Antenatal Preparation and Labor Support in Relation to Birth Outcomes

ABSTRACT: This study investigated the relationship between antenatal preparation, women's perception of the support they received, and the physical and psychological outcome of birth. Data on preparation, support and women's experience of birth were obtained by questionnaire-based interviews of a random sample of 398 low-risk primiparous women at five Sydney teaching hospitals three weeks after the birth. Medical data concerning labor and delivery were taken from women's hospital records. Most women (81%) attended some form of preparation classes. Number of hours attendance at classes was not related to physical labor variables but women who spent more hours at classes were less likely to use medication during labor and more likely to breastfeed their baby. Similarly, women's perceptions of support from doctor, midwives and partner were not related to physical labor variables but were related to pain relief methods used and to satisfaction ratings.     

Partner Support and Impact on Birth Outcomes among Teen Pregnancies in the United States

PurposeDespite hypothesized relationships between lack of partner support during a woman’s pregnancy and adverse birth outcomes, few studies have examined partner support among teens. We examined a potential proxy measure of partner support and its impact on adverse birth outcomes (low birth weight (LBW), preterm birth (PTB) and pregnancy loss) among women who have had a teenage pregnancy in the United States.MethodsIn a secondary data analysis utilizing cross-sectional data from 5609 women who experienced a teen pregnancy from the 2006-2010 National Survey of Family Growth (NSFG), we examined an alternative measure of partner support and its impact on adverse birth outcomes. Bivariate and multivariable logistic regression were used to assess differences in women who were teens at time of conception who had partner support during their pregnancy and those who did not, and their birth outcomes.ResultsEven after controlling for potential confounding factors, women with a supportive partner were 63% less likely to experience LBW [aOR: 0.37, 95% CI: (0.26-0.54)] and nearly 2 times less likely to have pregnancy loss [aOR: 0.48, 95% CI: (0.32-0.72)] compared to those with no partner support.ConclusionsHaving partner support or involvement during a teenager’s pregnancy may reduce the likelihood of having a poor birth outcome.     

Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors

BackgroundSexual satisfaction is one of the issues faced by breast cancer survivors (BCSs).AimThis study aims to explore the mediation of stigma in the relationship between perceived social support (PSS) and sexual satisfaction among breast cancer survivors.MethodsA cross-sectional study was conducted among 918 BCSs in Shanghai Cancer Rehabilitation Club. Data were collected using an online questionnaire including questions on sociodemographic characteristics, health status, PSS, stigma and sexual satisfaction of participants. The bootstrap method was used to test the significance of the simple mediation model.OutcomesThe simple mediation of stigma was found significant in the relationship between PSS and sexual satisfaction.ResultsStigma plays an intermediary role in the relationship between 2 dimensions of PSS (family and friends) and sexual satisfaction, but not in the relationship between the dimension of other significant people of PSS and sexual satisfaction.Clinical TranslationIt is important to reduce stigma when improving the sexual satisfaction of BCSs from the perspective of PSS.Strengths & LimitationsThe mediating role of stigma in the relationship between PSS and sexual satisfaction among BCSs has been shown for the first time. Study limitations include limitations in the representativeness of population by the study sample and the cross-sectional study design.ConclusionsStigma mediates the relationship between PSS and sexual satisfaction, which needs to be eliminated in intervention practice.Yuxin Zhang, Jie Zhao, Nan Jiang, et al. Effects of Stigma on the Relationship Between Perceived Social Support and Sexual Satisfaction Among Breast Cancer Survivors. J Sex Med 2022;19:1002–1011.     

Gender Dysphoria and Perceived Social Support: A Matched Case-Control Study

BackgroundIn people diagnosed with Gender Dysphoria (GD), low perceived social support from their families and society has been suggested to be associated with poor quality of life and mental well-being.AimTo compare the perceived social support in individuals with GD with that in individuals without GD matched for age and gender.MethodsThe study group (n = 50) consisted of individuals diagnosed with GD via psychiatric evaluation. A control group (n = 50) was created by matching volunteers without GD by age and gender. Sociodemographic data form, Structured Clinical Interview Form for DSM-IV TR Axis I Disorders (SCID-I), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to gather data from participants.Outcomescomparing the perceived social support, the total and subscale MSPSS scores of groups were calculated.ResultsThe presence of at least 1 psychiatric disorder was significantly higher in the GD group than in the control group, either lifetime or during evaluation (P < .001 and P = .025, respectively). The total MSPSS and family support subscale scores were found to be significantly lower in the GD group than in the control group (P = .001 and P ≤ .001, respectively). When the groups formed on the basis of gender identity (32 trans men vs 32 cis men and 18 trans women vs 18 cis women) were compared, only the family support subscale score was found to be lower in trans men than cis men (P = .005). In addition, comparisons within the groups formed based on sex assigned-at-birth revealed lower total, friend, and family support in those assigned female-at-birth and lower total and family support in those assigned male-at-birth in the GD group. A multiple linear regression analysis revealed that the presence of GD was significantly associated with total and family support MSPSS subscale scores.Clinical ImplicationsThe findings show that perceived social support in people diagnosed with GD is lower, even when the presence of psychiatric disorders is included in the analysis.Strengths and LimitationsThe matched case-control design was the major study strength, whereas the sample size was the major limitation.ConclusionClinical care of people diagnosed with GD should include the evaluation of diverse sources of social support, efforts to strengthen family and friend support, maintenance of interpersonal relationships, and support of mental well-being.Kaptan S, Cesur E, Ba?ar K, et al. Gender Dysphoria and Perceived Social Support: A Matched Case-Control Study. J Sex Med 2021;18:812–820.     

自由体位分娩对母婴分娩结局影响的Meta分析

目的:系统评价初产妇在产程中实施自由体位分娩对母婴结局的影响。方法:计算机检索Pub Med、Embase、CENTRAL、Web of Science、CINAHL、CBM、CNKI、VIP、Wan Fang Data数据库中有关自由体位分娩的随机对照试验,检索时间均为建库至2017年4月4日。由2名研究者独立按纳入、排除标准筛选文献、提取资料、评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入18项随机对照试验,3 603例患者。Meta分析结果显示:自由体位分娩与常规卧位分娩在总产程时间(MD=-2.98,95%CI:-3.29^-2.68,P<0.000 01)、剖宫产率(RR=0.43,95%CI:0.37~0.51,P<0.000 01)、自然分娩率(RR=1.33,95%CI:1.27~1.39,P<0.000 01)、产后出血发生率(RR=0.25,95%CI:0.15~0.40,P<0.000 01)、会阴Ⅲ度裂伤发生率(RR=0.33,95%CI:0.17~0.67,P=0.002)、宫颈裂伤发生率(RR=0.34,95%CI:0.21~0.55,P<0.000 01)、新生儿窒息率(RR=0.31,95%CI:0.21~0.47,P<0.000 01)、新生儿颅内出血发生率(RR=0.22,95%CI:0.08~0.57,P=0.002)比较,差异有统计学意义;新生儿吸入综合征发生率(RR=0.73,95%CI:0.30~1.80,P=0.50)比较差异无统计学意义。结论:与常规卧位分娩相比,初产妇产程中采用自由体位分娩可缩短总产程时间,提高自然分娩率,降低剖宫产率,减少产后出血、软产道损伤,降低新生儿窒息和颅内出血的发生率,并且不会增加新生儿吸入综合征的风险。但受纳入研究质量限制,上述结论尚需开展更多高质量研究予以验证。     

The Effects of Prenatal Secondhand Smoke Exposure on Preterm Birth and Neonatal Outcomes

ObjectiveTo examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine.DesignCross‐sectional, observational design.SettingA metropolitan Kentucky birthing center.ParticipantsTwo hundred and ten (210) mother–baby coupletsMethodsNicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis.ResultsSmoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=.74; p<.001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200‐300 g), and deliver shorter infants (decrease of 1.1‐1.7 cm).ConclusionsPrenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.     

水中分娩及分娩并发症的探讨

目的:时水中分娩产妇的产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局进行分析,以评价水中分娩的安全性.方法:2003年3月1日至2007年6月30日在我院选择水中分娩的1227例产妇作为水中分娩组,将同期的单胎(无妊娠合并症及并发症)顺产的1227例产妇作为对照组.比较两组产程、产道裂伤、产时和产后并发症、产时和产后镇痛药使用及新生儿结局.结果:水中分娩组第一及第二产程时间、产褥病率、产后出血、会阴阴道血肿、产后尿潴留、新生儿轻度及重度窒息与对照组比较,两组差异无统计学意义(P>0.05);水中分娩组均未行会阴切开,对照组会阴切开率66.67%,两组比较,差异有高度统计学意义(P<0.01);水中分娩组下水后用镇痛药及产后用镇痛药与对照组比较明显减少,两组差异有高度统计学意义(P<0.01).结论:水中分娩能减轻分娩疼痛,减少产时、产后镇痛药的使用.减少产道损伤,且未发现对母儿有其他不良结局.     

Outcomes of Father Involvement in Pregnancy and Birth

: To test the assumption that father involvement in pregnancy and childbirth results in more positive birth and fathering experiences, 40 primiparous couples recruited from childbirth education classes and obstetricians were studied. About two weeks before their due dates each mother was asked to rate her marital closeness and her husband's interest in children. These couples were observed for one hour in mid-labor. Then mothers and fathers were interviewed about one week after the birth. Fathers who were more involved in terms of their wives’ reports of prenatal marital closeness gave generally more positive reports of the delivery and the new baby. Fathers who were involved in terms of their wives’ estimates of their interest in children were rated by observers as interacting with their wives less during labor. (BIRTH 10:1, Spring 1983)     

Religion,Spirituality, Social Support,and Perceived Stress in Pregnant and Postpartum Hispanic Women

Objective:To examine the association between religion/spirituality and perceived stress in prenatal and postpartum Hispanic women.Design:Cross‐sectional survey.Setting:An urban, publicly funded hospital in California.Participants:Two hundred and forty‐eight pregnant and postpartum Hispanic women between age 18 and 45 years.Method:Patients presenting for prenatal or postpartum care or for the first infant visit were recruited to participate in the current study. Participants completed surveys consisting of questions about demographic characteristics, religiosity, spirituality, social support, and stress.Results:Most participants were unmarried, low‐income women with low educational attainment. Ninety percent of women reported a religious affiliation, with more than one half (57.4%) listing their religious affiliation as “Catholic.” Overall religiousness/spirituality was significantly associated with increased negative experiences of stress in women who selected English language instruments (Spearman's r=.341, p=.007); there was no such relationship in women who selected Spanish language instruments. Social support and greater relationship quality with a significant other were significantly associated with reduced perceived stress in Spanish reading and English reading women.Conclusions:In this sample of pregnant and postpartum Latinas, religiousness/spirituality was not associated with reduced perceived stress and was in fact associated with increased perceived stress among women who selected English‐language surveys. Additional research is needed to investigate this association. On the other hand, the current study reinforces the importance of social support and relationship quality for pregnant and postpartum women.     

Physical Abuse, Social Support, Self-care, and Pregnancy Outcomes of Older Adolescents

OBJECTIVE: To evaluate the relationships between physical abuse, social support, self-care agency and practices, and pregnancy outcome for older adolescent mothers and infants. DESIGN: Predictive-correlational design based on Orem's Self-Care Deficit Theory of Nursing and featuring a prospective cohort analysis. Prenatal interviews and medical record review after delivery were both used as data sources. SETTING: Public prenatal clinics. PARTICIPANTS: Pregnant adolescents who were at least 18 years of age at the time of the prenatal interview and no more than 19 years of age at conception. Complete data were available for 139 participants. MAIN OUTCOME MEASURES: Infant birth weight, pregnancy complications. RESULTS: Twenty-two percent (n = 30) of the adolescents in this sample reported that they experienced physical abuse during their pregnancy. Abused pregnant adolescents gave birth to infants with significantly lower birth weights (M = 3,144 g) than did adolescent mothers who were not abused (M = 3,310 g) (t = 1.99; p = .025). The interaction effect of abuse and the social support factors of shelter and family help, self-care agency, household size, and prenatal care were significant predictors of infant birth weight. Abused adolescents had significantly more previous miscarriages, substance use, and triage visits during their pregnancies. CONCLUSIONS: Identification of abused adolescents and their social resources during pregnancy may enhance prediction of infants at high risk and provide opportunities for intervention.     

Perinatal Outcomes of Women Intending to Give Birth in Birth Centers in Australia

Abstract: Background: A recent Australian study showed perinatal mortality was lower among women who gave birth in a birth center than in a comparable low‐risk group of women who gave birth in a hospital. The current study used the same large population database to investigate whether perinatal outcomes were improved for women intending to give birth in a birth center at the onset of labor, regardless of the actual place of birth. Methods: Data were obtained from the National Perinatal Data Collection (NPDC) in Australia. The study included 822,955 mothers who gave birth during the 5‐year period, 2001 to 2005, and their 836,919 babies. Of these, 22,222 women (2.7%) intended to give birth in a birth center at the onset of labor. Maternal and perinatal factors and outcomes were compared according to the intended place of birth. Data were not available on congenital anomalies, or cause, or timing of death. Results: Women intending to give birth in a birth center at the onset of labor had lower rates of intervention and of adverse perinatal outcomes compared with women intending to give birth in a hospital, including less preterm birth and low birthweight. No statistically significant difference was found in perinatal mortality for term babies of mothers intending to give birth in a birth center compared with term babies of low‐risk women intending to give birth in a hospital (1.3 per 1,000 births [99% CI = 0.66, 1.95] vs 1.7 per 1,000 births [99% CI = 1.50, 1.80], respectively). Conclusions: Term babies of women who intended to give birth in a birth center were less likely to be admitted to a neonatal intensive care unit or special care nursery, and no significant difference was found in other perinatal outcomes compared with term babies of low‐risk women who intended to give birth in a hospital labor ward. Birth center care remains a viable option for eligible women giving birth at term. (BIRTH 37:1 March 2010)     

The Impact of Prenatal Care Coordination on Birth Outcomes

ObjectiveTo measure the impact of a Medicaid benefit called Prenatal Care Coordination (PNCC) on healthy birth outcomes.DesignA cross sectional design was used to compare the birth outcomes of infants born to women who received Medicaid and PNCC services to the birth outcomes of infants born to women who received Medicaid but did not receive PNCC services.SettingServices were provided in community based settings in Wisconsin.ParticipantsOf the 45,406 Medicaid births in 2001 to 2002, 10,715 (23.6%) mothers received PNCC services and were considered the treatment group.MethodsSecondary analyses of birth certificate and Medicaid billing data were conducted using binary logistic regression analyses to evaluate the impact of PNCC and the hours of PNCC service on birth outcomes.ResultsControlling for nine covariates, women who received PNCC services were found to have significantly better birth outcomes, including fewer low‐birth‐weight infants (odds ratio [OR]=0.84; 95% CI [.777, .912]), fewer very‐low‐birth‐weight infants (OR=0.70; 95% CI [.587, .855]), fewer preterm infants (OR=0.83; 95% CI [.776, .890]), and fewer infants transferred to the neonatal intensive care units (OR=.83; 95% CI [.759, .906]).Women who received 6 or more hours of service were less likely to deliver infants with poor birth outcomes.ConclusionsThe use of PNCC is an effective strategy for preventing adverse birth outcomes.Strategies to further enhance PNCC's positive benefits include increased outreach and engagement with at risk pregnant women.     

Validity and reliability of the Perceived Readiness for Discharge After Birth Scale

Objective:  To assess the psychometric properties of a scale measuring mothers' perceptions of readiness for discharge after birth.
Design:  Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge.
Setting: Tertiary-level perinatal center in the Midwestern United States.
Participants:  1,462 postpartum mothers.
Intervention:  None.
Main outcome measures:  Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.
Results:  Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breastfeeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales.
Conclusions:  The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers' perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems. JOGNN , 35, 34-45; 2006.DOI: 10.1111/J.1552-6909.2006.00020.x     

Outcomes and Procedures in Low Risk Birth: A Comparison of Hospital and Birth Center Settings

ABSTRACT: Two retrospectively matched groups of low-risk women were studied, one that chose to give birth in an out-of-hospital birth center staffed and run by nurse-midwives, and another that labored and delivered in a tertiary care teaching hospital. The groups were matched for low risk status at 37 weeks. Although outcomes for both groups were similar, the use of almost all interventions during labor and delivery was significantly more frequent in the hospital group. These findings are consistent with studies of other settings in which the place of birth was shown to have an impact on childbirth experience, thus demonstrating that birth centers can oversee childbirth as safely and with less intervention than do hospitals. Larger comparative studies are needed to explore the impact and safety of hospital and out-of-hospital birth settings.     

High Parity and Adverse Birth Outcomes: Exploring the Maze

Abstract: Background : Despite extensive literature on the topic, it is uncertain if grand (para ≥ 5) and great grand (para ≥ 10) multiparity are associated with adverse birth outcomes. We critically evaluate the evidence for and against the existence of adverse maternal and/or fetal outcomes in high parity women. Methods : An electronic search of MEDLINE and other bibliographic databases (Current Contents, EMBASE, and CAB) was conducted, and all relevant articles in English language were retrieved. Results : Findings on the association between high parity and maternal‐fetal birth outcomes are not consistent. Although the older literature tends to suggest that multiparity is a risk factor for negative birth outcomes, more recent reports are not supportive. Comparison across studies was further complicated by confounding factors like maternal age, socioeconomic status, and levels of prenatal care, as well as by variations in study designs and in the definition of parity itself. Furthermore, most studies that examined women of extreme parity (para ≥ 10) were handicapped by inadequate power. Conclusions : After accounting for quality, culture, and degrees of associations, the preponderance of evidence seems to point to possible existence of heightened risk for certain medical complications and placental pathologies among women of extreme parity. The literature also provides reasonable evidence for a higher‐than‐expected likelihood for occurrence of fetal macrosomia with advanced parity.     

Why Nurses Are Essential to Research on Birth Outcomes in the United States

In a consensus study on birth settings in the United States, the National Academy of Sciences, Engineering, and Medicine concluded that childbirth outcomes are influenced by quality of care, access to services, and choices of women within the maternity health care system. The United States has one of the highest rates of maternal mortality among the most developed nations in the world, and outcomes are marked by disparities among racial and ethnic groups of women. However, recommendations for improving birth outcomes are limited by the lack of an evidence base related to the physical and psychological safety of women during childbirth. Nurses who care for pregnant women and their infants are dedicated to ensuring that safe, high-quality care is provided during every encounter. Therefore, they are uniquely positioned to conduct the research on the fundamental elements of safety, quality, and inequities in health care that is needed to improve the maternity care system and outcomes for women and infants.