Social Issues Among Children With High or Intermediate Imperforate Anus: A Proxy Perspective

PROBLEM:  Children with imperforate anus (IA) may be psychosocially affected.
METHODS:  Parents of children with IA and parents in two comparison groups rated their children using a study-specific questionnaire and the Competence Scales in the Child Behavior Checklist (CBCL). Teachers rated Academic and Adaptive Functioning Scales in the Teacher's Report Form (TRF).
FINDINGS:  School items were rated favorably by the fathers of children with IA, and mothers reported less expression of their children's will. Children with IA were socially competent according to CBCL, although they received lower ratings on the TRF.
CONCLUSIONS:  Psychosocial issues seem to be challenging for children with IA, and this needs attention in care management.     

Onset of Vocal Interaction Between Parents and Newborns in Skin‐to‐Skin Contact Immediately After Elective Cesarean Section

Abstract: Background: Cesarean section is associated with delayed mother‐infant interaction because neither the mother nor the father routinely maintains skin‐to‐skin contact with the infant after birth. The aim of the study was to explore and compare parent‐newborn vocal interaction when the infant is placed in skin‐to‐skin contact either with the mother or the father immediately after a planned cesarean section. Methods: A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin‐to‐skin contact either with fathers or mothers after an initial 5 minutes of skin‐to‐skin contact with the mothers after birth. The newborns’ and parents’ vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns’ and parents’ soliciting, newborns’ crying and whining, and parental speech directed to the other parent and to the newborn. Results: Newborns’ soliciting increased over time (p = 0.032). Both fathers and mothers in skin‐to‐skin contact communicated more vocally with the newborn than did fathers (p = 0.003) and mothers (p = 0.009) without skin‐to‐skin contact. Fathers in skin‐to‐skin contact also communicated more with the mother (p = 0.046) and performed more soliciting responses than the control fathers (p = 0.010). Infants in skin‐to‐skin contact with their fathers cried significantly less than those in skin‐to‐skin contact with their mothers (p = 0.002) and shifted to a relaxed state earlier than in skin‐to‐skin contact with mothers (p = 0.029). Conclusions: Skin‐to‐skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin‐to‐skin contact and exposed to the parents’ speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin‐to‐skin contact after cesarean section, to support the early onset of the first vocal communication. (BIRTH 37:3 September 2010)     

Relationship between plasma total homocysteine level and dietary caffeine and vitamin B6 intakes in pregnant women

A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B₆ antagonist. The objective of this study was to examine a relationship between circulating tHcy levels and dietary caffeine and vitamin B₆ intakes in pregnant Japanese women. A total of 321 healthy women with singleton pregnancies were recruited in metropolitan Tokyo, from June to December 2008, resulting in the final number included in the study as 254. Dietary caffeine intakes did not correlate with plasma tHcy levels. When we analyzed the data according to caffeinated beverages, caffeinated tea consumption was positively associated with plasma tHcy levels only among the women with a high intake of vitamin B₆, after controlling for confounding factors (P = 0.029). No correlation between coffee consumption and plasma tHcy levels was found. Pregnant Japanese women might need to cut down the consumption of caffeinated tea as well as take sufficient vitamin B₆ in order to prevent the tHcy levels from increasing.     

Transfers in Planned Home Births Related to Midwife Availability and Continuity: A Nationwide Population‐Based Study

ABSTRACT: Background: Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. Methods: A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care‐related risk factors for being transferred were measured using logistic regression. Results: Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8–3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1–9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1–9.4) and multiparas (RR 3.4; 95% CI 1.3–9.0). Conclusions: The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwife’s unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred. (BIRTH 35:1 March 2008)