What Women Say About Post-Partum Care and Breastfeeding in St. Petersburg,Russian Federation

A capacity-building programme for professionals in maternal and child health care in St. Petersburg, Russian Federation, was begun in 1994. The programme was designed for health care professionals in the city, and provided 12 workshops in evidence-based antenatal, intrapartum and post-partum care as well as appropriate preparation of parents for pregnancy, birth and parenthood.As part of this initiative, women’s observations on the quality of their maternity care services during their transition to parenthood were explored. This article deals with women’s knowledge of, attitudes towards and practices during post-partum care and breastfeeding in St. Petersburg. These reports describe maternity care practices in the former Soviet Union.     

Consultation,Referral, and Collaboration Between Midwives and Obstetricians: Lessons From New Zealand

There has been substantial growth in the provision of midwifery‐led models of care, yet little is known about the obstetric consultation and referral practices of these midwives or the quality of the collaboration between midwives and obstetricians. This study aimed to describe these processes as they are practised in New Zealand, where midwifery‐led maternity care is the dominant model. A total population postal survey was conducted that included 649 New Zealand midwives who provided midwifery‐led care in 2001. There was a 56.5% response rate, describing care for 4251 women. Within this cohort, there was a 35% consultation rate and 43% of these women had their lead carer role transferred to an obstetrician. However, the midwives continued to provide care in collaboration with obstetricians for 74% of transferred women. Seventy‐two percent of midwives felt that they were well supported by the obstetricians to continue care. Midwifery‐led care is reasonable for the general population of childbearing women, and a 35% consultation rate can be seen as a benchmark for this population. Midwives can, when well supported, provide continuity of care for women who experience complexity during pregnancy and/or birth. Collaboration with obstetricians is possible, but there needs to be further work to describe what successful collaboration is and how it might be fostered.     

Health care-seeking practices of pregnant women and the role of the midwife in Cape Town, South Africa

The objective of this study was to investigate the health-seeking practices of pregnant women in a periurban area in Cape Town, South Africa. This qualitative study was based on 103 minimally structured in-depth interviews of 32 pregnant women. Most women were interviewed on several occasions, and a group discussion was held with women. The interviews were taped, transcribed, analyzed ethnographically, and, if necessary, translated into English. Antenatal care attendance was influenced by a number of factors, including women's knowledge of the role of antenatal care, perceived health needs, booking systems, nurse-patient relationships, economics, child care, and transport. The expected benefits were weighed against the anticipated costs before decisions about seeking care were made. The findings highlight the importance of women's perceptions of quality of care in influencing their health seeking practices. The study suggests that considerably more attention needs to be given to this aspect of maternity services.     

The experiences of postpartum hospital stay and returning home among Thai mothers in Australia.

OBJECTIVE: To describe the experience of postpartum care among Thai women in Melbourne, Australia. DESIGN: Ethnographic interviews and participant observation with women in relation to postpartum care and practices. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 26 Thai born women who gave birth in Australia. FINDINGS: The Thai women had varying views about the length of time they should spend in hospital and the care they received. Ten of the twelve women who had had a caesarean birth stayed in hospital for six or more days, consistent with the hospital practice. However, most of those who had had a vaginal delivery opted to go home earlier than the standard hospital practice of four days stay. This was because they were unhappy about specific hospital practices, the hospital environment, or because there are several Thai confinement customs, which, traditionally, a new mother must observe in order to maintain good health and avoid future ill health and which they were not able to follow in hospital. Nevertheless, most women were satisfied with their postpartum care. Most women were aware of the Thai cultural beliefs and practices. However, they showed varying ways of coping with the hospital environment in relation to their varying social situations. IMPLICATIONS FOR PRACTICE: Thai women are diverse in their needs, perceptions and experience of postpartum care. Therefore, it is appropriate neither to stereotype all Thai women as requiring to follow traditional confinement practices nor to require them to adjust to standard hospital practices. Rather an environment of caring concern whereby each woman's individual needs can be solicited, understood and, where possible, attended to as required. The challenge is in achieving this.     

CONCEPTIONS OF PRENATAL CARE AMONG SOMALI WOMEN IN SAN DIEGO

Studies have shown that culturally sensitive prenatal care improves access to and utilization of that care. Focus groups were used to explore the beliefs and attitudes toward prenatal care among Somali women in San Diego, particularly in regard to their perinatal experiences following immigration. The women were very well informed about healthy prenatal practices, including nutrition and exercise, and very compliant in following such practices, having found ways and means to accommodate these practices into their new American lifestyle. The women were generally pleased with the care that they have received in San Diego and tolerant of most diagnostic and therapeutic interventions. The women preferred to be seen by a female doctor/health care practitioner who is informed about the female circumcision practiced in Somalia and who is conservative in the decision to perform cesarean section deliveries.     

Nyo dua hli--30 days confinement: traditions and changed childbearing beliefs and practices among Hmong women in Australia

OBJECTIVE: To examine traditional and changed beliefs and practices related to the puerperium of Hmong women in Melbourne, Australia. DESIGN: An ethnographic study of reproductive health among Hmong women in Australia. SETTING: Melbourne Metropolitan Area, Victoria, Australia. PARTICIPANTS: 27 Hmong women, three shamans, two medicine women and one magic healer who are now living in Melbourne. FINDINGS: In the Hmong tradition, the first 30 days after birth is seen as the most dangerous period for a new mother. There are several beliefs and practices which women must observe in order to regain strength and avoid poor health in the future. Lying near the fire in the first three days is one such belief. The woman's body during the puerperium is considered polluted. Hence, there are several rules to restrict the woman and the substance of her body. It appears the Hmong continue to observe their post-birth confinement practices regardless of their new environment. Most women mentioned that this is to avoid ill health and misfortune in the future. There are only a few customs which they have to modify due to changes in their living situations in a new country. IMPLICATIONS FOR PRACTICE: Hmong cultural beliefs and practices concerning the puerperium in particular, and childbearing in general, have specific implications for midwifery care. Since midwives will continue to encounter many traditional beliefs and practices of the Hmong when providing birthing care to Hmong women, it is essential that their cultural beliefs and practices be taken into account. This will not only help to avoid misunderstanding, but also result in culturally appropriate and sensitive care for immigrant women.     

Promoting, protecting, and supporting normal birth: a look at the evidence

Interfering with the normal physiological process of labor and birth in the absence of medical necessity increases the risk of complications for mother and baby. Six evidence-based care practices promote physiological birth: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in nonsupine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding. Nurses are in a unique position to provide these care practices and to help childbearing women make informed choices based on evidence.     

Traditional beliefs about pregnancy and child birth among women from Chiang Mai, Northern Thailand

OBJECTIVE: To examine women's embodied knowledge of pregnancy and birth, women's explanations of precautions during pregnancy and birth and preparations for easy birth and the role of a traditional midwife in a Thai birthing care. DESIGN: In-depth interviews relating to traditional and changed beliefs and practices of pregnancy and childbirth with Thai women in Northern Thailand. SETTING: Chiang Mai city and Mae On sub-district in Chiang Mai province, Northern Thailand. PARTICIPANTS: 30 Thai women living in Chiang Mai in Thailand. FINDINGS: The social meaning of childbirth in Thai culture is part of the larger social system, which involves the woman, her family, the community, society and the supernatural world. Traditional beliefs and practices in Thai culture clearly aim to preserve the life and well-being of a new mother and her baby. It seems that traditional childbirth practices have not totally disappeared in northern Thailand, but have gradually diminished. Women's social backgrounds influence traditional beliefs and practices. The traditions are followed by most rural and some urban poor women in Chiang Mai. IMPLICATIONS FOR PRACTICE: The findings of this study may assist health professionals to better understand women from different cultures. It is important to recognise many factors discussed in this paper within the context of Thai lives and traditions. This will prevent misunderstanding and, consequently, encourage more sensitive pregnancy and birthing care for pregnant women.     

Care of the Native American woman: strategies for practice, education, and research

Native Americans, the smallest racial minority in the United States, comprise the fastest growing ethnic group and have a myriad of social and health problems. Women play an important role in health care practices and decision making in this community because many tribes are matrilineal. Practice, education, and research strategies should include identification of beliefs and practices specific to the clan or tribe because there is wide variance in values, lifestyles, and taboos from tribe to tribe. Traditional healers, Native American storytelling, and talking circles can be incorporated into the health care of urban Native American women and their families.     

Evidence-based practice and its application to childbirth care for low-risk women.

"Evidence-based medicine" has been hailed as the "new paradigm" for health care. This paper defines evidence-based practice, describes its development and growing importance, explains why randomized controlled trials are the "gold standard" for evidence about the effectiveness of specific therapeutic methods, warns about reaching conclusions based on any single study, and points the reader towards good sources of information on how to assess the relevance of findings from published studies and systematic reviews of the most reliable evidence regarding particular components of the care of pregnant women. As a result of those reviews, specific elements of perinatal care have been classified into categories based on their usefulness or harmfulness when applied to low-risk women. The paper goes on to summarize the evidence regarding three intrapartum practices that are demonstrably safe and useful and "should be encouraged" and four intrapartum practices that have trade-offs between beneficial and adverse effects and are "frequently used inappropriately." Some of the most beneficial elements of intrapartum care are not available to most women who give birth in American hospitals, and some practices that are useful but have adverse effects are being provided to an ever-expanding proportion of women.     

ACOG Practice Bulletin No. 117: Gynecologic care for women with human immunodeficiency virus

The increased use of screening tests has led to the identification of large numbers of women with human immunodeficiency virus (HIV). Consequently, there is an increased role for obstetrician-gynecologists in caring for infected women. Women infected with HIV are living longer, healthier lives and, therefore, the need for routine gynecologic care has increased. The purpose of this document is to educate clinicians about routine HIV screening practices as well as basic women's health screening and care, family planning, and preconception care for women who are infected with HIV.     

Pregnancy, childbirth, mother and child care among the indigenous people of Zimbabwe

Even in areas of Zimbabwe with easy access to Western-type delivery care, the majority of women are cared for and delivered by traditional birth attendants who are members of their extended family. To understand the social, cultural context of pregnancy, childbirth and subsequent maternal and child care and to use this information for the improvement of maternal and child-health care an anthropological investigation was conducted in an area near Harare, Zimbabwe from June 1983 to the end of 1984. Certain aspects of childbirth such as primagravida deliveries and the origins of peripartum complications, are intimately linked to the religious beliefs and values; other aspects such as the relationship of nutrition and pregnancy are not so linked. An understanding of the traditional concepts of pregnancy, delivery and child care is invaluable if not essential for the upgrading of pregnancy and delivery care, the elimination of harmful practices and the building of supportive links between the traditional and the formal health system.     

‘It's your body,but…’ Mixed messages in childbirth education: Findings from a hospital ethnography

Objectiveto investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth.Designethnography.Settingtertiary hospital in Australian city.Participantssequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork.Findingswomen were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence.Key conclusionsinformed consent is an oft-cited human right in health care, yet in maternity care the micro-politics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices.Implications for practiceas primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.     

Maternal Positions for Childbirth A Historical Review of Nursing Care Practices

The basis of maternity care practices related to maternal position for childbirth is analyzed historically in a review of the American periodical nursing literature from the early 1900's to the present and of contemporary maternity nursing texts. The factors of 1) concomitant obstetrical practices, 2) the prerogative of the physician, and 3) the evolving and predominantly supportive role of the nurse are identified as the major influences on these nursing practices. Historical aspects of the development of the current role of the nurse in maternity care are identified. While nurses are currently questioning care practices related to the positions of women for childbirth and offering more explicit rationale, the need for research related to features of physical care and a more assertive professional role for nurses is emphasized.     

Traditional beliefs and practices in pregnancy,childbirth and postpartum: A review of the evidence from Asian countries

INTRODUCTION: Asian women suffer the largest proportion of the world’s maternal deaths. To reduce this, policymakers and healthcare providers must encourage women with traditionally low rates of maternal health care utilization to access services.OBJECTIVE: The purpose of this study is to provide a comprehensive review of the most common traditional practices in Asia relating to pregnancy, childbirth and the postpartum period.DESIGN: We conducted a literature search of articles: a) focusing on Asia; b) relating to pregnancy, childbirth or postpartum, c) relating to traditional beliefs and/or cultural practices; and 4) published in English in the year 2000 or more recently.FINDINGS: A total of 74 articles are included in this review; 20 articles related to pregnancy, 44 to childbirth, and 45 to postpartum. More than one-half (38) of the articles focused on South Asia and 13 related to China. In the pregnancy category, the majority of the studies focused on dietary recommendations and behavioral taboos. For the childbirth category, many articles examined beliefs and practices that helped to explain women’s aversion to institutional births, such as preference for traditional birth positions, and fear of medical interventions. In the postpartum period, confinement was common because postpartum women were perceived to be weak, fragile and vulnerable to illness. Other prevalent beliefs and practices across Asian countries included massage, the state of pollution after childbirth, the use of traditional healers and traditional medicine and herbs, beliefs relating to hot/cold imbalance, behavioral taboos, magic, and superstition.KEY CONCLUSIONS: Many Asian women continue to practice a wide range of traditional beliefs and practices during pregnancy, childbirth, and the postpartum period. More information is needed on the benefits of formal maternal healthcare services; such educational programs should be geared towards not only women but also husbands, parents, and in-laws. By recognizing and appreciating common local beliefs, providers can be better positioned to provide culturally competent care. Instead of reducing the choices available to women during the birth experience, providers should understand, respect, and integrate cultural interpretations of childbirth and the needs of women and their families.     

EVIDENCE-BASED PRACTICE AND ITS APPLICATION TO CHILDBIRTH CARE FOR LOW-RISK WOMEN*

“Evidence-based medicine” has been hailed as the “new paradigm” for health care. This paper defines evidence-based practice, describes its development and growing importance, explains why randomized controlled trials are the “gold standard” for evidence about the effectiveness of specific therapeutic methods, warns about reaching conclusions based on any single study, and points the reader towards good sources of information on how to assess the relevance of findings from published studies and systematic reviews of the most reliable evidence regarding particular components of the care of pregnant women. As a result of those reviews, specific elements of perinatal care have been classified into categories based on their usefulness or harmfulness when applied to low-risk women. The paper goes on to summarize the evidence regarding three intrapartum practices that are demonstrably safe and useful and “should be encouraged” and four intrapartum practices that have trade-offs between beneficial and adverse effects and are “frequently used inappropriately.” Some of the most beneficial elements of intrapartum care are not available to most women who give birth in American hospitals, and some practices that are useful but have adverse effects are being provided to an ever-expanding proportion of women J Nurse Midwifery 1999;44:355–69 © 1999 by the American College of Nurse-Midwives.     

Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis

Background

Maternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices.

Methods

We used cross-sectional data from a representative sample of 4684 women with children aged 0–11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding.

Results

About 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p < 0.05).

Conclusion

We found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.

     

Guideline use for gestational diabetes mellitus and current screening, diagnostic and management practices in Australian hospitals

A postal questionnaire investigating screening, diagnosis and management practices for gestational diabetes mellitus (GDM) and guidelines use for GDM, was sent to 544 Australian hospitals providing maternity care. Of these, 360 (66%) responded. Guidelines for GDM were available in 127 (39%) hospitals. Screening for GDM was undertaken by 284 (87%) hospitals and of these, 151 (53%) screened all women and 63 (22%) selectively screened women. Half (143, 50%) of the hospitals surveyed screened women using a 50 g oral glucose challenge test (OGCT) and 70 hospitals (25%) used a 75 g OGCT. A 75 g oral glucose tolerance test was most commonly used to diagnose GDM (207; 81%) and 126 hospitals (60%) recommended a 2 hour blood glucose level of > or = 8.0 mmol/l as diagnostic for GDM. In the management of women with GDM, levels for optimal glycaemic control varied. Postpartum testing for diabetes mellitus was recommended by the majority of hospitals (202; 72%). This study has shown the majority of Australian hospitals providing maternity care screening for GDM, but there is little consensus in screening practices.