Late preterm birth: preventable prematurity?

Prematurity is one of the leading causes of infant morbidity and mortality globally. Over the years, however, advances in medicine and technology have enhanced the ability to care for babies at very early gestations. There has also been a shift in the distribution of births away from term/post-term gestations and toward earlier gestational ages. These changes have added to the burden of premature births. The focus of this article is to present both sides of the story, one that highlights the many problems and morbidities faced by this subgroup of premature infants and the other that justifies their early delivery.     

Normal birth or spontaneous vertex delivery?

The declining normal birth rate and increasing Caesarean Section (CS) rates have been a worldwide cause for concern and debate for two decades. In the United Kingdom (UK) normal birth rates have fallen from 70 per cent in the 1970s to 46.7 per cent in 2009 (Birth Choice UK 2011). As normal birth rates continue to fall, researchers and advocates of normality are focusing on the midwife's role in response to this decline. The language and definitions used to classify normality and normal birth are contentious issues leading to confusion for midwives and women. This paper seeks to contribute to the debates around defining and promoting normality.     

Does fish oil prevent preterm birth?

A literature review was performed on the effect of fish oil on preterm birth in observational and randomized studies. The only weak effect on preterm birth found in meta-analyses could be caused by the low compliance, and the fact that many women stop supplementation before term together with a fast acting effect on fish oil.     

Is low pre-pregnancy body mass index a risk factor for preterm birth and low neonatal birth weight?

OBJECTIVES: A pregnant woman's weight is an extremely important factor in the course of pregnancy and delivery. Not only obesity but also being underweight may lead to complications in pregnancy such as: preterm delivery and low neonatal birth weight. DESIGN: The aim of this study was to analyze the relationship between a low BMI and outcome of pregnancy, birth weight and general well being of the neonates. MATERIAL AND METHODS: 415 patients who were hospitalized in the Department of Obstetrics and Reproduction Wroc?aw Medical University between 1996-2005 was done. The patients were divided into 3 groups I--Underweight (BMI <19,8), II--Appropriate weight (BMI 19,8-26,0) and III--Overweight (BMI>26,0). RESULTS: The frequency of preterm deliveries as well as low neonatal birth weight <2500g, in underweight mothers was higher than in other groups. CONCLUSIONS: Low pre-pregnancy BMI is an important factor risk factor in preterm deliveries. There was no correlation between BMI and the general well being of the neonates.     

Why home birth? A qualitative study exploring women's decision making about place of birth in two Canadian provinces

Objective

the aim of this study was to increase our understanding of why Canadian women choose to give birth at home. Despite on-going debate regarding the safety of home birth, a small number of Canadian women choose home as a place to give birth. The factors influencing a woman's decision to plan a home birth remain poorly understood.

Design

a qualitative, grounded theory approach using semi-structured interviews.

Participants

a purposive sample of women from two Canadian provinces, who planned to give birth at home in their current pregnancy or who had planned a home birth within the last 2 years.

Findings

thematic analysis highlighted key motivating factors as well as a decision-making framework by which women chose home birth. The decision making process includes an exploration of internal motivators for wanting home birth, a phase of information gathering and taking ownership for the decision to give birth at home.

Key conclusions

the study showed that women in two geographically distinct parts of Canada approach decision making around home birth in a similar fashion and provides a framework for decision making for choosing to birth at home.

Implications for practice

improved understanding of the decision making process for choice of birth place is useful for midwives for the provision of information to their clients and for midwifery policy and practice within Canada.