Maternity and extreme poverty: the relationship between mothers and midwives

A research team consisting of a female physician and a female sociologist studied the "interface" between the needs and perceptions of impoverished pregnant women who gave birth at a regional maternity hospital in France and the perceptions of the midwives who attended them. The ultimate goal of the study was to shed light on reasons for the extreme vulnerability of very poor women and their infants during pregnancy and delivery. 30 new mothers meeting the criteria of extreme poverty were interviewed at their bedsides and 57 of 97 midwives returned questionnaires. 29 of the 30 pregnant women received regular prenatal care and 26 had their pregnancies diagnosed in the first trimester. 27 of the women received all or part of their prenatal care at the maternity hospital. The 3 women receiving all their prenatal care from private physicians averaged 5 consultations each, while the 16 receiving all their care from the hospital averaged 8.3 visits each. The number of health professionals seeing each woman varied from 2-9, not counting hospitalizations. 20 of the 30 women were hospitalized a total of 43 times. 2 other women refused hospitalization. 3 of the mothers stated that prenatal visits were useless and 8 stated that they had derived no benefit from the visits. 16 stated they were disturbed by seeing so many different health workers. 16 said they had some good experiences during the visits. 10 reported they had had "bad moments" resulting from the unpleasant general ambience, the dry and unfriendly attitude of the health workers, long waits, and the succession of workers. Lack of communication, the absence of moral support, and the feeling of being negatively judged were other complaints. 63% of the midwives believed the very poor women were indifferent to their pregnancies, and only 26% believed they were happy to be expecting babies. Only 21% believed they sought regular prenatal care, and 75% believed their care was haphazard. 30% of the midwives believed the women found the visits boring or useless. 44% of the midwives believed the very poor women saw more health workers than other women, but 60% felt they did not object to seeing so many workers. The feelings and attitudes attributed to poor women by the midwives did not correspond to the perceptions of the poor women themselves. Health improvements for newborns in situations of poverty may require a better fit between the needs of the mothers and what the health care system offers.     

From distress to flourishing: towards a strengths-based approach for young mothers

ABSTRACT

Objective: The current study aims to better understand the predictors of flourishing, as well as the predictors of distress, among first-time Australian mothers in their teens and early 20s in the first year postpartum.

Background: Past research has linked early motherhood with poor outcomes for mother and baby. However, other research has demonstrated that disadvantage often precedes early motherhood, rather than results from it, and there has been a consistent body of qualitative research highlighting positive outcomes for young mothers. In this paper, we investigate who is doing well amongst a sample of young mothers.

Methods: Through quantitative analysis of survey data of 86 women aged 16–24 years who had transitioned to motherhood in the past 12 months, we investigate the predictors of flourishing, along with postnatal distress.

Results: Our findings suggest that this sample of women was doing well, with relatively high scores on flourishing and low scores on distress. As expected, the two constructs were negatively correlated.

Conclusion: Whilst self-esteem was a consistent predictor of both distress and flourishing, and acted as a mediating factor, this research also showed that there are unique and independent predictors for distress and flourishing, which can be used to inform tailored programs for young mothers.     

Pregnancies in young adolescent mothers: a population-based study on 37 million births

ObjectivesPregnancy in young adolescents is often understudied. The objective of our study was to evaluate the effect of young maternal age on adverse obstetrical and neonatal outcomes.MethodsWe conducted a population-based cohort study using the Center for Disease Control and Prevention’s Linked Birth-Infant Death and Fetal Death data on all births in the US between 1995 and 2004. We excluded all births of gestational age under 24 weeks and those with reported congenital malformations or chromosomal abnormalities. Maternal age was obtained from the birth certificate and relative risks estimating its effect on obstetrical and neonatal outcomes were computed using unconditional logistic regression analysis.Results37,504,230 births met study criteria of which 300,627 were in women aged <15 years with decreasing rates from 11/1,000 to 6/1,000 over a 10-year period. As compared to women 15 years and older, women <15 were more likely to be black and Hispanic, less likely to have adequate prenatal care, and more likely to not have had any prenatal care. In adjusted analysis, births to women <15 were more likely to be IUGR, born under 28, 32, and 37 weeks’ gestation and to result in stillbirths and infant deaths. Prenatal care was protective against infant deaths in women < 15 years of age.ConclusionAlthough public health initiatives have been successful in decreasing rates of young adolescent pregnancies, these remain high risk pregnancies that may benefit from centers capable of ensuring adequate prenatal care.     

Factors associated with negative emotional expression: a study of mothers of young infants

This interview study of mothers with 3‐month‐old infants sought to determine factors associated with maternal negative emotional expression regarding their infants. In a cross‐sectional study, 179 mothers were given a shortened version of the Five Minute Speech Sample technique, requesting that they speak for only 2 minutes about their child and their relationship. Negative comments about the infant, maternal health prior to and since the birth, and the impact of the infant on her life were coded. They also completed attitudinal questionnaires and reported on marital relationships and the infant's health and temperament. A Caesarean section, infant illness, current maternal depressive symptoms, fussy infant temperament, and lack of enjoyment of feeding were all independently associated with negative remarks. Depression, infant illness and fussy temperament were all independent predictors of negative remarks about the infant, and Caesarean section and time in Special Care Baby Unit were independent predictors of negative remarks about maternal health and well‐being. This kind of open‐ended enquiry could be adapted for use in routine clinical contact with mothers of new infants to identify those who may need support.     

Maternity Care Practices: Implications for Breastfeeding

Background: Many United States mothers never breastfeed their infants or do so for very short periods. The Baby‐Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby‐Friendly practices experienced on breastfeeding. Methods: A longitudinal mail survey (1993–1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods. Predictor variables included indicators of the absence of specific Baby‐Friendly practices (late breastfeeding initiation, introduction of supplements, no rooming‐in, not breastfeeding on demand, use of pacifiers), and number of Baby‐Friendly practices experienced. The main outcome measure was breastfeeding termination before 6 weeks. Results: Only 7 percent of mothers experienced all five Baby‐Friendly practices. The strongest risk factors for early breastfeeding termination were late breastfeeding initiation and supplementing the infant. Compared with mothers experiencing all five Baby‐Friendly practices, mothers experiencing none were approximately eight times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination. Conclusion: Increased Baby‐Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to increase adoption of these practices is illustrated by the small proportion of mothers who experienced all five practices measured in this study.     

The factor structure of the GHQ-30 for mothers with young children

Abstract

A comparison is made between the factor structure for the 30-item version of the General Health Questionnaire (GHQ) found for an American sample (Goldberg et al., 1976) and that obtained for two samples of British mothers of young children. In the American study the first factor extracted loaded most heavily on items concerned with anxiety and depression. In the present study a more general first factor was obtained in three separate factor analyses that accounted for a larger proportion of the variance in the item scores (37 per cent, 34 per cent, 35 per cent). It is concluded that a number of possible sample characteristics could be affecting the obtained factor structure. It is necessary to exercise caution before adopting a previously established factor structure to compute subscale scores for this instrument.     

MOM Survey: Maternity Options for Mothers—What Do Women Want in Maternity Care?

ABSTRACT: As part of planning a new maternity wing of a Boulder, Colorado hospital, a telephone interview survey of 645 women who delivered within one year at this hospital was made to determine their preferences for 49 different options in maternity care. The sample was divided into 210 women chosen at random, 230 from La Leche League groups, and 205 women from prepared childbirth classes. The most important areas of concern to these new mothers were similar in all three groups and revolved around maintaining family closeness and obtaining help from hospital staff rather than desire for new or different facilities. Proposals resulting from this study were for the new maternity service to provide 1) combined labor-delivery-recovery rooms; 2) most post-partum rooms to be private; 3) father unrestricted in visiting throughout; 4) sibling visitation; 5) inservice training for medical and nursing staff in childbirth and breastfeeding techniques; 6) family-centered cesarean births; 7) alternative birth arrangement with early discharge.     

Teenage mothers: a pilot study

This paper presents the findings of a pilot study carried out in one regional center in Queensland, Australia. The study aimed to develop a snapshot image of teenage mothers. Of the thirty mothers who participated; just over half (16/30; 53%) reported using contraceptives, less than a third (8/30; 27%) used condoms to protect themselves from STDs and the majority (23/30; 77%) said their pregnancy was unplanned. Despite this, 16 (53%) attended prenatal classes, 16 (53%) breast-fed their infants and 27 (90%) were satisfied with motherhood. On average the fathers were almost four years older than the mother were (range 17 to 29 years), most fathers (23/30; 77%) were not teenagers themselves and only 11 (37%) were resident fathers following the birth of the baby. Exploratory analysis suggests that the fathers were significantly older than the teenage mothers were (t = -6.73, df 29, p = 0.0001). Although these preliminary results are similar to those reported in the American literature further research is needed to confirm if the findings presented are representative of teenage mothers in Australia. While we await the results of future studies, practitioners are encouraged to continue to educate young women about appropriate and safer sexual practices.     

Exploration of the experiences of young mothers seeking and accessing health services

Objective: The objective was to explore young mothers’ experiences of seeking and accessing health services, specifically maternity care. Study design: A phenomenological approach underpinned by the work of Husserl and guided by the framework offered by Giorgi. Participants: A purposive sample of seven young mothers took part in audio-recorded unstructured interviews in either the young mother’s home or in a private room at their GP practice. Findings: Six themes emerged from the initial thematic analysis: (1) feeling abandoned, (2) information is vital, (3) feeling judged, (4) family and friends, (5) interference, (6) younger mothers need additional support. After ‘bracketing’ the preconceptions evident in the initial analysis, essential themes describing the young mothers’ experience of accessing healthcare were identified: (1) the need for support and information; (2) fear of stigmatisation and stigmatisation of self. Conclusions: The young mothers in this study experienced a need for support and information, which reflects the findings of previous studies. This study has added to the knowledge base as it also found that these young mothers were hindered from obtaining or making use of available support and information through fear or expectation of stigmatisation and self-stigmatisation. There is a need to improve availability of support and information for young mothers, who may benefit from one-to-one education to help them gain confidence to deal with pregnancy and parenthood issues. Further research on young mothers’ perceptions of maternity service provision will advance understanding of young mothers’ help and support needs during pregnancy, birth and the postnatal period.     

Maternity protection vs. maternity rights for working women in Chile: a historical review

Maternity leave in Chile has been a social right since 1919, when the International Labour Organization set the first global standards. From its inception, Chile's labour legislation focused on protecting motherhood and the family. The length of maternity leave has been extended several times since then but its main aim remains the protection of infant health. In 1931, Chile's first Labour Code required anyone employing 20 or more women to provide day care services and facilitate childcare and paid breastfeeding time for all mothers of children under one. Labour laws began to play an important role in accommodating the care of infants within working conditions, though not always effectively. In spite of job protection during pregnancy and breastfeeding, women can be dismissed on grounds other than pregnancy. It was only under Salvador Allende and again in the past two decades that Chile has enfranchised women as holders of health rights. However, many unresolved tensions remain. Chile promotes motherhood, but often considers that working women who demand employment protection abuse the system. Motherhood is a magic wand that represents the selflessness of women, but society throws a blanket of mistrust over women who wish to exercise their maternity rights and to determine the number and spacing of their children.     

Willingness to Pay for a Maternity Waiting Home Stay in Zambia

Introduction

Complications of pregnancy and childbirth can pose serious risks to the health of women, especially in resource‐poor settings. Zambia has been implementing a program to improve access to emergency obstetric and neonatal care, including expansion of maternity waiting homes‐residential facilities located near a qualified medical facility where a pregnant woman can wait to give birth. Yet it is unclear how much support communities and women would be willing to provide to help fund the homes and increase sustainability.

Methods

We conducted a mixed‐methods study to estimate willingness to pay for maternity waiting home services based on a survey of 167 women, men, and community elders. We also collected qualitative data from 16 focus group discussions to help interpret our findings in context.

Results

The maximum willingness to pay was 5.0 Zambian kwacha or $0.92 US dollars per night of stay. Focus group discussions showed that willingness to pay is dependent on higher quality of services such as food service and suggested that the pricing policy (by stay or by night) could influence affordability and use.

Discussion

While Zambians seem to value and be willing to contribute a modest amount for maternity waiting home services, planners must still address potential barriers that may prevent women from staying at the shelters. These include cash availability and affordability for the poorest households.     

What mothers want: a postnatal survey

Mothers in the public health care system undergo mandatory early discharge after childbirth. The challenges associated with the decreasing length of hospital stay have rarely been investigated from a service consumer perspective. The aim of this study was to identify mothers' needs in the immediate postpartum period. An inpatient survey of 500 postnatal mothers undertaking the Early Discharge Program. Survey questions aimed to elicit the needs of mothers in the immediate postnatal period; perceived barriers to optimal care; and suggestions as to how these barriers could be addressed. Forms were distributed to all women on admission to a postnatal ward over a two month period and completed prior to discharge. Of 500 eligible mothers, 151 (30.2%) responded to the anonymous open ended survey. A thematic analysis of comments revealed that women wanted specific information about mothering, the creation of a restful environment, adequate pain relief, practical assistance, education, and set visiting times. For new mothers, early discharge made the need for rest and information a high priority. Constraints within the public health care system and midwifery practice need to be examined to better serve mothers' needs. Midwifery practice within the context of early postpartum discharge should seek to better serve new mothers by giving high priority for rest and information requirements.