A systematic review of telephone support for women during pregnancy and the early postpartum period

OBJECTIVE: To assess the effects of telephone-based support on smoking, preterm birth, low birthweight, breastfeeding, and postpartum depression. DATA SOURCES: Cochrane Pregnancy and Childbirth Group trials register (March 2006), Cochrane Central Register of Controlled Trials (March 2006), Medline (1966-2006), EMBASE (1980-2006), and CINAHL (1982-2006). Secondary references were scanned and experts in the field were contacted. STUDY SELECTION: All published, unpublished, and ongoing randomized controlled trials of telephone support interventions in which the primary aim was smoking, preterm birth, low birthweight, breastfeeding, or postpartum depression were reviewed. DATA EXTRACTION: Data were independently extracted by both authors and double entered into the Cochrane Collaboration's Review Manager (2003) software. DATA SYNTHESIS: Trials evaluating different primary outcomes were analyzed separately. For dichotomous data, results were presented as summary relative risk with 95% confidence intervals. For continuous data, weighted mean difference was used. CONCLUSIONS: Proactive telephone support may (a) assist in preventing smoking relapse, (b) play a role in preventing low birthweight, (c) increase breastfeeding duration and exclusivity, and (d) decrease postpartum depressive symptomatology. No telephone interventions were effective in improving preterm birth or smoking cessation rates. Additional research is encouraged.     

The trend in the relationship of advanced maternal age to preterm birth and low birthweight

Purpose: As women in developed countries tend to delay childbearing, it becomes more important to understand the relationship of advanced maternal age to birth outcomes. We aimed to estimate the trend in the relationship of advanced maternal age to preterm birth and low birthweight.

Materials and methods: We analysed 4,264,417 ethnically homogeneous, singleton firstborns, born in hospitals to married couples in South Korea in 1997–2014. We regressed an indicator for preterm birth or low birthweight on advanced maternal age, the baby’s sex, advanced paternal age, and a set of socioeconomic status (SES) variables by year. We then collected the coefficient on advanced maternal age and charted its trend. We repeated the same procedure for 4,153,313?second- and third births.

Results: When we controlled for only the baby’s sex, the relationship between advanced maternal age and preterm birth dramatically weakened in the 2000s and slightly more thereafter: being an older mother was related to a 3.5% point increase in preterm birth in the late 1990s, but this figure decreased to less than 2% points by the early 2010s. Controlling for advanced paternal age slightly decreased the relationship and controlling for SES hardly affected the relationship. We obtained almost the same results for low birthweight. Second- and third-borns exhibited a declining, much weaker influence of advanced maternal age on the birth outcomes.

Conclusions: In relative terms, mothers of advanced age were more likely to deliver preterm and low birthweight babies than younger mothers. In absolute terms, however, the risk was small in the 1990s and much smaller in the early 2010s.     

Birth outcomes of cases with left-sided obstructive defects of the heartin the function of maternal socio-demographic factors: a population-based case-control study

Objective: To evaluate the birth outcomes and maternal variables of cases with different types of left-sided obstructive defects (LSOD) of the heart. Methods: Live-born infants were selected from the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, and 302 cases with LSOD, 469 matched controls and 38,151 all controls without any defect, and 20,750 malformed controls with other isolated defects were compared. The diagnosis of LSOD was based on autopsy report or the documents of surgical intervention. Results: Four types of LSOD were differentiated: 56 cases with valvular aortic stenosis (VAS), 76 cases with hypoplastic left heart syndrome (HLHS), 113 cases with coarctation of the aorta (COA) and 57 cases with other congenital abnormalities of aorta (OCA). Cases with LSOD had male excess (64.6%) with a higher rate of preterm birth (14.2 vs. 6.6%) and low birthweight (15.6 vs. 4.3%) compared to matched controls. The high rate of preterm birth was particularly characteristic for HLHS (17.1%) while intrauterine fetal growth restriction was found in cases OCA (22.8%) and COA (13.3%). The mothers of cases with LSOD had higher birth order and lower socio-economic status than controls without any defect. Conclusions: The general pattern of birth outcomes and maternal variables were similar in the types of LSOD cases, but the higher rate of preterm birth and low birthweight indicated some association with their adverse fetal development.     

Impact of Participation in the Halifax County Preterm Birth Prevention Project

Objectives: (I) To determine if participation in the Halifax County Preterm Birth Prevention Project (HCPBPP) reduced the risk of preterm birth; (2) to evaluate the degree to which specific components of the HCPBPP contributed to preterm birth risk reduction.Methods: A nested case-control study was conducted among women residing in Halifax County who gave birth at the IWK Grace Health Centre during the final year of the HCPBPP. Cases, defined as women who delivered preterm (<37 weeks), and controls, defined as women who delivered at full term, were recruited to complete interviewer-administered questionnaires. Three controls per case were sequentially selected. The exposures of interest were overall participation and compliance with specific components of the program. Univariate and multivariate statistical methods were employed to evaluate the effect of exposure to the preterm-birth prevention program.Results: Seventy cases and 210 controls were enrolled in the study. Although 82% of subjects participated in some aspect of the HCPBPP, only 8% of high-risk and 6% of low-risk women complied fully with program recommendations. Exposure to project educational strategies or pelvic examinations provided no protective benefit for preterm birth in low-risk or high-risk women. However, compliance with prenatal care providers’ recommendations to restrict activity or monitor for uterine contractions by self-palpation was associated with a marked reduction in the risk of preterm birth among low-risk women (odds ratio, 0.20; 95% confidence interval, 0.08–0.50).Conclusion: Although full participation in the HCPBPP protocol was limited, the findings of this case-control study suggest that activity restriction and uterine activity monitoring by self-palpation may reduce the likelihood of preterm birth in women with no identifiable risk factors for prematurity.     

Racial discrimination and the black-white gap in adverse birth outcomes: a review

Introduction: The purpose of this integrative review was to evaluate what is known about the relationship between racial discrimination and adverse birth outcomes. Methods: A search of the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PsycINFO was conducted. The keywords used were: preterm birth, premature birth, preterm delivery, preterm labor, low birth weight, very low birth weight, racism, racial discrimination, and prejudice. Ten research studies were reviewed. All of the studies included African American women in their samples, were conducted in the United States, and were written in English. We did not limit the year of publication for the studies. Data were extracted based on the birth outcomes of preterm birth, low birth weight, or very low birth weight. Results: A consistent positive relationship existed between perceptions of racial discrimination and preterm birth, low birth weight, and very low birth weight. No relationship was found between racial discrimination and gestational age at birth. Discussion: Future research should explore the effects of racial discrimination as a chronic stressor contributing to the persistent gap in birth outcomes between racial groups.     

Impact of Training of Traditional Birth Attendants on Maternal Health Care: A Community-based Study

Objective

To study the impact of Training of Traditional Birth Attendants (TBAs) on maternal health care in a rural area.

Methods

An interventional study in the Primary Health Center area was conducted over 1-year period between March 2006 and February 2007, which included all the 50 Traditional Birth Attendants (30 previously trained and 20 untrained), as study participants. Pretest evaluation regarding knowledge, attitude, and practices about maternal care was done. Post-test evaluation was done at the first month (early) and at the fifth month (late) after the training. Analysis was done by using Mc. Nemer’s test, Chi-square test with Yates’s correction and Fischer’s exact test.

Results

Early and late post-test evaluation showed that there was a progressive improvement in the maternal health care provided by both the groups. Significant reduction in the maternal and perinatal deaths among the deliveries conducted by TBAs after the training was noted.

Conclusion

Training programme for TBAs with regular follow-ups in the resource-poor setting will not only improve the quality of maternal care but also reduce perinatal deaths.     

Impact of maternal nutritional supplementation in conjunction with a breastfeeding support program on breastfeeding performance,birth, and growth outcomes in a Vietnamese population

Purpose: This study aimed to evaluate the effects of maternal nutritional supplementation (MNS) in conjunction with a breastfeeding support program on birth outcomes and breastfeeding performance.

Methods: A total of 228 singleton Vietnamese mothers aged 20–35?years at 26–29?weeks of gestation with pre-pregnancy body mass index (BMI)?2 were randomized to the intervention (n?=?114), receiving MNS (252?kcal/day) daily up to 12?weeks postpartum and four breastfeeding education and support sessions or to the control (n?=?114), receiving standards of care.

Results: The intervention was 2.09 times more likely to exclusively breastfeed over the 12?weeks than the control (95%CI: 1.05–4.13, p?=?.0358), after controlling for potential confounders. Infant’s breast milk intake was significantly higher in the intervention than the control among mothers with baseline mid-upper arm circumference (MUAC)?p?=?.0251). Infants in the intervention had significantly higher birth weight (p?=?.0312), birth weight-for-age (p?=?.0141) and birth head circumference-for-age (p?=?.0487), and higher head circumference-for-age z-score (p?=?.0183) development over the postnatal period, compared with the control.

Conclusions: Use of MNS and breastfeeding support improve birth outcomes and exclusive breastfeeding (EBF) rate in Vietnamese mothers. Additionally, it promotes breast milk production among mothers with lower baseline MUAC.     

Evaluation of a Student‐Nurse Doula Program: An Analysis of Doula Interventions and Their Impact on Labor Analgesia and Cesarean Birth

Introduction: The aim of this study was to describe specific doula interventions, explore differences in doula interventions by attending provider (certified nurse‐midwife vs obstetrician), and examine associations between doula interventions, labor analgesia, and cesarean birth in women receiving doula care from student nurses. Methods: A secondary analysis of data from the Birth Companions Program at the Johns Hopkins University School of Nursing was conducted using t tests, chi‐square statistics, and logistic regression models. Results: In the 648 births in the sample, doulas used approximately 1 more intervention per labor with certified nurse‐midwife clients compared to obstetrician clients. In multivariate analysis, the increase in the total number of interventions provided by doulas was associated with decreased odds of epidural (adjusted odds ratio [AOR] 0.92; 95% confidence interval [CI], 0.86‐0.98) and cesarean birth (AOR 0.90; 95% CI, 0.85‐0.95). When examined separately, a greater number of physical interventions was associated with decreased odds of epidural (AOR 0.85; 95% CI, 0.78‐0.92) and cesarean birth (AOR 0.80; 95% CI, 0.73‐0.88), but number of emotional/informational interventions was not. Discussion: Student nurses trained as doulas have the opportunity to provide a variety of interventions for laboring clients. An increase in the number of interventions, especially physical interventions, provided by doulas may decrease the likelihood of epidural use and cesarean birth.     

Survival of pre-viable preterm infants in the United States: A systematic review and meta-analysis

The objective of this paper is to review observational studies that addressed the survival of pre-viable gestations in the United States. We searched PubMed, Ovid, CINAHL, and Web of Knowledge for studies reporting survival of infants born at <24 gestational weeks and/or <500 g in the United States and published between January 2003 and January 2013. The full texts of 70 articles were examined and a total of 15 studies qualified and were selected. We analyzed fixed-effect and random-effects models for eight studies on survival to discharge. Pooled survival to discharge in the random-effects model was 45.9% (95% CI: 41.1–51.7) and 39.7% in the fixed-effect model (95% CI: 38.8–40.7). Studies differed by pre-viable survival measures and epochs (1985–2009). Protective factors included antenatal corticosteroids, neonatal resuscitation, and intensive care. The current survival threshold for pre-viable infants warrants reconsideration of the limits of viability. Protective factors that enhance survival should be considered in the management of these infants.     

Midwives' and doulas' perspectives of the role of the doula in Australia: a qualitative study

Objective

to explore midwives’ and doulas’ perspectives of the role of the doula in Australia.

Background

doulas are relatively new in Australia; nevertheless, demand for them is increasing. Research has not previously explored the role of a doula in Australia. This research aimed to answer the question: What are midwives’ and doulas’ perspectives of the role of a doula in Australia?

Design

qualitative study using focus groups that were digitally recorded, transcribed and the data analysed using thematic analysis.

Setting

New South Wales, Australia.

Participants

11 midwives and six doulas.

Findings

the key theme that emerged was that ‘the broken maternity system’ is failing women and midwives. The system is preventing midwives from providing woman- centred care. As a result, doulas are ‘filling the gap’ and midwives feel that doulas are ‘taking our role’. Doulas fill the gap by providing continuity of care, advocating for women, protecting normal birth and by providing breast-feeding advice and emotional support in the community. Midwives are concerned that doulas are taking the caring part of their role from them and want the ‘broken’ maternity system fixed. Midwives described that doulas take their role from them by changing the relationship between themselves and labouring women, by reducing their role to obstetric nurses, by overstepping the doula role boundaries, and by holding the power at births.

Implications for practice

despite the conflict reported between midwives and doulas, both groups identified that they see the potential for future collaboration. Taking into account the continued employment of doulas, it is important to improve collaboration between midwives and doulas for the sake of childbearing women.