Unauthorised pregnancies and use of maternity care in rural China

ABSTRACT

Objectives To describe the use of maternity care in rural China by the legal status of the pregnancy.

Methods Cross-sectional survey wherein information was obtained about 2576 women who gave birth in 2006. Logistic regression was used to compare women having an unauthorised pregnancy with those having an authorised second birth, adjusting for confounding factors.

Results Almost all respondents had antenatal care and most deliveries occurred in hospitals. Women with unauthorised pregnancies were significantly less likely to have had maternity care, particularly prenatal care, postnatal care, to have been hospitalised during pregnancy, and to have been reimbursed for hospital delivery costs than women with an authorised second birth. They were also more likely to have been hospitalised for seven or more days after delivery. Primiparous women used maternity care services and received financial support more often than women with an authorised second birth. Among the women with an unauthorised pregnancy an important reason for not using hospital care during pregnancy or delivery was financial constraint.

Conclusions Women with unauthorised pregnancies use less maternity care, although pregnancy in such circumstances may adversely impact their health. Primiparous women benefit from more financial support than multiparous women.     

The experience of pregnancy, labour and birth of Thai women in Australia.

OBJECTIVE: To identify the perceptions and experience of pregnancy care, labour and birth of Thai women in Melbourne, Australia. DESIGN: An ethnographic interview and participant observation with women in relation to pregnancy, labour and birth. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 30 Thai women who are now living in Melbourne. FINDINGS: Thai women saw antenatal care as an important aspect of their pregnancy and sought care as soon as they suspected they were pregnant. They were more concerned about the well-being of their babies than their own health, therefore they attended all antenatal appointments. In general, these women were satisfied with care during labour, but some also had negative experiences with their caregivers and hospital routine. When asked to compare maternity services between Thailand and Australia, most of the women believed that services in Australia were better. However, women who had had good experiences of childbirth in Thailand, tended to have negative feelings about the Australian experience. There was also evidence in this study that most of these Thai women did not receive adequate information about care. IMPLICATIONS FOR PRACTICE: Women's perceptions and experiences of antenatal care, labour and birth deserve attention, if appropriate and sensitive care is to be provided to women in Australia and elsewhere. It is only when women's voices are heard in all aspects of health-care delivery that we may see better and appropriate health services for women in childbirth.     

Pregnancy and alcohol use: evidence and recommendations for prenatal care

Pregnancy alcohol consumption has been linked to poor birth outcomes and long-term developmental problems. Despite this, a significant number of women drink during pregnancy. Although most prenatal care providers are asking women about alcohol use, validated screening tools are infrequently employed. Research has demonstrated that currently available screening methods and intervention techniques are effective in identifying and reducing pregnancy drinking. Implementing universal screening and appropriate intervention for pregnancy alcohol use should be a priority for prenatal care providers, as these efforts could substantially improve pregnancy, birth, and longer term developmental outcomes for those affected.     

Women's perspectives on maternity services in Sweden: processes, problems, and solutions

Most measures of health care quality focus on medical outcomes rather than patients' assessments of quality. Drawing on data from a national survey of Swedish women, this study describes women's opinions about what is important to them during pregnancy and birth. This qualitative study is based on responses of 827 pregnant women to an open question completed in the second trimester. In total, 2061 separate statements were analyzed. Using content analysis, these statements were clustered into 4 themes: desirable characteristics of midwife, prenatal care during pregnancy, care during labor and birth, and care after birth. Within those themes, 13 categories were found. Findings suggest areas for improvement in maternity services including: the timing and length of prenatal visits, making parent education classes available to all women, prelabor visits to the maternity ward, continuous information about the progress of labor, flexibility in time of discharge, and postpartum support for families. Women also stated that characteristics of the midwife, such as being supportive, friendly, attentive, respectful, and nonjudgemental, were important. A patient-centered and individualized approach, with women and their partners as the subjects rather than the objects of care, would increase satisfaction and the overall quality of maternity services in Sweden.     

Hospitalizations during pregnancy among managed care enrollees

OBJECTIVE: To describe the prevalence of hospitalizations during pregnancy, the reason for hospitalization, the length of stay, and the associated costs. METHODS: We analyzed data from a national managed care organization and determined the occurrence of hospitalizations for 46,179 women who had a live birth or a pregnancy loss in 1997. RESULTS: Overall, 8.7% of women were hospitalized during their pregnancy. Of these, 5.7% were hospitalized and discharged while pregnant, 0.8% experienced extended stays before a live birth or pregnancy loss, and 2.1% experienced pregnancy loss. Hospitalizations were more common among younger women, women with multiple gestations, and women in the northeastern United States. Women who had a live birth were primarily hospitalized for preterm labor (24%), hyperemesis (9%), hypertension (9%), kidney disorders (6%), and prolonged premature rupture of membranes (6%). Charges totaled over $36 million. CONCLUSION: Antenatal hospitalizations are common.     

Comparison of Perception of Pregnancy Risk of Nulliparous Women of Advanced Maternal Age and Younger Age

Introduction : Over the last 3 decades, the proportion of women who have delayed childbearing into their mid 30s and early 40s has been increasing. Because advanced maternal age (AMA) is associated with several adverse maternal, fetal, and neonatal outcomes, these pregnancies are considered to be “high risk.” Research indicates that pregnancy risk perception is an important factor in pregnant women's health care use and decision making during pregnancy. The objectives of this study were to compare risk perception in pregnant women of AMA (aged 35 years or older) with that of younger women and to explore the relationship between perception of pregnancy risk and selected variables. Methods : A sample of 159 nulliparous pregnant women (105 aged 20‐29 years and 54 aged 35 years or older) was recruited from a variety of settings in Winnipeg, Manitoba, Canada. Women were asked to complete questionnaires to assess perception of pregnancy risk, risk knowledge, pregnancy‐related anxiety, perceived control, health status, and medical risk. Results : Women of AMA had higher education levels, were more likely to work during pregnancy, and had higher medical risk scores than younger women. Women of AMA perceived higher pregnancy risk for both themselves and their fetuses than did younger women. They rated their risks of cesarean birth, dying during pregnancy, preterm birth, and having a newborn with a birth defect or one needing admission to a neonatal intensive care unit higher than those of younger women. There were no significant differences between the 2 age groups in pregnancy‐related anxiety, knowledge of risk, perceived control, and health status. Discussion : Women of AMA have a higher perception of pregnancy risk than younger women, regardless of their medical risk. This evidence suggests that incorporating discussions of pregnancy risk into prenatal care visits may assist pregnant women of AMA to make more informed choices, reduce anxiety, and avoid unnecessary interventions.     

Do foreign-born women in Sweden have an increased risk of non-normal childbirth?

BACKGROUND: In this cross-sectional study, we analyze whether foreign-born women in Sweden had more non-normal childbirths than Swedish-born women during 1996-1998, adjusting for age, parity, level of education, number of antenatal care visits, and complications in pregnancy. METHODS: The study includes 215 497 singleton deliveries (including the first childbirth of each woman during the time period) of women aged 18-47 in Sweden during 1996-1998, divided into 12 subgroups of countries. The risk of non-normal birth was analyzed by means of logistic regression. RESULTS: Women from Sub-Saharan Africa, Iran, Asia, and Latin America had a higher age-adjusted risk of non-normal childbirth than Swedish-born women that remained and even increased for the African and Latin American women in the main effect model. Interactions between country of birth and antenatal care visits showed that women from Sub-Saharan Africa, Iran, Asia, and Latin America had almost 50% higher risk of non-normal birth with > or =13 antenatal care visits than Swedish-born women. Interactions between country of birth and complications in pregnancy showed that women from Turkey, Iran, Asia, and Latin America had over 50% higher risk of non-normal birth than the Swedish-born women. CONCLUSIONS: This study shows an association between being foreign-born and non-normal childbirth. Questions can be raised whether we are aware of, pay sufficient attention to, and allocate sufficient resources for these women at higher risk of non-normal birth in maternity care.     

Prenatal care and the low birth weight infant

In this study the authors assessed human and economic consequences of low birth weight linked to the lack of prenatal care for indigent women. Low birth weight infants were defined as those who weighed between 860 and 2220 g, corresponding to the 50th percentiles at 26 and 34 weeks' gestation. Women seeking prenatal care had a significantly decreased incidence of low birth weight infants compared with those without such care. Concomitantly, low birth weight infants born to women with prenatal care had significantly better perinatal survival as well as less frequent respiratory distress and intraventricular hemorrhage. Because of these factors, infants born to clinic mothers used fewer neonatal intensive care days and had shorter hospitalizations. Hospital costs were reviewed for 175 surviving infants and failure to obtain prenatal care was associated with a 50% increase in costs for each infant. The frequencies of the most common pregnancy complications in women with and without prenatal care, coupled with corresponding obstetric interventions, suggest that such care facilitates identification and management of women at risk for delivery of low birth weight infants. The authors conclude that there are important human and economic advantages of antenatal care for indigent women.     

432 Somali Women's Birth Experiences in Canada after Earlier Female Genital Mutilation

Background: Women with previous female genital mutilation (sometimes referred to as circumcision) are migrating, with increasing frequency, to countries where this practice is uncommon. Many health care professionals in these countries lack experience in assisting women with female genital mutilation during pregnancy and birth, and they are usually untrained in this aspect of care. Somali women who customarily practice the most extensive form of female mutilation, who were resident in Ontario and had recently given birth to a baby in Canada, were surveyed to explore their perceptions of perinatal care and their earlier genital mutilation experiences. Method: Interviews of 432 Somali women with previous female genital mutilation, who had given birth to a baby in Canada in the past five years, were conducted at their homes by a Somali woman interviewer. Results: Findings suggested that women's needs are not always adequately met during their pregnancy and birth care. Women reported unhappiness with both clinical practice and quality of care. Conclusions: Changes in clinical obstetric practice are necessary to incorporate women's perceptions and needs, to use fewer interventions, and to demonstrate greater sensitivity for cross‐cultural practices and more respectful treatment than is currently available in the present system of care.     

Perinatal Outcomes and Satisfaction with Care in Women with High Body Mass Index

Introduction: The majority of studies on pregnant women with high body mass index (BMI) have focused on medical complications and birth outcome, rather than these women's encounters with health care providers. The aims were to identify the proportion of pregnant women with high BMIs (≥30); compare maternal characteristics and pregnancy and birth outcomes; and assess the experiences of prenatal, intrapartum, and postnatal care in women with high (≥30) and lower (<30) BMIs. Methods: Data were collected through questionnaires and antenatal records from 919 women recruited in mid‐pregnancy at 3 hospitals in the north of Sweden, with a follow‐up questionnaire 2 months after birth. Results: The prevalence of obesity was 15.2%. Women with high BMIs were more often aged 35 years or older and less likely to have a university education. They had more negative attitudes regarding being pregnant and reported more childbirth fear compared to women with lower BMIs, but they did not differ in regard to their feelings about the approaching birth or the first weeks with the newborn. They reported more pregnancy complications and had less continuity of caregiver. High BMI was associated with labor induction and emergency cesarean birth. No differences were found in birth complications; birth experience; or satisfaction with prenatal, intrapartum, or postnatal care. Discussion: The findings reveal that women who are obese have more complicated pregnancies and births but are generally satisfied with the care they receive. There are some differences in the way they experience care. Health care providers have a delicate task to provide sufficient information about health risks while still offering respect, encouragement, and support.     

Why Do Women Seek Antenatal Care Late? Perspectives From Rural South Africa

Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women's primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.     

Pregnancy complications in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. There is an increasing body of evidence indicating that PCOS may have significant implications for pregnancy outcomes and long-term health of a woman and her offspring. Whether or not PCOS itself or the symptoms that coincide with PCOS, like obesity and fertility treatment, are responsible for these increased risks is a continuing matter of debate. Miscarriage rates among women with PCOS are believed to be increased compared with normal fertile women, although supporting evidence is limited. Pregnant women with PCOS experience a higher incidence of perinatal morbidity from gestational diabetes, pregnancy-induced hypertension, and preeclampsia. Their babies are at an increased risk of neonatal complications, such as preterm birth and admission at a neonatal intensive care unit. Pre-pregnancy, antenatal, and intrapartum care should be aimed at reducing these risks. The use of insulin sensitizing drugs to decrease hyperinsulinemic insulin resistance has been proposed during pregnancy to reduce the risk of developing preeclampsia or gestational diabetes. Although metformin appears to be safe, there are too few data from prospective, randomized controlled trials to support treatment during pregnancy.     

Risk factors for preterm birth in Vietnam.

OBJECTIVE: To identify the risk of preterm birth and possible determinants among women in Hanoi, Vietnam. METHOD: Prospective cohort study of 1709 women with singleton live births at Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam, June-October 2002. Logistic regression analysis was used to examine predictors of preterm birth (<37 weeks' gestation). RESULT: The risk of preterm birth was 11.8%. Physically demanding work during pregnancy, two or more prior spontaneous abortions, history of preterm birth, vaginal bleeding, inadequate prenatal care during the first 20 weeks of gestation, and history of intrauterine device use with removal less than 12 months before the current pregnancy were associated with increased risk of preterm birth (adjusted odds ratios between 1.8 and 2.6). CONCLUSION: Preterm birth is relatively frequent in this population. Beyond established risk factors, these data implicated agricultural work and physical work demands with preterm birth, as well as history of recent IUD use.     

Geburtshilfe bei Adipositas permagna

Obesity presents a major challenge during pregnancy, birth and in the postpartum period. Indeed, certain illnesses during pregnancy such as hypertension, gestational diabetes and preeclampsia occur significantly more commonly in obese individuals. There is also a higher incidence of cesarean sections in obese individuals, a fact which requires clarification. In general, the fetal outcome is only marginally poorer than that for babies born to normal weight mothers, although more hypertrophic babies are born which require a children’s hospital. Consideration should be given to weight reduction before a planned pregnancy. Obese pregnant women require more care than normal weight women in order to prevent or effectively control complications. If this is carried out, then the fetal outcome is comparable to that from normal weight mothers.     

What Somali women say about giving birth in Canada

It is estimated that about 130 million women worldwide have been circumcised and that 2 million or more girls experience this procedure each year. Women with previous female genital mutilation/circumcision are immigrating, with increasing frequency, to countries where this practice is uncommon. Many health care providers in these countries lack experience in assisting women with female genital mutilation during pregnancy and birth and are usually untrained in this aspect of care. In this study, Somali women (who customarily practise the most extensive form of female mutilation), who were resident in Ontario and who had recently given birth to a baby in Canada, were asked about their experiences in an attempt to explore the situation faced by women in Canada. A total of 432 Somali women with previous female genital mutilation who had given birth to a baby in Canada in the past 5 years were interviewed at home by a Somali interviewer.Women's comments are reported. Findings suggest that women are frequently treated in ways that are perceived to be harsh and even offensive to cultural values. Women are, however, also appreciative of the clinical care they receive. There is a need to modify knowledge about female genital mutilation as well as attitudes towards women who have experienced this practice during perinatal care. Less interventionist clinical care, and increased sensitivity for cross-cultural practices together with more respectful treatment, are needed.     

Childbirth Fear: Relation to Birth and Care Provider Preferences

Introduction

The purpose of this study was to assess how preferences for place of birth and mode of birth relate to different dimensions of childbirth fear and whether there is an association between Canadian women's prenatal fear of childbirth and the type and quality of prenatal care they received.

Methods

A link to an online survey was posted on Canadian pregnancy and birth websites; 409 women completed the survey that included sociodemographic questions, questions about the current pregnancy and previous pregnancy experiences (if applicable), and the Childbirth Fear Questionnaire, a validated 40‐item scale that measures 9 dimensions of childbirth fear.

Results

Women under physician care and those with a preference for cesarean birth were generally more fearful of pain associated with vaginal birth, fear of loss of sexual pleasure and attractiveness, and fear of harm to themselves or their infant. Conversely, women under the care of midwives and women who preferred to give birth vaginally were more fearful of interventions. Women who preferred a cesarean birth were significantly more likely to report that fear of childbirth interfered with daily functioning, compared to women who preferred a vaginal birth. Satisfaction with care was associated with lower scores on the Childbirth Fear Questionnaire full and subscales, especially among midwifery clients.

Discussion

At present there are no guidelines in Canada or the United States for the treatment and/or referral of pregnant women who suffer from childbirth fear. Until such guidelines are developed, findings from the current study can help maternity care providers identify and address specific fears among women in their care and understand how different fear domains relate to care provider choice, satisfaction with care, and women's preferences for place and mode of birth.     

Relationships between physical abuse during pregnancy and risk factors for preterm birth among women in Manitoba

OBJECTIVE: To describe the prevalence and correlates of physical abuse during the year of pregnancy and to explore the association between physical abuse and other risk factors for preterm birth. DESIGN: Secondary analysis of data from a case-control study of risk factors for preterm birth. SETTING: Two tertiary care hospitals in the Canadian province of Manitoba. PARTICIPANTS: Six hundred eighty postpartum women who delivered a live singleton newborn after spontaneous onset of labor. MAIN OUTCOME MEASURES: Instruments included the Abuse Assessment Screen, Prenatal Psychosocial Profile, Perceived Stress Scale, and a questionnaire to collect data on demographic characteristics, complications during pregnancy, and lifestyle behaviors. RESULTS: Sixty-four women (9.4%) reported being physically abused during the year of pregnancy. Abused women were significantly more likely to be younger, single, of lower income, and less educated than nonabused women. Significant correlates of abuse, after adjusting for other factors in a logistic regression, included the following: illicit drug use, low support from partner, moving two or more times in the past year, high life event stress, bladder infection during pregnancy, Aboriginal race/ethnicity, and single marital status. CONCLUSION: This study suggests that physical abuse during pregnancy is associated with other risk factors for preterm birth, particularly stress and behavioral risk factors such as substance abuse.     

Changes in smoking and alcohol consumption during pregnancy: a population-based study in a rural area

Changes in smoking and drinking behavior during pregnancy and factors influencing these changes were studied in a typical rural county. Using birth certificates and mailed questionnaires, information was obtained from 255 married women residents of Callaway County, Missouri, who gave birth in a one-year period. The women were much more likely to drink alcohol than to smoke before pregnancy (48.6 versus 28.2%, P less than .01). There was a significant decrease in both smoking and drinking during pregnancy, though the women were much more likely to modify drinking behavior than smoking behavior. Of the women who drank alcohol before pregnancy, 53.2% stopped alcohol consumption completely during pregnancy, while only 16.7% of smokers stopped smoking during pregnancy (P less than .001). Women cited fear for the infant's health as an important factor underlying the decision to decrease these behaviors more often than they did advice from doctor, family, friends, or media, or adverse physical effects of tobacco or alcohol. It was very difficult to predict changes in smoking and drinking behavior during pregnancy on the basis of demographic and behavioral characteristics such as age, income, education, attendance of childbirth classes, desirability of pregnancy, and method of infant feeding.     

A Randomized Controlled Study of Birth Center Care versus Standard Maternity Care: Effects on Women's Health

ABSTRACT: Background : The safety of birth center care for low-risk women is an important issue, but it has not yet been studied in randomized controlled trials. Our purpose was to evaluate the effect of birth center care on women's health during pregnancy, birth, and 2 months postpartum by comparing the outcomes with those of women experiencing standard maternity care in the greater Stockholm area. Methods : Of 1860 women, 928 were randomly allocated to birth center care and 932 to standard antenatal, intrapartum, and postpartum care. Information about medical procedures and health outcomes was collected from clinical records, and a questionnaire was mailed to women 2 months after the birth. Analysis was by “intention to treat;” that is, all antenatal, intrapartum, and postpartum transfers were included in the birth center group. Results : During pregnancy, birth center women made fewer visits to midwives and doctors, experienced fewer tests, and reported fewer health problems. No statistical difference occurred in hospital admissions (4.8%) compared with the control group (4.7%). During labor, birth center women used more alternative birth positions, had longer labors, and did not differ inperineal lacerations. In both groups 1.7 percent of women developed complications, requiring more than 7 days of hospital care after the birth. During the first 2 postpartum months, about 20 percent of women in both groups saw a doctor for similar types of health problems, and no statistical difference occurred in hospital readmissions, 1.4 and 0.8 percent in the birth center and control groups, respectively, Conclusion : The results suggest that birth center care is effective in identifying signijicant maternal complications and as safe for women as standard maternity care.