and process outcomes. Where the strength and quality of the evidence permitted, the review aimed to identify implications for practice within the UK and priority areas for future research. METHODS DATA SOURCES: A range of electronic databases were searched from inception to November 1998, several relevant journals were hand-searched, and references of retrieved papers were examined. Relevant experts, organisations and lay groups were contacted to help identify further published or unpublished material. Additionally, an expert panel was consulted. SELECTION CRITERIA: Four types of criteria were used to select eligible studies for this review: STUDY DESIGN - randomised controlled trials (RCTs), non-RCTs with concurrent controls, and before-after studies (cohort or cross-sectional). PARTICIPANTS - pregnant women, mothers in the immediate postpartum period before the first breastfeed, any participant linked to pregnant women or new mothers, or any participant who may breastfeed in the future, or be linked to a breastfeeding woman in the future. INTERVENTIONS - any type of intervention designed to promote the uptake of breastfeeding was included; control groups could receive an alternative breastfeeding promotion programme or standard care. OUTCOMES - the primary outcome was initiation of breastfeeding; secondary outcomes (duration and exclusivity of breastfeeding) were included if initiation was reported in the same study; intermediate and process outcomes were also included, and need not necessarily be associated with reported initiation rates. DATA EXTRACTION AND VALIDITY ASSESSMENT: Data were extracted into structured tables. All included studies were checked against a comprehensive methodological checklist. Different checklists were used for RCTs, non-RCTs and before-after studies. Data extraction and validity assessment were independently checked by a second reviewer. DATA SYNTHESIS: The studies were grouped according to intervention type, and were combined using a narrative synthesis. For individual RCTs and non-RCTs reporting initiation of breastfeeding, relative risks with associated 95% confidence intervals were estimated, with calculations performed on an intention-to-treat basis where possible. Pooling of relative risks was considered inappropriate owing to the lack of similarity across the studies. RESULTS: A total of 59 studies met the selection criteria, comprising 14 RCTs, 16 non-RCTs and 29 before-after studies. Interventions were grouped into the following categories: health education, health sector initiatives (HSI) - general, HSI - Baby Friendly Hospital Initiative (BFHI), HSI - training of health professionals, HSI - US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), HSI - social support from health professionals, peer support, media campaigns, multifaceted interventions. In many cases, studies were dissimilar in terms of the type of intervention(s), participants and the definitions of outcomes. Methodological problems of some studies also limited interpretation of findings. (ABSTRACT TRUNCATED)

Breast Feeding↗
PubMed2001

A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge.

OBJECTIVE: Short postpartum stays are common. Current guidelines provide scant guidance on how routine follow-up of newly discharged mother-infant pairs should be performed. We aimed to compare 2 short-term (within 72 hours of discharge) follow-up strategies for low-risk mother-infant pairs with postpartum length of stay (LOS) of <48 hours: home visits by a nurse and hospital-based follow-up anchored in group visits. METHODS: We used a randomized clinical trial design with intention-to-treat analysis in an integrated managed care setting that serves a largely middle class population. Mother-infant pairs that met LOS and risk criteria were randomized to the control arm (hospital-based follow-up) or to the intervention arm (home nurse visit). Clinical utilization and costs were studied using computerized databases and chart review. Breastfeeding continuation, maternal depressive symptoms, and maternal satisfaction were assessed by means of telephone interviews at 2 weeks postpartum. RESULTS: During a 17-month period in 1998 to 1999, we enrolled and randomized 1014 mother-infant pairs (506 to the control group and 508 to the intervention group). There were no significant differences between the study groups with respect to maternal age, race, education, household income, parity, previous breastfeeding experience, early initiation of prenatal care, or postpartum LOS. There were no differences with respect to neonatal LOS or Apgar scores. In the control group, 264 mother-infant pairs had an individual visit only, 157 had a group visit only, 64 had both a group and an individual visit, 4 had a home health and a hospital-based follow-up, 13 had no follow-up within 72 hours, and 4 were lost to follow-up. With respect to outcomes within 2 weeks after discharge, there were no significant differences in newborn or maternal hospitalizations or urgent care visits, breastfeeding discontinuation, maternal depressive symptoms, or a combined clinical outcome measure indicating whether a mother-infant pair had any of the above outcomes. However, mothers in the home visit group were more likely than those in the control group to rate multiple aspects of their care as excellent or very good. These included the preventive advice delivered (76% vs 59%) and the skills and abilities of the provider (84% vs 73%). Mothers in the home visit group also gave higher ratings on overall satisfaction with the newborn's posthospital care (71% vs 59%), as well as with their own posthospital care (63% vs 55%). The estimated cost of a postpartum home visit to the mother and the newborn was $265. In contrast, the cost of the hospital-based group visit was $22 per mother-infant pair; the cost of an individual 15-minute visit with a registered nurse was $52; the cost of a 15-minute individual pediatrician visit was $92; and the cost of a 10-minute visit with an obstetrician was $92. CONCLUSIONS: For low-risk mothers and newborns in an integrated managed care organization, home visits compared with hospital-based follow-up and group visits were more costly but achieved comparable clinical outcomes and were associated with higher maternal satisfaction. Neither strategy is associated with significantly greater success at increasing continuation of breastfeeding. This study had limited power to identify group differences in rehospitalization and may not be generalizable to higher-risk populations without comparable access to integrated hospital and outpatient care.

Adult↗
PubMed2005

Screening for postnatal depression in routine primary care: properties of the Edinburgh Postnatal Depression Scale in an Australian sample.

OBJECTIVES: First, to explore the utility of the Edinburgh Postnatal Depression Scale (EPDS) in routine primary care through a large community screening program. Next, to compare administration of a second EPDS versus the Beck Depression Inventory (BDI) in identifying postnatal depression in the prescreened population. METHOD: Screening with the EPDS through Maternal and Child Health Centres at 4 months post-partum. Women scoring > or = 12 were assessed against DSM-IV criteria and completed a BDI and a second EPDS. These data were subjected to receiver operating characteristic (ROC) analyses. RESULTS: Of 4148 screened, 533 (12.8%) scored > or = 12. Of these, 344 were assessed against DSM-IV criteria: 193 (56%) - major depressive disorder; 67 (20%) - other diagnoses that incorporated depression. Positive predictive value at screening was therefore 76%. Another 45 (13%) had non-depressive disorders and 39 (11%) were psychiatric non-cases. The BDI was the better diagnostic instrument in the prescreened population, having a significantly higher efficiency as quantified by ROC curve analysis, though the absolute difference in efficiency was small (approximately 6%). CONCLUSIONS: Screening with the EPDS integrated well into routine primary care. Two-step screening offers one way of achieving acceptable balances of operational simplicity and diagnostic accuracy.

Adult↗
PubMed1998

The WHO antenatal care randomised controlled trial: rationale and study design.

The World Health Organisation and collaborating institutions in developing countries are conducting a multicentre randomised controlled trial to evaluate a new antenatal care (ANC) programme, consisting of tests, clinical procedures and follow-up actions scientifically demonstrated to be effective in improving maternal and newborn outcomes. These activities are distributed, for practical reasons, over four visits during the course of pregnancy and are aimed at achieving predetermined goals. The study is taking place in four countries, Argentina, Cuba, Saudi Arabia and Thailand. Recruitment of study subjects started on 1 May 1996. All 53 ANC clinical units had been enrolled by December 1996. Clinics in each country were randomly allocated (cluster randomisation) to provide either the new programme or the traditional programme currently in use. Approximately 24,000 women presenting for ANC at these clinics over an average period of 18 months will have been recruited. As women attending the control clinics receive the 'best standard treatment' as currently offered in these clinics, individual informed consent is requested only from women attending the intervention clinics. Authorities of the corresponding health districts and all participating clinics have provided written institutional informed consent before randomisation. The primary outcome of the trial in relation to maternal conditions is the rate of a morbidity indicator index, defined as the presence of at least one of the following conditions for which ANC is relevant: (a) pre-eclampsia or eclampsia during pregnancy or within 24 h of delivery; (b) postpartum anaemia (haemoglobin < 90 g/L); or (c) severe urinary tract infection/pyelonephritis, defined as an episode requiring antibiotic treatment and/or hospitalisation. The primary fetal outcome is the rate of low birthweight (< 2500 g). Adverse maternal and fetal outcomes are expected for approximately 10% of the control group. Several maternal and perinatal secondary outcomes are also considered. A comprehensive cost-effectiveness analysis and women's and providers' satisfaction evaluation are performed concurrently with the trial. Health-care programmes should be rigorously evaluated by randomised controlled trials, which are feasible in developing countries and should be conducted before introducing new treatments or health interventions.

Argentina↗
PubMed1995

Apoptosis contributes to the involution of beta cell mass in the post partum rat pancreas.

A significant reduction of beta cell mass has been described during the post partum period in the endocrine rat pancreas. We examined the mechanisms of this involution in Sprague Dawley rats by analyzing beta cell mass, beta cell replication, and beta cell size at end of pregnancy and 4 and 10 days after delivery. beta cell replication was significantly decreased at 4 days post partum but had returned back to nonpregnant levels by 10 days post partum. Similarly, beta cell size was significantly decreased at 4 and 10 days post partum as compared with the end of pregnancy, and at 10 days post partum was significantly decreased as compared with controls. At 4-6 days post partum, DNA fragmentation characteristic of apoptosis (programmed cell death) was detected in pancreatic islets, as assessed by in situ terminal deoxynucleotidyl transferase and nick translation assay. Only occasional cells were labeled with this assay in nonpregnant rats and at other time points after delivery. Condensed chromatin and apoptotic bodies, the morphological characteristics of apoptosis, were detected in beta cells of pancreatic islet at 3 and 4 days after delivery by electron microscopic analysis, confirming the occurrence of apoptosis in involuting islets. The expression of TRPM 2 and TGF beta 1, often enhanced in models of apoptosis, were studied during the post partum period by Northern blot analysis and immunohistochemistry. Levels of TRPM 2 gene and its protein, clusterin, were not different from controls; however, the TGF beta 1 gene and its protein expression were enhanced at 3 days post partum. Our study confirms the capability of beta cells to down-regulate their mass using the mechanisms of changes in rates of beta cell replication and of beta cell death, and changes in beta cell size to achieve homeostasis of the functional endocrine tissue.

Animals↗
PubMed1994

Breastfeeding practices and lactation mastitis.

Clinical impression suggests that lactation mastitis is associated with inexperienced nursers, improper nursing techniques, stress and fatigue. A pilot study was conducted to describe the frequency of self-reported breastfeeding practices during the first week post partum among 100 breastfeeding women delivering at a freestanding birthing center or participating in an early discharge program. Nine cases of lactation mastitis were identified from the survey population and an additional 8 from the target population for the survey. Seventeen controls matched by delivery date were identified from survey participants. The frequency of self-reported breastfeeding practices, the presence of fatigue and stress during the week prior to the mastitis date in the case was compared among cases and controls. In the first week post partum, most women fed their babies every 2-3 hr for approx. 20 min a feeding. The cradle or Madonna position was the most frequently used nursing position. Nine percent reported supplementing feedings with formula. Women with mastitis were more likely than controls to report a history of mastitis with a previous child. In the week prior to the mastitis date of the case, women with mastitis were more likely than controls to report breast or nipple pain and cracks or breast fissures. They were less likely to report being able to take a daytime nap. Future studies should focus on the relative importance of and interrelationships among these factors.

Adult↗
PubMed1994

[Clinical study of autologous blood transfusion in pregnant women].

The effect of autologous blood donation during the third trimester of pregnancy on the maternal circulation, the properties of blood collected in a phosplatebuffered citrate anticoagulant solution, and the clinical outcome of autologous blood donation and transfusion for pregnant women were investigated in this study. Thirty-four pregnant women with placenta previa or previous cesarean delivery underwent phlebotomies in an autologous transfusion program. Three hundred ml of blood was collected under the observation of fetal heart rate patterns and uterine contractions from 3 weeks prior to the planned date of cesarean section and a total of 900 ml of blood was stored. Electronic fetal monitoring tracings were all normal and changes in blood pressure and pulse rates were minimal during the blood donation. The decrease in hemoglobin after the removal of 900 ml of blood was only 0.6g/dl on average during the 3 weeks, since the concentration of erythropoietin in serum and the counts of reticlocyte increased in a few days after blood removal. But there were no significant changes in TAT levels in serum. Twelve out of 34 pregnant women received the autologous blood transfusion during or after cesarean delivery and the homologous transfusions were avoided. The results of this study suggested that autologous blood transfusion for pregnant women with a high incidence of blood loss at delivery, such as placenta previa or previous cesarean delivery was safe and advantageous in avoiding homologous blood transfusion.

Adult↗
PubMed1999

State-mandated voluntary newborn human immunodeficiency virus screening in a New York City Hospital.

OBJECTIVE: To report the experience with state-mandated voluntary newborn human immunodeficiency virus (HIV) screening in a large university hospital. METHODS: Retrospective analysis of delivery records and newborn HIV screening data for infants born between May 4, 1996, and January 31, 1997. RESULTS: Of 3111 women, 40% had HIV testing during pregnancy, 28% had testing before pregnancy, 30% never had testing, and 2% gave no information. Most (91%) consented to postpartum newborn HIV testing, although rates varied by HIV counselor (range 81-96%, P < .001) and maternal HIV testing history (range 72-94%, P < .001). Maternal antepartum HIV testing rates varied by delivering physician (range 8-100%, P < .001) and by antepartum care site (clinics, 83%; faculty practices, 72%; private practices, 57%; P < .001). Fourteen HIV-exposed infants (0.46% of infants tested) were identified, 13 of whom were born to women known to be HIV positive before delivery. These women had received zidovudine prophylaxis according to Adult AIDS Clinical Trials Group 076 guidelines. All 14 infants subsequently tested negative for HIV. Human immunodeficiency virus-positive women were more likely than HIV-negative women to have received antepartum care in clinics (93% compared with 11%), have care paid by Medicaid (93% compared with 28%), and reside in high-risk areas (72% compared with 11%) (P < .001). CONCLUSION: Newborn HIV screening has little incremental impact in settings with aggressive antepartum screening and/or low HIV infection rates. Interventions to increase antepartum HIV screening in the private sector should be implemented.

Adult↗
PubMed2005

Factors influencing the initiation and duration of breastfeeding among low-income women followed by the Canada prenatal nutrition program in 4 regions of quebec.

The factors that influence the actual initiation and duration of breastfeeding were studied among low-income women followed by the Canada Prenatal Nutrition Program (CPNP). A group of 196 pregnant women were selected at random from a sample of 6223 pregnant women who registered with the CPNP. Two 24-hour recalls and information regarding lifestyle habits, peer support, and infant-feeding practices were obtained between 26 and 34 weeks of gestation and 21 days and 6 months after birth. Women who received a university education (completed or not completed) versus women with < or = high school education (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.02-69.50), women born outside Canada (OR,8.81; 95% CI, 3.34-23.19), and women of low birth weight infants (OR, 0.39; 95% CI, 0.16-0.96) were more likely to initiate breastfeeding. Late introduction of solid foods (P = .004), nonsmoking (P = .005), multiparity (P = .012), and a higher level of education (P = .049) were positively associated with the duration of breastfeeding among initiators. Understanding factors associated with initiation and duration of breastfeeding among low-income women is critical to better target breastfeeding promotion.

Adult↗
PubMed2005

Factors that influence women's decisions about whether to participate in research: an exploratory study.

BACKGROUND: Women are increasingly being asked to consider participating in medical research. We sought to investigate views of women who participated in and declined to participate in a study that was part of a program of maternity care research. METHODS: An exploratory study using focus group interviews and semistructured interviews was conducted. A purposive sample of 17 postnatal women who had participated in research, from a hospital in the North West of England, were interviewed. An open coding mechanism to identify emergent themes was used for the analysis of data. RESULTS: Of women who had not declined to participate in any research, the following themes were identified: altruism versus self-protection, enhanced versus inferior care, professional guidance versus self-direction, and welcome versus unacceptable methodology. Of women who had participated in some research but declined to participate in other research, the following themes were identified: feeling disempowered by the process, inability to believe equipoise existed, and practical inconvenience. CONCLUSIONS: These findings suggest that although health care researchers adopt an individualistic approach to care, they may fail to adopt a similar approach within research. What is important and acceptable to women needs to be ascertained to develop appropriate research strategies. This plan will ensure that research is carried out to the highest ethical standard, which may increase recruitment rates.

Clinical Trials as Topic↗
PubMed2001

Peripartum plasticity within the hypothalamo-pituitary-adrenal axis.

The hypothalamo-pituitary-adrenal (HPA) axis plays important roles in the adaptive changes in physiology that occur during pregnancy and lactation. Although the axis still exhibits a pulsatile pattern of secretion, the normal diurnal rhythm of pulse amplitude is lost during lactation, such that mean basal levels remain constant throughout the day. In addition, the peripartum period is associated with a remarkable plasticity in stress-induced HPA activity, in that the increase of HPA activity normally seen in response to either physical or psychological stresses in the non-reproductive state become severely attenuated or absent in the lactating animal. This stabilization of both basal and stress-induced HPA activity may be important for maintaining a constant endocrine environment, thereby preventing any programming effects on the developing offspring. Attenuation of the stress response is initiated in late pregnancy and is temporally associated with luteolysis, indicating possible steroid hormone involvement. Indeed, mimicking the luteolytic changes in oestrogen and progesterone levels in non-pregnant animals induces a similar attenuation of the stress response. Furthermore down-regulation of the stress response is, at least in part, centrally mediated since in the period following luteolysis rats will show a decreased level of stress-induced neuronal activation of the PVN, as measured by the expression of either c-fos or CRH mRNAs. Persistence of this adapted state is dependent upon the continued suckling stimulus, as removal of the offspring litter rapidly leads to resumption of HPA responses to and the appearance of an exaggerated diurnal rhythm. The underlying mechanisms responsible for this stress hyporesponsiveness may include plasticity of noradrenergic and oxytocin pathways. In view of its role in other reproductive behaviors, a stress-inhibiting effect of oxytocin may reflect a more widespread co-ordinating role in the peripartum animal.

Animals↗
PubMed2006

Health professional's knowledge and awareness of perinatal depression: results of a national survey.

INTRODUCTION: Postnatal depression affects 14% of women, occurring also antenatally, with potential long-term consequences, making it an important disorder to detect and manage early. In this study we sought to examine knowledge and awareness of perinatal depression in health professionals involved in perinatal care throughout Australia prior to the implementation of a comprehensive screening program, aimed at improving detection and access to appropriate management. METHODS: A random sample of General Practitioners (GPs) and Maternal Child Health Nurses (MCHNs) and Midwives, in regions throughout Australia to be subsequently targeted by a screening and education program, were invited to participate. Responses to a hypothetical vignette and a knowledge questionnaire, as well as details of experience were completed. FINDINGS: Questionnaires were completed by 246 GPs, 338 MCHNs and 569 midwives, with overall response rates; GP's 23%; MCHN's 55% and midwives 57%. Although knowledge level was similar among professional groups, MCHNs had higher levels of awareness of perinatal depression. Both GPs and MCHNs were more likely than midwives to recognize the need for providing help to women with emotional distress. Depression was more likely to be considered postnatally than antenatally in all groups, with GPs most likely to provide this diagnosis. GPs had a significant propensity to recommend antidepressants, and midwives to select non-specific medications. CONCLUSIONS: Health professionals responding to this survey had a high awareness and similar knowledge base. Further education on antenatal depression and the safety risks and alternatives to medication is important for all groups, but particularly important for midwives and GPs. The latter is especially relevant given the preference for women with perinatal depression not to use pharmacological interventions to treat their emotional distress.

Analysis of Variance↗
PubMed1994

Childbirth in rural areas: maternal deaths, village deliveries and obstetric service use.

We explored village maternal deaths in an area of the East Sepik Province of Papua New Guinea where most women delivered at home. Postpartum haemorrhage, retained placenta and puerperal sepsis were common causes of death. Follow-up of a group of pregnant women showed that abnormal labour was frequent. 24% of multigravidae (95% CI 17-33) reported a labour that lasted longer than 24 hours. In 9% of all births (95% CI 5-15) the third stage lasted longer than one hour, or products were retained. Despite a high proportion of obstetric complications in apparently low-risk villages births, few women attend a health facility for delivery. Health centre attenders were a relatively privileged group. Some hospital users complained about staff attitudes. A poor reputation means that women are less likely to use health services for delivery. Providers need to improve the acceptability of the care provided, and communities should be encouraged to help with transport for their women to go to a health facility when they are in labour.

Community Health Services↗
PubMedDate not supplied

Barriers to prenatal care among low-income women in New York City.

Postpartum in-hospital interviews with 496 low-income women in New York City revealed that attitudinal and motivational barriers as well as financial obstacles are significant impediments to timely initiation of prenatal care. The two most common reasons cited by these women in explaining why they had obtained prenatal care late or not at all were motivational items: "feeling depressed and not up to going for care" and "needing time and energy to deal with other problems." In logistic regression analyses, receipt of late or no prenatal care was significantly associated with the latter motivational barrier, along with the cost of care, having no health insurance, being Hispanic, being a substance abuser and holding negative attitudes toward the use of prenatal care.

Adolescent↗
PubMed2001

Calf removal improves conception rates to the Ovsynch and CO-Synch protocols.

Beef cows (n = 473) from two locations were stratified by breed, postpartum interval, age, and AI sire and were randomly allotted to one of four treatments for synchronization of ovulation. Ovulation synchronization protocols included the Ovsynch protocol with (n = 114) or without (n = 123) 48-h calf removal from d 7 to 9 (d 0 = 1st GnRH injection) or the CO-Synch protocol with (n = 119) or without (n = 117) 48-h calf removal from d 7 to 9. The Ovsynch protocol included administration of GnRH (100 microg; i.m.) on d 0, PGF2alpha (25 mg; i.m.) on d 7, GnRH (100 microg; i.m.) on d 9, and timed insemination on d 10. The CO-Synch protocol included administration of GnRH (100 microg; i.m.) on d 0, PGF2alpha (25 mg; i.m.) on d 7, and GnRH (100 microg; i.m.) with timed insemination on d 9. Blood samples were collected from all cows on d -10 and d 0 for analysis of serum progesterone. Cows with at least one serum progesterone concentration greater than 1 ng/mL were considered to be cyclic at the time of treatment. Conception rates of cows that received the CO-Synch + calf removal, Ovsynch + calf removal, CO-Synch, or Ovsynch protocol (63, 61, 54, and 52%, respectively) were not different (P = 0.50). Conception rates were not different (P = 0.80) among CO-Synch- and Ovsynch-treated cows; however, both estrual status and 48-h calf removal affected conception rates. Conception rates of cyclic cows (66%) were greater (P = 0.01) than those of anestrous cows (53%), regardless of which synchronization protocol was used. When data were pooled across synchronization protocol, conception rates of cows with 48-h calf removal (62%) were greater (P = 0.09) than conception rates of cows without calf removal (53%). The CO-Synch + calf removal protocol induces a fertile ovulation in cyclic and anestrous cows, requires handling cattle just three times, results in high conception rates from timed insemination, and should be a useful program for synchronization of ovulation in beef cows.

Anestrus↗