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High U.S. incarceration rates have motivated recent research on the negative effects of imprisonment on later employment, earnings, and family relationships. Because most men in jail and prison are fathers, a large number of children may be placed at considerable risk by policies of incarceration. This article examines one dimension of the economic risk faced by children of incarcerated fathers: the reduction in the financial support that they receive. We use a population-based sample of urban children to examine the effects of incarceration on this support. Both cross-sectional and longitudinal regressions indicate that formerly incarcerated men are less likely to contribute to their families, and those who do contribute provide significantly less. The negative effects of incarceration on fathers' financial support are due not only to the low earnings of formerly incarcerated men but also to their increased likelihood to live apart from their children. Men contribute far less through child support (formal or informal) than they do when they share their earnings within their household, suggesting that the destabilizing effects of incarceration on family relationships place children at significant economic disadvantage. [ABSTRACT FROM AUTHOR]

To evaluate the quality of maternity care, women’s perception of the quality of care and factors influencing the same in Delhi. Women who delivered a viable live birth in the past 6 months were recruited from South Delhi by a two-stage stratified cluster randomized sampling. In stage 1, two colonies each from three predefined economic strata (high-, middle- or low-income areas) were selected by simple-random sampling. In stage 2, a sequential house-to-house survey was conducted in each selected colony. The information was collected by interview and review of medical records. A total of 5,279 houses were screened to recruit 249 subjects. Several disparities were notable. 25.2 and 14.8% of the women from middle- and lower-income areas delivered by cesarean section, while the rate was 53.6% in the higher-income areas. In women from lower-income areas urine testing was not done in 76.9% and blood sugar was not tested in 18.2%, while in high-income areas 44.6% had ≥10 antenatal visits and 87.8% had ≥3 ultrasounds. Of the women who experienced labor only 11% received support from a friend or family member, 4.4% received any medicine/measures for pain relief, 44.3% were allowed to walk and 14.6% were catheterized. Health care providers are unable to meet national minimal care standards in poorer areas, while over investigation and over intervention appear prevalent in higher-income areas. This warrants a more representative evaluation to enable more equitable and evidence-based practice. [ABSTRACT FROM AUTHOR]

A case of HIV seroconversion associated with high viral load occurring at or near delivery is described. The management of the case in terms of prevention of mother-to-child-transmission is described and discussed in terms of the published literature and guidelines. From this instructive case a constructive strategy for delivery and immediate post-natal care is derived. [ABSTRACT FROM AUTHOR]

Information on the topics discussed at the 15th African Union (AU) Summit held in Kampala, Uganda on July 19-27, 2010 is presented. Topics include the situation of refugees and internally displaced persons (IDPs) in Africa, the destabilizing effect of renegade armed groups, and the Africa's access to quality healthcare. It mentions that the summit featured several court judges including Gerald Niyungeko, Augustino Ramadhani, and Duncan Tambala.

The current emphasis in maternity services on risk creates stress in women that may adversely affect the neurological development of the unborn child. Wellbeing across the transition to parenthood requires a paradigm of care that focuses on building self-efficacy rather than infantilising mothers and fathers. [ABSTRACT FROM AUTHOR]

The policies of the early twentieth-century maternalist state have been studied extensively. This article argues that in order to understand Edwardian welfare provision, the relationships between class, place and gender in the previous century must be explored. This is studied through the interaction between child-rearing literature and the experiences of fathers and mothers in three contrasting localities in England from about 1860 to 1910. Mid-nineteenth-century advice manuals and parents expressed very similar understandings of child health. Only from about the 1890s were middle-class attitudes influenced by new medical ideas, which constructed working-class child-rearing as uniquely ignorant. Local government and philanthropic initiatives largely emphasised the importance of domestic care, which ignored parents' anxieties about dangers outside the home and left non-elite medical services structured to exclude children. However, diverse cultures of parental responsibility, of understandings of illness, and of public attitudes to childhood made class, place and gender central to the shifting ways in which health care was provided for children. [ABSTRACT FROM PUBLISHER]

Background: Prenatal supplementation has been inversely associated with childhood, but not with infant, leukaemia.Methods: Mothers of 443 cases of infant leukaemia diagnosed during 1996-2006 and 324 frequency-matched controls completed interviews. Associations were evaluated by unconditional logistic regression.Results: We observed no associations between prenatal vitamin (odds ratio (OR)=0.79, 95% confidence interval (CI): 0.44-1.42) or iron supplementation (OR=1.07, 95% CI: 0.75-1.52) and infant leukaemia after adjustment for race/ethnicity and income. Similar results were observed for leukaemia subtypes analysed separately.Conclusion: The observed null associations may be attributable to high supplementation rates and/or national fortification programmes. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Both J, van Roosmalen J. The impact of Prevention of Mother to Child Transmission (PMTCT) programmes on maternal health care in resource-poor settings: looking beyond the PMTCT programme-a systematic review. BJOG 2010;117:1444-1450. Background There is increasing debate about the impact of scaled-up HIV/AIDS programmes on fragile healthcare systems in low-income countries. Objectives To contribute to the understanding of the relation between HIV/AIDS programmes and healthcare systems, this systematic review focuses on the impact of Prevention of Mother to Child Transmission (PMTCT) programmes on maternal health care. Search strategy Publications describing the effect of PMTCT programmes on maternal healthcare services were sought through computerised searches in five electronic databases. Selection criteria Abstracts of publications were evaluated for appropriateness for inclusion based on whether they met the inclusion criteria. Data collection and analysis Copies of all selected publications were obtained. A classification system was developed to group the relevant publications. Main results The findings show that empirical evidence of the effect of PMTCT programmes on maternal health care is scarce and further research is badly needed. Twenty-one studies that were included in the systematic review showed that PMTCT programmes are often semi-integrated in maternal health care with positive as well as negative effects on various aspects of maternal health care. Authors' conclusions It appears that PMTCT programmes miss the opportunity to have an overall positive effect on maternal health care because of their verticality. [ABSTRACT FROM AUTHOR]

Aiming to analyze the spatial distribution and self-correlation of data of mother-child health in Parana, Brazil, variables were selected from the Information System on Live Births, grouped into socioeconomic indicators: teenage mother, low education, high parity, race/color black of newborn; healthcare indicators: the prenatal coverage, prematurity and cesarean delivery and result indicators: low birth weight. The indicators were distributed in thematic maps and spatial self-correlation was measured using Moran's index that quantifies the degree of self-correlation. There was significant spatial self-correlation of teenage mother, low education and high parity of the "high-high" type in the macro-regions East, Campos Gérais and South; of low coverage of antenatal care in Campos Gérais, Central-south and North and of cesarean delivery in the Northwest. Elevated proportions of indicators of risk to the health of mother and child were found in the regions East, Campos Gérais and South. These results support the evaluation and planning of health services. [ABSTRACT FROM AUTHOR]

Management of post-partum haemorrhage (PPH) involves the treatment of uterine atony, evacuation of retained placenta or placental fragments, surgery due to uterine or birth canal trauma, balloon tamponade, effective volume replacement and transfusion therapy, and occasionally, selective arterial embolization. This article aims at introducing pregnancy- and haemorrhage-induced changes in coagulation and fibrinolysis and their relevant compensatory mechanisms, volume replacement therapy, optimal transfusion of blood products, and coagulation factor concentrates, and briefly cell salvage, management of uterine atony, surgical interventions, and selective arterial embolization. Special attention, respective management, and follow-up are required in women with bleeding disorders, such as von Willebrand disease, carriers of haemophilia A or B, and rare coagulation factor deficiencies. We also provide a proposal for practical instructions in the treatment of PPH. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Kelly J, Kohls E, Poovan P, Schiffer R, Redito A, Winter H, MacArthur C. The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia. BJOG 2010;117:1377–1383. Objective To describe maternal mortality and stillbirth rates among women admitted via a maternity waiting area (MWA) and women admitted directly to the same hospital (non-MWA) over a 22-year period. Design Retrospective cohort study. Setting Hospital in rural Ethiopia, which provided comprehensive emergency obstetric care and has an established MWA. Population All women admitted for delivery between 1987 and 2008. Methods Data on maternal deaths, stillbirths, caesarean section and uterine rupture were abstracted from routine hospital records. Sociodemographic characteristics, antenatal care and other data were collected for 2008 only. Rates and 95% confidence intervals were calculated for maternal mortality and stillbirth. Main outcome measures Maternal mortality and stillbirth. Results There were 24 148 deliveries over the study period, 6805 admitted via MWA and 17 343 admitted directly. Maternal mortality was 89.9 per 100 000 live births (95% CI, 41.1–195.2) for MWA women and 1333.1 per 100 000 live births (95% CI, 1156.2–1536.7) for non-MWA women; stillbirth rates were 17.6 per 1000 births (95% CI, 14.8–21.0) and 191.2 per 1000 births (95% CI, 185.4–197.1), respectively; 38.5% of MWA women were delivered by caesarean section compared with 20.3% of non-MWA women, and none had uterine rupture, compared with 5.8% in the non-MWA group. For the 1714 women admitted in 2008, relatively small differences in sociodemographic characteristics, distance and antenatal care uptake were found between groups. Conclusions Maternal mortality and stillbirth rates were substantially lower in women admitted via MWA. It is likely that at least part of this difference is accounted for by the timely and appropriate obstetric management of women using this facility. [ABSTRACT FROM AUTHOR]

Early results examining nutritional behaviour of Caucasian, English-speaking, postpartum women living in Sheffield, who were beneficiaries or eligible for the Welfare Food Scheme (WFS) or the Healthy Start (HS) scheme, suggested significant between-groups differences. The aim of this study was to examine whether differences observed at 4 weeks postpartum were sustained over time. Eighty-six WFS and 64 HS participants were recruited at baseline and, thereafter, 53 WFS and 33 HS participants at week 8, and 47 WFS and 39 HS participants at week 12. Dietary intakes were assessed by an interviewer-administered, semi-quantified food frequency questionnaire. At 4 weeks, HS women had higher energy intakes compared to WFS women, (9.7 MJ and 8.1 MJ, respectively). Differences were also sustained at 8 weeks, (8.8 MJ and 7.2 MJ) and 12 weeks (9.4 MJ and 7.6 MJ) for the HS and WFS participants, respectively. Within-groups, energy and most of nutrient intakes did not change appreciably over time. Consumption of fruit and vegetables at baseline, were significantly higher ( P = 0.023) for participants under the HS scheme (3.4 portions) compared to WFS participants (2.7 portions). Differences were sustained over time as HS women reported consuming 4.1 and 3.7 portions/day respectively at 8 and 12 weeks, as opposed to 2.8 and 2.7 portions/day reported by WFS women. The study findings provided evidence of the potential effectiveness of the HS scheme in a population subgroup at risk of dietary deficiencies. Early findings could provide a useful snapshot of the diet of such mobile population and should be further exploited. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to examine the current state of knowledge regarding the relationships between maternal hydration and pregnancy outcomes as a basis of the management of maternal hydration status during pregnancy. Methods A search of literature was conducted using four key electronic databases (Central Medical Journal web version , PubMed, CINAHL, and the Cochrane Library) and reference lists from: three widely used medical obstetric textbooks and selected articles. In order to integrate available knowledge, all published literature before the 5th of August 2009, written in the Japanese or English language that focused on the effects of maternal hemodynamic patterns and maternal hydration on pregnancy outcomes was sought yielding 83 articles for review. The articles were grouped by: language, type of article, and specialty, and categorized according to the research focus. Findings were systematically synthesized and discussed according to three foci of this review: 1) the relationship between maternal hydration and pregnancy outcomes; 2) recommended hydration methods for pregnant women; 3) measurement methods evaluating maternal hemodynamic patterns and hydration status in pregnancy. Results A number of studies reported the positive relationship between maternal hydration and increased amniotic fluid volume. However, limited research findings were noted regarding preventive or treatment effects of maternal hydration on complications in pregnancy. Although no study was found with regard to the trends of maternal fluid intake, the relationship between maternal caffeine consumption and pregnancy outcomes and the validity of a selfreport survey in determining the quantity of maternal caffeine consumption were found. There were a variety of methods and measurement tools evaluating maternal hemodynamic patterns and hydration status in pregnancy. However, as a management strategy for prenatal care, optimal methods that enabled only non-invasive measurement of maternal hemodynamic patterns were not found. Also, clinical evidence for methods in maintaining maternal hydration status during pregnancy was not found. Conclusions The association of maternal hydration with increased amniotic fluid volume, the needs of careful examination for a type of fluids recommended for pregnant women, and bioelectrical impedance analysis as a potential non-invasive tool measuring maternal hydration status in pregnancy were found in this review. Future studies might include conducting descriptive or exploratory studies in the trends of fluid intake in relation to the pregnancy outcomes, identifying recommended hydration methods for pregnant women, and developing non-invasive and feasible measurement tools in determining physiological effects of maternal fluid intake. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study is to describe the relationships among thermal environment, skin temperatures and infants’ daytime outdoor sleep duration in northern winter conditions. Methods: This study is a cross-over observational study. Skin temperatures of three-month-old infants were recorded from seven skin sites continuously throughout outdoor (n = 34) and indoor sleep (n = 33) in the families’ homes. The duration of the sleep was observed, and temperature and the air velocity of the environment were recorded. Results: Skin temperatures increased towards the end of indoor sleeping, whereas they decreased during outdoor sleeping. The cooling rate of mean skin temperature (Tsk) increased in lower outdoor temperatures (rs = 0.628, p < 0.001) in spite of increased clothing. On some occasions, cold extremities were observed, suggesting slight deviations from thermoneutrality. Sleep time was 92 min longer in outdoors than in indoors. However, outdoor sleep duration was shortened when the cooling rate of Tsk increased (rs = 0.611, p < 0.001). Conclusion: The longest sleep was recorded outdoors when the cooling rate of Tsk was minimal. Restriction of movements by clothing probably increases the length of sleep, and a cold environment makes swaddling possible without overheating. A decrease in ambient temperature increased the cooling rate, suggesting that the cold protection of the clothing compensated only partly for the increased heat loss. [ABSTRACT FROM AUTHOR]

Illicit substance use is not uncommon in women of childbearing age. The direct effects of illicit substance use on the mother, pregnancy and the fetus are not well understood, in contrast to the indirect effects of social disadvantage and intercurrent medical and psychiatric illness, which are well documented. We have undertaken a review of the current literature regarding the effects of illicit substance use in pregnancy and include a suggested approach to identification and management of at-risk women. [ABSTRACT FROM AUTHOR]

The article investigates the inequalities in the maternal and infant health care in developing countries. Urban poverty in 30 countries was measured via improved methods, wherein significant inequality in maternal and infant health and in health care services accessibility was found. It cites the factors that hinder health care access including geographical distance, cost, and lack of services. Due to increasing number of urban poor, improvement in basic health care services is being suggested.

This study examines the total package of child support that mothers receive from the nonresident fathers of their children, by focusing on three components of total support: formal cash, informal cash, and in-kind support. Using the Fragile Families and Child Wellbeing Study, this article considers how contributions change over time and the effects of child support enforcement on these contributions. Findings suggest that total cash support received drops precipitously over the first 15 months of living apart (as informal support drops off) and then increases slightly after 45 months (as the increase in formal support overtakes the decrease in informal support). While the study finds no effect of enforcement on total support received in the first 5 years after a nonmarital birth, the substantial differences in total cash support received by the length of time that parents have not been cohabiting suggest that strong enforcement may be efficacious over time. [ABSTRACT FROM AUTHOR]

The need for early ambulation for caring of the neonate by mothers makes postoperative pain management after cesarean delivery unique. Favorable results have been observed with buprenorphine, clonidine and bupivacaine as epidural analgesics. This prospective, randomised triple blind control study was carried out among 112 lower segment caesarean segment (LSCS) patients, divided into three groups, to assess the analgesic efficacy and side effects of epidural analgesia, with an intermittent top up of (i) bupivacaine (0.125%) and buprenorphine (0.075 mg) (ii) bupivacaine (0.125%) and clonidine (37.5 microgram) and (iii) bupivacaine (0.125%) alone, in LSCS cases. The demographic characteristics (age, weight and height) of the three groups were comparable and the differences were not statistically significant. The mean duration of the analgesia was significantly longer in the group one patients receiving buprenorphine plus bupivacaine (690 ± 35 minutes) and it was lowest in group three patients receiving bupivacaine (170 ± 31 minutes) alone. The mean highest pain score (VAS scale) was significantly lower (3.4 ± 0.6) in group one patients and it was highest in group three (6.7 ± 0.8) patients. Requirement of continuation of epidural analgesia after 15 hours of operation and requirement of diclonfenac injections as well as incidence of itching and pruritus was significantly lower in group one patients. Incidence of nausea and vomiting was the lowest in group one patients. Incidence of respiratory depression, sedation and hypotension were nil in all three group of patients. Epidural buprenorphine combined with bupivacaine produced significantly longer duration and better quality of analgesia than bupivacaine combined with clonidine or bupivacaine alone, and it was safe in LSCS patients, for post-operative analgesia. [ABSTRACT FROM AUTHOR]

Obstetric patients admitted to an Intensive Care Unit (ICU) present a challenge to an intensivist because of normal physiological changes associated with pregnancy and puerperium, the specific medical diseases peculiar to pregnancy and the need to take care of both the mother and the foetus. Most common causes of admission to an ICU for obstetric patients are eclampsia, severe preeclampsia, haemorrhage, congenital and valvular heart disease, septic abortions, severe anemia, cardiomyopathy and non-obstetric sepsis. The purpose of this review is to present the recent concepts in critical care management of obstetric patients with special focus mainly on ventilatory strategies, treatment of shock and nutrition. The details regarding management of individual diseases would not be discussed as these would be beyond the purview of this article. In addition, some specific issues of importance while managing such patients would also be highlighted. [ABSTRACT FROM AUTHOR]

Any anaesthetic technique, either regional or general, has potential for complications. Moreover, it has been seen that in obstetric patients, the complications are potentiated due to pregnancyrelated changes in physiology and due to various other factors. Increasing trend of caesarean section in the setting of increasing maternal age, obesity and other concomitant diseases will continue to challenge the obstetric anaesthetist in his/her task of providing safe regional and general anaesthesia. This review has highlighted the possible complications of regional and general anaesthesia encountered during the obstetric anaesthesia practice. [ABSTRACT FROM AUTHOR]

Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patientcontrolled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computerintegrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety. [ABSTRACT FROM AUTHOR]

The author comments on the studies that investigate maternal mortality in the field of obstetric anesthesia. The author highlights the global efforts and initiatives, which are specified within the Millennium Declaration to address the problems on the increasing incidences of maternal mortality. The author also stresses the importance on the role among anesthesiologists, who are capable to provide the care of the critically ill obstetric patients based on their practice in obstetric anesthesia.

The present study aims to determine the patterns of breast feeding, return of menstruation, and contraceptive practices in the first six months postpartum in women visiting the outpatient department at a teaching hospital in Lucknow, Northern India. Mothers of infants between six to eight months of age visiting the outpatient department of Era's Lucknow Medical College were interviewed regarding breast feeding practices, return of menstruation, sexual activity, and contraceptive practices within the first six months postpartum using a structured questionnaire. Of all women interviewed only 75.8% practiced exclusive breast feeding with the mean duration of exclusive breast feeding (EBF) being 3.5 months with only 41% practicing EBF for six months, 28% were sexually active within six weeks postpartum, 64.5% women had a return of menstruation within six months. Contraception was practiced by only 54.4% women with a barrier method such as a condom, being the most common. Better education was the only factor significantly affecting EBF (p < 0.004) and use of contraception (p < 0.027). There were a total of 10 pregnancies within six months postpartum. In conclusion, optimal breast feeding practices are poor in this part of the country and lactational amenorrhoea cannot be effectively and reliably used as a method of contraception. Therefore, optimal breast feeding practices, timely introduction of contraception and institutional delivery need to be encouraged. [ABSTRACT FROM AUTHOR]

The article looks at the status of postnatal care practices including cord care and thermal care for mothers and newborns in Uttar Pradesh, India. It mentions that only 14 percent of the mothers in the rural areas received postnatal care from a health provider and that most of them applied various methods for newborn thermal care. Details related to the barriers of healthy postnatal care practices and the behavior change methods to improve postnatal care are also included.

The article presents an analysis on the effectiveness of the maternal health care programs developed by the National Rural Health Mission (NRHM) for pregnant women in Uttar Pradesh, India. It discusses the impact of the Janani Suraksha Yojana on promoting institutional delivery and the use of skilled birth attendants for safe delivery of women who opt to deliver at home. The reasons for the preference of home delivery and the barriers in access to obstetric care are also discussed.

This paper examines data on teenage fertility and patterns of uptake of the Child Support Grant in South Africa from 1998 to 2005, to assess how far this Grant is associated with the trend in teenage childbearing. Teenage fertility was fairly high during the 1980s when state financial assistance to teenage mothers did not adequately serve the majority of South Africans. Since the first half of the 1990s, however, teenage fertility has steadily declined. This trend was already underway when the grant was expanded in 1998 to reach beneficiaries in all sub-groups of the national population. If teenage girls were having children primarily to benefit from the Child Support Grant, then more would be making claims than is in fact the case. The findings of this study do not suggest any significant positive association between the grant and the trend in teenage childbearing in South Africa during the past decade. [ABSTRACT FROM AUTHOR]

Objective: This study aims to describe the blood pressure profile of newborns of preeclampsia mothers in Vali-e-Asr hospital during 2003-2004. Materials and methods: In this cross-sectional descriptive analytical study 200 mothers and their newborns were studied. Blood pressure of all newborns was checked by oscillometric method on the first day after birth and recorded in a questionnaire along with information pertaining to the mother, obtained by interview or through medical file retrieval. Results: The newborns of mothers with high systolic (>140 mmHg) and diastolic (>90 mmHg) blood pressure had mean systolic (65.40 mmHg) and diastolic (42.85 mmHg) blood pressures higher than that in neonates of normotensive mothers( P <0.006). Mean systolic and diastolic blood pressure of neonates whose mothers were preeclampsia (68.2/42.11 mmHg or chronically hypertensive (68.59/ 41.50 mmHg-) were significantly higher than neonates of normotensive mothers (P<0.0001 and P<0.002, respectively).Newborns of smokers had significantly higher blood pressures too (P<0.02). Conclusion: Mother's blood pressure can affect neonatal blood pressure. Chronic hypertension, pre- eclampsia, and cigarette smoking in mothers can adversely alter neonatal blood pressure. These maternal conditions should be screened and managed as soon as possible. [ABSTRACT FROM AUTHOR]

In the begining of 1990 Romania had the highest maternal and infant mortality in Europe and one of the highest in the world. Through complex and integrated programs, Romania succeded to improve it's mothers and child health. Improvements in mothers and childrens health were the result of both program implementation, which produced an increase of quality and eficiency of medical services and improvement in the socioeconomic conditions for the general population. The Cluj district presents an even higher improvement compared with the Romanian average; the district implements many of the programs included in the National Mother and Child Health Program. [ABSTRACT FROM AUTHOR]

Background: In many hospitals in former Soviet countries, traditional Soviet perinatal policies remain in place, although in others reforms have been introduced. This study explores women’s experiences during labor and birth in two Lithuanian maternity hospitals. The hospitals differed in that one (S) followed traditional Soviet era maternity practices whereas the other (P) had been exposed to World Health Organization-Euro practices and policies with respect to more up-to-date evidence-based and family-centered care. Methods: Consecutive women giving birth in the two maternity hospitals were asked to participate in a survey. Completed responses were obtained from 416 women in one hospital (P) and 304 in the other hospital (S) representing 92.4 and 67.5 percent response rates, respectively. Results: Rates of interventions in both hospitals were similarly high with, however, P hospital being more likely to be sensitive to women’s psychosocial needs, such as being allowed to eat and drink more often during labor, and to have their husband or partner with them for labor and birth. Conclusion: It appears that in Lithuania, as in many parts of the world, introducing changes to the clinical care of birth takes time, and psychosocial changes may be easier to introduce than alterations in clinical practice. (BIRTH 37:2 June 2010) [ABSTRACT FROM AUTHOR]

Background: Until recently, external cephalic version to prevent breech presentation at birth was not widely accepted. The objective of our study was to assess the prevalence, outcomes, and women’s experiences of external cephalic version to improve the implementation of the procedure in the Netherlands. Methods: A prospective cohort study was conducted of 167 women under the care of a midwife with confirmed breech presentation at a gestational age of 33 completed weeks or more. Results: Between June 2007 and January 2008, 167 women with a confirmed breech presentation were offered an external cephalic version. Of this group, 123 women (73.7%, 95% CI: 65.5–80.5) subsequently received the version. These women had about a ninefold increased probability of a cephalic presentation at birth compared with women who did not undergo a version (relative risk [RR]: 8.8, 95% CI: 2.2–34.8). The chance of a vaginal birth after an external cephalic version was almost threefold (RR: 2.7, 95% CI: 1.5–5.0). The success rate was 39 percent, although considerable differences existed associated with region and parity. Ninety-four percent of women with a successful version rated it as a good experience compared with 71 percent of women who had a failed version (p = 0.015). Significant pain during the version was experienced by 34 percent of women, of whom 18 percent also experienced fear during the version, compared with no women who reported little or no pain (p = 0.006). Women who reported significant pain or fear during the version experienced the version more negatively (OR: 6.0, 95% CI: 3.3–12.2 and OR: 2.7, 95% CI: 1.1–6.0, respectively). Conclusions: One in every four women with a breech presentation in independent midwifery care did not receive an external cephalic version. Of the women who received a version one third experienced significant pain during the procedure. Considerable regional variation in success rate existed. (BIRTH 37:2 June 2010) [ABSTRACT FROM AUTHOR]

Background: Since the 1970s, the movement to “humanize” birth in North America has evolved into “family-centered maternity care,” which has focused on providing evidence-based maternity care that is responsive to the needs of women and their families. The objective of this research was to explore women’s birth experiences within the context of the numerous changes that have occurred in perinatal care and to determine how information and knowledge acquired about pregnancy and birth influenced women’s birth experiences. Methods: Semi-structured interviews were conducted in prenatal health clinics in Montreal and Vancouver with 36 women before and after birth. Results: Most study participants were unaware of the range of available providers and birth settings. Of the women who were more aware of their options, those selecting a birth center or home birth and midwives had different notions of risk than those who planned a hospital birth. Study participants felt generally well informed, but thought that information sharing, collaborative decision making, or both were inadequate during labor and birth within the hospital setting. Conclusions: Despite positive changes in recent years, family-centered maternity care in Canada still needs to be improved. Women’s ability to use their acquired prenatal knowledge to feel satisfied by their birth experience continues to be undermined by a system of care that does not prioritize women’s informed choice. Further systemic change is required to align maternity care with the needs of Canadian birthing women and their families. (BIRTH 37:2 June 2010) [ABSTRACT FROM AUTHOR]

Social workers assist women of child-bearing age in a wide variety of settings. Although pregnancy and pregnancy loss are often associated with medical settings, the reality is that any clinical social worker will encounter women who are currently pregnant, who have been pregnant, and/or who have experience pregnancy loss. Clinical social workers need to understand the theoretical underpinnings of maternal attachment and loss to adequately meet the needs of the women who have had these experiences. Clinical social workers must be able to competently assess the problems that occur when attachment goes awry or pregnancy loss is experienced. This article provides an overview of maternal attachment and responses to pregnancy loss from the biological, psychological and social perspectives. This enables social workers to be sensitized to the impact of these issues in the work we do with all women of child-bearing age across all settings. [ABSTRACT FROM AUTHOR]

The aim of this comparative study was to investigate social representations of assisted women (20) and health care professionals (20) concerning childbirth assistance in maternities. Forty interviews were made examining two maternities with different approaches to childbirth assistance. In dealing with the data, we used lexicographical analysis and hierarchical descending clustering of texts (ALCESTE software). Among the health care professionals, two distinct representations were found: the first denoting a medicalized vision of assistance, and the second pointing towards an assistance identified with the Humanization of Birth Movement. Among the assisted women, the quality of their relationship with health care professionals seems to be the main influence on the way they represent the received assistance. [ABSTRACT FROM AUTHOR]

Semi-structured interviews were conducted with 55 mothers of infants. Some had received Home-Start during their infant’s first year, others were offered the support but declined and the remainder were not offered Home-Start. Most of their support had come from informal sources, such as family and friends with less from professionals. Mothers who received Home-Start described beneficial aspects, in particular, the extent of practical support provided, preferable to calling on close relatives or friends. Difficulties related to volunteer characteristics and administrative problems. Overall volunteer support can be important to complement informal and formal support, but needs careful management. [ABSTRACT FROM AUTHOR]

Background The success of breastfeeding promotion is influenced by maternal factors. Therefore, it is vital to examine the influence of basic maternal demographic factors on breastfeeding practices. Objective To determine the influence of maternal socio-demographic factors on the initiation and exclusivity of breastfeeding. Method A cross-sectional survey of mothers of children aged from 1 to 24 months attending a Nigerian Infant Welfare Clinic was conducted. Respondents were grouped according to age, parity, education, occupation, sites of antenatal care and delivery. These groups were compared for breastfeeding indices using bivariate and multivariate analysis. Results All the 262 respondents breastfed their children. The exclusive breastfeeding rate was 33.3% for children aged 0–3 months, 22.2% for children aged 4–6 months and 19.4% for children aged 7–24 months at the time of the study. Significantly higher proportions of mothers with at least secondary education, clinic-based antenatal care and delivery in health facilities initiated breastfeeding within 1 h of birth, avoided pre-lacteal feeding and practiced exclusive breastfeeding for the first 6 months of life. Maternal age and parity did not confer any advantage on breastfeeding practices. Delivery of children outside health facilities strongly contributed to delayed initiation of breastfeeding ( P < 0.001), pre-lacteal feeding ( P = 0.003) and failure to breastfeed exclusively ( P = 0.049). Maternal education below secondary level strongly contributed to pre-lacteal feeding ( P = 0.004) and failure to practice exclusive breastfeeding ( P = 0.008). Conclusion Low maternal education and non-utilization of orthodox obstetric facilities impairs early initiation and exclusivity of breastfeeding. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess whether embedding pediatric anticipatory guidance into books read to infants is an effective way to educate low-income, first-time mothers about injury-prevention and health promotion practices. PATIENTS AND METHODS: Primiparous women (N = 168) were randomly assigned to 1 of 3 groups: an educational-book group; a noneducational-book group; or a no-book group. Knowledge of anticipatory-guidance topics regarding children from birth to 12 months of age (eg, injury prevention, parenting, nutrition) was assessed during the third trimester of pregnancy and again when infants were ∼2, 4, 6, 9, 12, and 18 months of age. RESULTS: Women in the educational-book group scored consistently higher on knowledge than did those in the other 2 groups. Those ri the educational-book group were found to have significantly higher knowledge scores than those in both the noneducational-book group (effect size [ES]:O.3, P< .001) and the no-book group (ES:0.3, P< .001) in the longitudinal model. CONCLUSIONS: Books read by mothers to infants seem to be an effective way to provide anticipatory guidance to new mothers. However, future work is needed to determine if increased knowledge translates into safer and more developmentally appropriate parenting practices. [ABSTRACT FROM AUTHOR]

Abstract: A longitudinal study of maternal self-efficacy (SE) and hostile-reactive parenting (HRP) was conducted with a community sample of 1836 mothers. Mothers completed questionnaires when their child was 4.5, 16.6 and 28.5 months of age. Maternal SE showed little change, whereas HRP sharply increased from 4.5 to 28.5 months. Structural equation models suggest these initially correlated variables did not influence each other over time, but rather became increasingly independent. Three distinct developmental trajectories were fitted for both maternal SE and HRP. In contrast to the overall portrait of stability, 12.6% of mothers followed a trajectory of declining SE. Likewise, 12.1% of mothers showed initially high and sharply increasing HRP. Few mothers (3.1%) simultaneously followed both of these trajectories, yet overall, SE and HRP trajectories were modestly associated (τ b =−.23, p <.0001). Failure to support the expected reciprocal influences between SE and HRP over time, as well as maternal and child contributions to early manifestations of maternal HRP and their evolution are discussed. [Copyright &y& Elsevier]

Abstract: Children of anxious mothers are at risk for social–emotional difficulties and disturbed, early interactions with their mother may account for some of the risk. This study evaluated the association between maternal anxiety, features of mother–infant interactions, and infants’ emotion regulation during stressful situations (still-face, play with a stranger). Thirty-four anxiety-disordered mothers of 6-month-old infants and 59 typical dyads comprised the sample. Dyads were filmed during free play, teaching, care giving, and face-to-face play; and monadic (e.g., maternal sensitivity, infant affect) and dyadic measures (e.g., synchrony) were derived by global or time-event coding of the films. Results indicate that, compared to controls, more anxious mothers showed exaggerated behavior with their infant during free play and teaching, and infants of anxious mothers were less likely to show negative affect during the still-face and stranger challenges. We conclude that anxious maternal behavior reflects the hyperarousal that is characteristic of most anxiety disorders; and infants of anxious mothers and controls show differences in the manner in which they cope with social challenges. [Copyright &y& Elsevier]

OBJECTIVE: To determine vitamin D status and associated factors in a cohort of newly delivered infants and their mothers in Boston, Massachusetts. PATIENTS AND METHODS: Enrollment in this cross-sectional study took place from 2005 to 2007 in an urban Boston teaching hospital with 2500 births per year. A questionnaire and medical-record data were used to identify variables that are potentially associated with vitamin D deficiency (25-hydroxyvitamin 0 [25(OH)D1 < 20 ng/mL). Infant and maternal blood was obtained by venipuncture within 72 hours of birth. The main outcome measure was infant and maternal 25(OH)D status, assessed by competitive protein binding. RESULTS: We enrolled 459 healthy mother/infant pairs. After subsequent exclusions, analyses were performed on 376 newborns and 433 women. The median infant 25(OH)D level was 17.2 ng/mL (95% confidence interval [CII: 16.0-18.8; range: <5.0 to 60.8 ng/mL). The median maternal 25(OH)D level was 24.8 ng/mL (95% Cl: 23.2-25.8; range: <5.0 to 79.2 nglmL). Overall, 58.0% of the infants and 35.8% of the mothers were vitamin D deficient (25[OHID <20 nglmL); 38.0% ofthe infants and 23.1% ofthe mothers were severely deficient (25[OHID < 15 ng/mL). Risk factors for infant vitamin 0 deficiency included maternal deficiency (adjusted odds ratio [aOR]: 5.28 [95% Cl: 2.90-9.621), winter birth (aOR: 3.86 [95% Cl: 1.74-8.551), black race (aOR: 3.36 [95% Cl: 1.37-8.251), and a maternal BMI of ⩾35 (aOR: 2.78 [95% Cl: 1.18-6.55]). Maternal prenatal-vitamin use throughout the second and third trimesters was protective against infant deficiency (aOR: 0.30 [95% Cl: 0.16-0.56]). Similarly, prenatal-vitamin use of ⩾5 times per week in the third trimester was protective for mothers (aOR: 0.37 [95% Cl: 0.20-0.69]). Despite this, >30% of the women who took prenatal vitamins were still vitamin D deficient at the time of birth. CONCLUSIONS: A high proportion of infants and their mothers in New England were vitamin B deficient. Prenatal vitamins may not contain enough vitamin D to ensure replete status at the time of birth. [ABSTRACT FROM AUTHOR]

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Interest in preconceptional healthcare was advanced by release of the recommendations of the Centers for Disease Control and Prevention (CDC) and its Select Panel on Preconception Care in 2006. With increasing interest, apprehension surfaced from healthcare professionals, women, and the public at large. The most common themes of concerns are that an emphasis on preconception care is pronatalist, unnecessary, exclusive of men, framed too narrowly, doomed to failure because of competing clinical demands and influences, and involves a vocabulary that is meaningless to the public. This article explores the themes and argues that none of them are fatal to moving forward with a preconception agenda—rather, they should stimulate thoughtful response, careful framing, and vigilance for unintended consequences related to restructuring the basic perinatal prevention paradigm from a prenatal care approach to a women's wellness model. [ABSTRACT FROM AUTHOR]

Pregnant asylum-seeking women and those with young babies living in initial accommodation centres are a highly vulnerable group. The care that these women receive during pregnancy, childbirth and in the postnatal period can have a lifelong impact on them and their babies. This study, conducted in June 2008, investigates the health and wellbeing needs of this group of women through holding in-depth consultations with professionals from the main organisations involved in their care and accommodation. Analysis of consultations identified areas of concern - health needs, women in transition, access to services, access to resources and information, and working environment. Several recommendations are made, which constitute small changes in practice that could make large differences to the quality of life of women in this group. [ABSTRACT FROM AUTHOR]

We used the National Longitudinal Survey of Youth 1979 cohort (NLSY79) from 1979 to 2002 and the Children of the National Longitudinal Survey of Youth (CNLSY) from 1986 to 2002 to describe the number, shape, and population frequencies of U.S. nonresident father contact trajectories over a 14-year period using growth mixture models. The resulting four-category classification indicated that nonresident father involvement is not adequately characterized by a single population with a monotonic pattern of declining contact over time. Contrary to expectations, about two-thirds of fathers were consistently either highly involved or rarely involved in their children's lives. Only one group, constituting approximately 23% of fathers, exhibited a clear pattern of declining contact. In addition, a small group of fathers (8%) displayed a pattern of increasing contact. A variety of variables differentiated between these groups, including the child's age at father-child separation, whether the child was born within marriage, the mother's education, the mother's age at birth, whether the father pays child support regularly, and the geographical distance between fathers and children. [ABSTRACT FROM AUTHOR]

Abstract: Relations among different measures of maternal sensitivity were assessed longitudinally by examining maternal behavior when infants were 4 months, 15 months, and 2.5 years. At each time period, two measures of maternal sensitivity were scored (4 months: maternal vocal and smiling contingency in face-to-face interactions; 15 months: maternal scaffolding and following of infants’ play within joint attention; 2.5 years: maternal facilitative and collaborative play within joint attention). When infants were 2.5 years, attachment security was assessed. Mothers’ scores on each maternal sensitivity measure within each time period were correlated with their maternal sensitivity scores in another time period, suggesting individual measures of maternal sensitivity were tapping similar aspects across the time periods. Maternal vocal contingency at 4 months was the strongest predictor of infants’ attachment security over 2 years later. [Copyright &y& Elsevier]

Using the 1994-2004 waves of the Current Population Survey-Child Support Supplement, this article tracked child support outcomes, including child support orders, receipts, and payments, and examined the associations between state child support enforcement and child support outcomes. The results indicated moderate improvements in child support outcomes over the 1994-2004 period. The strength of state child support enforcement had positive effects on child support outcomes for young mothers under 35. The findings indicate that the recent policy efforts to strengthen child support enforcement may have large effects for recent cohorts of mothers eligible for child support. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the influences of mothers' demographic characteristics, environmental constraints and maternal beliefs on mothers' time to return to work and infant care decisions in a prospective model (Pungello & Kurtz-Costes, 1999). A total of 200 pregnant women participated in this study. Women were included who were married, pregnant with a first child, working full time and over the age of 20 years. The participants were recruited from university hospitals and birth clinics in Ankara. Participants were interviewed on the average at 6th months of pregnancy and at 6th months after the birth. Each interview included structured items to measure relevant variables and lasted approximately 40-50 minutes. Model testing results revealed that maternal demographics (maternal age, education and income) were related with maternal beliefs towards mothers' working and maternal care. Environmental constraints (work schedule and long-term career goal flexibility) were related with maternal plans about the time to return to work. Duration of returning to work was related with prenatal maternal plans. Mothers who chose maternal care had more flexibility to reach their career goals, and mothers who chose relative care reported their available child care options to be of higher quality than other mother. Mothers also changed their maternal beliefs and care preferences between the prenatal to postnatal interviews, but these changes were not significantly related to their care choices. The uncontrollable environmental constraint (i.e., needing to work for the income) did not moderate the association between mothers' preference and selection. [ABSTRACT FROM AUTHOR]

The study focuses on basic relations between some personality characteristics of mothers and their subjective perceptions of infant crying. It presents the method of Feelings about Infant Crying and discusses its possible utilization for research purposes. The data on 125 women who participated in the research were gathered during the third trimester of their pregnancy and between 4th and 8th week after delivery. The study revealed that depression, trait anxiety, maternal self-esteem and infant rearing attitudes correlate with maternal feelings about infant crying. [ABSTRACT FROM AUTHOR]

Abstract Remarried stepfathers' experiences paying child support for nonresidential children were explored using a multiple-interview phenomenological approach with 11 fathers in the United States. Circumstances that negatively affected satisfaction with paying child support were seldom related to money, per se. Rather, the pervasive phenomenon that emerged was attempts at managing competing interests among themselves, their children, and their new families. Remarriage magnified feelings of disempowerment and introduced additional complexities to existing child support arrangements. Although generally satisfied with their child support obligations at divorce, fairness concerns arose over time and are situated within equity theory. Nonetheless, identity conceptualizations were more salient than exchange principles, and identity theory therefore frames a discussion on the centrality of a provider mentality among these fathers. [ABSTRACT FROM AUTHOR]

The authors illustrate how their work on mother-infant “relational psychophysiology” might inform psychotherapy research. They examined psychophysiology in 18 mother-infant dyads (infants' age: 5 months) during normal interaction and a still-face perturbation. They measured respiratory sinus arrhythmia (RSA) as an index of emotion regulation and explored whether skin conductance (SC) concordance, previously linked to therapist empathy, occurs in mothers and infants. During the still-face episode, SC concordance correlated to infant negative engagement. Upon reengagement, when mothers often soothe their infants, concordance instead correlated to behavioral synchrony, an index of maternal sensitivity. Furthermore, maternal RSA became correlated to infant negative engagement. These findings suggest that a mother trying to calm her infant calms herself physiologically and her sensitivity on a behavioral level becomes coherent physiologically. Implications for psychotherapy research are discussed. [ABSTRACT FROM AUTHOR]