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PubMed1999

The obstetrical and postpartum benefits of continuous support during childbirth.

The purpose of this article is to review the evidence regarding the effectiveness of continuous support provided by a trained laywoman (doula) during childbirth on obstetrical and postpartum outcomes. Twelve individual randomized trials have compared obstetrical and postpartum outcomes between doula-supported women and women who did not receive doula support during childbirth. Three meta-analyses, which used different approaches, have been performed on the results of the clinical trials. Emotional and physical support significantly shortens labor and decreases the need for cesarean deliveries, forceps and vacuum extraction, oxytocin augmentation, and analgesia. Doula-supported mothers also rate childbirth as less difficult and painful than do women not supported by a doula. Labor support by fathers does not appear to produce similar obstetrical benefits. Eight of the 12 trials report early or late psychosocial benefits of doula support. Early benefits include reductions in state anxiety scores, positive feelings about the birth experience, and increased rates of breastfeeding initiation. Later postpartum benefits include decreased symptoms of depression, improved self-esteem, exclusive breastfeeding, and increased sensitivity of the mother to her child's needs. The results of these 12 trials strongly suggest that doula support is an essential component of childbirth. A thorough reorganization of current birth practices is in order to ensure that every woman has access to continuous emotional and physical support during labor.

Breast Feeding↗
PubMed1979

[Continuous lumbar peridural anesthesia in obstetrics].

Review of 1000 continuous peridural anesthesias during labor and delivery. Reasons and conditions for the application of this analgetic procedure in our delivery rooms are discussed. The duration of labor and delivery is reduced by this method. The rate of vacuum extraction and forceps delivery is slightly increased. The rate of cesarean section is independent of this procedure. No adverse effects on the fetus were found. We obtained complete analgesia in 93 per cent of the cases. Severe complications were not observed.

Anesthesia, Epidural↗
PubMed2003

[Perinatal care in Livno immediately after the war from 1995 to 1999].

The paragraphs of statistics for maternity hospital of county hospital in Livno for period 1995-1999, year are presented and describe perinatal, fetal and early neonatal mortality, newborns to birth-weight, the frequency of caesarean section, eclampsia, vacuum extraction, antenatal care and equipment maternity hospital and morbidity of the infants. Perinatal mortality in 1995 was 5.6@1000, but for 4 years 6.9@1000. Early neonatal mortality was appearing till 1996 year only with one death of newborn (1.1@1000). Fetal mortality was increased to 12.3@1000 in 1997; but the years before was 6.2@1000. According to the weight of newborns, 3.5% were no more than 2.500 g, but 93.5% were between 2.500-3.000 g, while newborns over 4.000 g where 3.0 percent. Watching and closely looking statistics for years in the classified groups does not fortify the major differences, except 1995 when was 1.7% newborns less than 2.500 g, but over 4.000 g 7.9%, that is under average and explaining to the minimum numbers of birth that year, and orienting refugees and exilied pregnant women to the centres with stronger obstetric and neonatal care Eclampsy were 9 and it was 2.2@1000. The number of antenatal visits of pregnant women increase during all these years, so that total number of visits was 20.905, that means 5.2 was the middle number of visits. There are much more without 2.0% or less than 3 visits 5.0%; with 9 or more 29.0%; the average number ultrasound examination is 3.4, and total 13.748, 37.0 percent of pregnant women is with 3 examples and 10.0% with 4 or over it, but 7.0% without ultrasonographc. It is obviously, that the number of the pregnant women without ultrasound examination is falling, so in 1995 there was 14.0% but 2.0% in 1999. Very important is increase those with 3 examination according to 1995 when there was 27.0%, but 47.0% in 1999. The usage of caesarean section is 7.7% but the major increase was in 1998 and it was 9.4% and 1999 is 10.1%. Vacuum extraction was used in 67 (1.7%) of newborns but in 1995 was 3.2%, the obstetric activity does three gynecologists. For perinatal mortality is important to say, that, during the war time, about 6.9@1000 in maternity hospital Livno was ranged into the group with low perinatal mortality. According to, the number of vacuum extraction belongs to the number of maternity hospital with vacuum extractions below 2.0%. Maternity hospital has two incubator after 1997 year and cardiotocographic intrapartal monitoring was used in about 55-65% of all deliveries.

Adult↗
PubMed1982

The effect of sickle cell anemia on obstetric performance in a Nigerian community.

Twenty-six pregnancies in 20 parturients were studied. There was a high frequency of antenatal complications, especially bone pain crisis (61%), haemolytic crisis (31%), urinary tract infection (42%), pneumonia (23%) and malaria (23%). Ninety-six percent of the patients were anaemic at first clinic attendance. There was a high operative delivery rate (29%), mainly by forceps or vacuum extraction. The perinatal mortality rate was 250 per 1000. There was one maternal death.

Adolescent↗
PubMed2006

First cesarean birth and subsequent fertility.

OBJECTIVE: To determine whether cesarean delivery is independently associated with later subfertility. DESIGN: Retrospective cohort study. SETTING: Maternity records kept for Scotland, 1980-1999. PATIENT(S): The study included 109,991 women who had first births between 1980 and 1984, excluding multiple or preterm births and perinatal deaths. INTERVENTION(S): Exposures studied were spontaneous vaginal birth, operative vaginal birth, planned cesarean delivery for breach presentation, planned cesarean delivery for other indications, and emergency cesarean delivery. MAIN OUTCOME MEASURE(S): The relative risk of not having a second pregnancy over the following 15 years, the interpregnancy interval, and the number of spontaneous early pregnancy losses between the first and second birth. RESULT(S): Women who delivered by planned cesarean section for breech presentation had an increased risk of not having a second birth compared with women whose first birth was a spontaneous vertex delivery (relative risk [RR]: 1.21, 95% confidence interval [CI]: 1.14 to 1.29). However, after adjustment for maternal and obstetric characteristics, there was no longer a strong association (adjusted RR: 1.07, 95% CI: 1.00 to 1.15). Operative vaginal delivery (forceps and vacuum extraction) and all types of cesarean delivery were associated with longer interpregnancy intervals. There was no relationship between mode of delivery and the number of spontaneous early pregnancy losses between the first and second birth. CONCLUSION(S): It is unlikely that delivering by cesarean section in a first pregnancy decreases a woman's likelihood of having a second viable pregnancy.

Abortion, Spontaneous↗