Effect of Modern Obstetrics on Mothers from Third-World Countries

Mothers born and raised in third-world countries compared to women born in the United States are on average of shorter size, have less weight, have narrower pelvic dimensions, and give birth to smaller infants without much difficulty. This may be due to a low-protein diet and inadequate prenatal care. Those mothers who were born and raised outside the United States (therefore with narrow pelvic dimensions), but who eat a high-protein diet and receive adequate prenatal care after migrating as adults to the United States, give birth to relatively large infants. This results in a marked cephalopelvic disproportion and severe dystocia, which frequently leads to cesarean birth. It appears that nutritional factors during pregnancy and infancy play a role as important as genetic factors in the etiology of cephalopelvic disproportion.     

The Lesbian Childbearing Couple: A Case Report

Increasing numbers of lesbians are choosing to bear children. Inadequate information about these women's childbearing concerns, together with discrimination and insensitivity to their needs, places these couples at risk for receiving less than optimal health care. Lesbians who desire children are faced with numerous psychosocial problems that should be addressed by open and sensitive caregivers. Providing care to a lesbian couple demonstrated the ways in which their needs were similar to and different from those of heterosexual couples.     

The Risks of Not Breastfeeding for Mothers and Infants

Health outcomes in developed countries differ substantially for mothers and infants who formula feed compared with those who breastfeed. For infants, not being breastfed is associated with an increased incidence of infectious morbidity, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome. For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, myocardial infarction, and the metabolic syndrome. Obstetricians are uniquely positioned to counsel mothers about the health impact of breastfeeding and to ensure that mothers and infants receive appropriate, evidence-based care, starting at birth.Key words: Breastfeeding, Antenatal care, Infant health outcomes, LactationHealth outcomes differ substantially for mothers and infants who formula feed compared with those who breastfeed, even in developed countries such as the United States. A recent meta-analysis by the Agency for Healthcare Research and Quality reviewed this evidence in detail¹:

• For infants, not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS).
• Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC).
• For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome.

These findings suggest that infant feeding is an important modifiable risk factor for disease for both mothers and infants. The American College of Obstetricians and Gynecologists (ACOG) therefore recommends 6 months of exclusive breastfeeding for all infants.² The American Academy of Pediatrics (AAP)³ and the American Academy of Family Physicians (AAFP)⁴ similarly recommend exclusive breastfeeding for the first 6 months of life, continuing at least through the infant’s first birthday, and as long thereafter as is mutually desired. The World Health Organization (WHO) recommends at least 2 years of breastfeeding for all infants.In the United States, breastfeeding durations fall far short of these guidelines.⁵ In 2005, 74.2% of US infants were breastfed at least once after delivery, but only 31.5% were exclusively breastfed at age 3 months, and just 11.9% were exclusively breastfed at age 6 months. These rates show considerable regional variation, with the highest rates in the Pacific Northwest and the lowest rates in the Southeast. Although some of this variation reflects cultural differences, recent data suggest that variations in hospital practices account for a considerable proportion of disparities in breastfeeding duration.⁶ This suggests that improvements in the quality of antenatal and perinatal support for breastfeeding could have a substantial impact on the health of mothers and infants.This article reviews the health risks of not breastfeeding, for infants and for mothers, as well as the obstetrician’s role in counseling women regarding infant feeding and ensuring an optimal start for breastfeeding at birth.     

Postpartum Teaching Priorities: The Viewpoints of Nurses and Mothers

Objective: To compare mothers' and nurses' perceptions of postpartum learning needs and effective teaching modalities.
Design: Cross-sectional research design. Mothers were given a questionnaire during their postpartum stay to rate how important it was for them to learn about 44 maternal-infant topics before discharge. Nurses rated similar items on the basis of their perception of what is most important for mothers to learn during their postpartum stay.
Setting: Postpartum units in six hospitals that are part of a large midwestern health care system.
Participants: English-speaking women who delivered either vaginally or by cesarean section without complications and the nurses on their postpartum units.
Main outcome Measures: Identification of preferred topics and methods for postpartum teaching.
Results: Mothers and nurses agreed that topics related to immediate physical health needs were most important. Unmarried mothers considered topics related to personal care and mobility as particularly important. First-time mothers rated more topics as important than did experienced mothers. Individual teaching was rated most effective by both groups. Classroom teaching and the use of audiovisual media were considered less effective.
Conclusions: This study supports postpartum education that focuses on the physical needs of mothers and infants, as well as individual teaching models. The special learning needs of new mothers, including those who are not married, must be considered.     

The Childbirth Experience: A Study of 295 New Mothers

ABSTRACT: Background : The childbirth experience is multidimensional, and therefore difficult to describe and explain. Studies of it have produced inconsistent findings, and the phenomenon is often confused with satisfaction with the care provided. This study aimed to clarify different aspects of the birth experience, and to identify factors that could explain the variation in women's overall assessment of it. Methods : All Swedish-speaking women in a large city who gave birth during a two-week period in 1994 were given a questionnaire one day after the birth, and 295 (91%) of the questionnaires were returned. Information about the labor process and medical interventions was collected from hospital records Results : Women usually experienced severe pain and various degrees of anxiety, and most were seized with panic for a short time or some part of their labor: Despite these negative feelings, most women felt greatly involved in the birth process, were satisfied with their own achievement, and thought they had coped better than expected. The overall experience was assessed as positive by 77 percent of women and negative by 10 percent. No statistical difference was observed between primiparas and multiparas in total birth experience, and few differences in the specific aspects of the birth. Of the 38 variables tested in regression analysis, the six that contributed to explaining womens overall birth experience were support from the midwife (sensitivity to needs), duration of labor; pain, expectations of the birth, involvement and participation in the birth process, and surgical procedures (emergency cesarean section, vacuum extraction, forceps, episiotomy). Conclusions : The study showed that negative and positive feelings can coexist, thus confirming the multidimensional character of the birth experience. Women's assessment of their childbirth is influenced by both physical and psychosocial factors, highlighting the importance of a comprehensive approach to care in labor.     

The Language of Birth

Our language both reflects and influences our attitudes and behavior. This Roundtable Discussion explores the language used in obstetrics and in the interactions between caregivers and women or their families: What do practitioners say to mothers and families during labor? At birth? In consultations? To describe what is happening? To encourage a woman's efforts? To lighten the atmosphere? When advising about possible interventions? Medical terminology in perinatal care can often be deceptive or confusing, not only for mothers but for caregivers. The authors of this Roundtable, representing health professionals from different specialties and interests in the field, have examined some examples of such language use, misuse, and abuse in perinatal care. (BIRTH 39:2 June 2012)     

The FIGO Save the Mothers Initiative: the Uganda-Canada collaboration.

In 1998, the ob/gyn associations of Uganda and Canada launched, under the umbrella of the FIGO Save the Mothers Initiative, a district-wide intervention which aimed to increase the availability and utilization of emergency obstetric care (EmOC) services in a rural district of Uganda. The article describes the experience of two professional ob/gyn associations in the development, implementation, monitoring and evaluation of the project. Preliminary results after 24 months of intervention indicate important gains in the capacity of health professionals to deliver EmOC, the availability of emergency transportation services and met need for EmOC.     

The FIGO Save the Mothers Initiative: the Ethiopia-Sweden collaboration.

The overall goal of the FIGO Save the Mothers Fund was to establish basic and comprehensive emergency obstetric care (EmOC) with the specific objectives of increasing the availability and utilization of quality obstetric care as measured by the UN indicators. As a result of this commitment by FIGO, the Ethiopian Society of Obstetricians and Gynecologists (ESOG) launched the Save the Mothers Project (SMP) in West Showa Zone (WSZ), Ethiopia in 1998 to implement and test a demonstration project and evaluate the feasibility and impact of the intervention. The overall objectives matched FIGO's-reducing maternal deaths by promoting the availability, access and utilization of EmOC services for women with complications of pregnancy and childbirth. The intervention package included capacity building as a major activity, and physicians and other service providers from Ambo Hospital, Shenen and Ijaji Health Centers were trained in EmOC. This was intended to combat the high staff turnover in the area. Equipment, materials and supplies were also provided to the demonstration sites to enable them provide basic and comprehensive EmOC services. The interventions, begun in 1999, led to improvements in availability, utilization and met need, which suggests that such an approach may eventually lead to the reduction of maternal deaths. The cesarean section rate for Ambo Hospital increased from 3.7% in 1998 to 17.3% in 2001--an almost six-fold increase. At Ambo Hospital both the total number of deliveries and cases admitted with obstetric complications have increased from baseline. Patients with obstructed labor comprise 39% of all obstetric patients making it the leading cause of hospitalization. Obstetric hemorrhage comes next with 24% of all admissions. The case fatality rate (CFR) (for direct maternal deaths) decreased from 7.2% at baseline, to 4.6% in 2001--showing a definite trend of improvement. Currently, there is 24-h EmOC service at Ambo Hospital where an obstetrician and general medical practitioners with EmOC training are responsible for the service. Shenen and Ijaji health Centers are upgraded in terms of training of staff members, provision of equipment and supplies, and regular supervision so that the community in these areas has access to basic EmOC services. To replicate similar activities, in a setting like ours, EmOC projects have to be low cost to attract decision-makers. The SMP used almost US dollars 100,000 over 3 years to ensure availability of EmOC services for women in WSZ. A favorable political climate such as maintenance of relative peace, and flexibility in adapting to local conditions also contributed to the success of the SMP.     

Behaviour of Fetuses from Hypertensive Mothers

Fetal behavioural state determination allows the evaluation of fetal spontaneous CNS activity. The term fetuses in normal pregnancies show a well defined behavioural pattern with a stable percentage of 1F, 2F, 3F, 4F, and values of coincident epochs over 80–85%. In hypertensive pregnancies the determination of behavioural states has been conducted after the cardiovascular impairment of the fetuses, defined by means of Doppler flow evaluation, had been estabilished. In these fetuses an increase in non coincidence of behavioural state variables and a decrease in 3F and 4F states have been found. A slight decrease is showed in 2F, while state IF is increased in earlier gestational ages, and lowers to normal values in term pregnancies.     

Postpartum Depression Identification of High-risk Mothers

Various types of puerperal depressions, symptoms exhibited, and factors that predispose women to develop postpartum depression are reviewed. A case example of a woman who experienced a postpartum depression is discussed. A prenatal checklist is presented to assist clinicians working in obstetrics in evaluating the risk of postpartum depression in their various clients.