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BackgroundClient-centered contraceptive counseling is critical to meeting demand for contraception and protecting human rights. However, despite various efforts to optimize counseling, little is known outside of the United States about what individuals themselves value in counseling. In the present study we investigate women's preferences for contraceptive counseling in Mexico to inform efforts to improve service quality.MethodsWe conducted applied qualitative research, using six focus group discussions with 43 women in two cities in Mexico with distinct sizes and sociocultural contexts (Mexico City and Tepeji del Río, Hidalgo) to assess contraceptive counseling preferences. We used a framework approach to thematically code and analyze the transcriptions from focus groups.ResultsConsistent with quality of care and human rights frameworks for family planning service delivery, participants expressed a desire for privacy, confidentiality, informed choice, and respectful treatment. They expanded on usual concepts of respectful care within family planning to include avoidance of sexual assault or harassment-in line with definitions of respectful care in maternal health. In contrast to counseling approaches with method effectiveness as the organizing principle, participants preferred counseling centered on personalized assessments of needs and preferences. Many, particularly older, less educated women, highly valued hearing provider opinions about what method they should use, based on those personalized assessments. Participants highlighted the necessity of clinical assessments or physical exams to inform provider recommendations for appropriate methods. This desire was largely due to beliefs that more exhaustive medical exams could help prevent negative contraceptive outcomes perceived to be common, in particular expulsion of intra-uterine devices (IUDs), by identifying methods compatible with a woman's body. Trust in provider, built in various ways, was seen as essential to women's contraceptive needs being met.ConclusionsFindings shed light on under-represented perspectives of clients related to counseling preferences. They highlight specific avenues for service delivery improvement in Mexico to ensure clients experience privacy, confidentiality, informed choice, respectful treatment, and personalized counseling-including around reasons for higher IUD expulsion rates postpartum-during contraceptive visits. Findings suggest interventions to improve provider counseling should prioritize a focus on relationship-building to foster trust, and needs assessment skills to facilitate personalization of decision-making support without imposition of a provider's personal opinions. Trust is particularly important to address in family planning given historical abuses against women's autonomy that may still influence perspectives on contraceptive programs. Findings can also be used to improve quantitative client experience measures.

ObjectiveTo define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ≥ 34 weeks' gestation.MethodsWe conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth. Using a combination of recursive partitioning and logistic regression, we developed a risk classification scheme for EOS on the derivation dataset. This scheme was then applied to the validation dataset.ResultsUsing a base population of 608,014 live births ≥ 34 weeks' gestation at 14 hospitals between 1993 and 2007, we identified all 350 EOS cases

The use of spinal anesthetics during labor and childbirth is reviewed. This type of anesthetic is called epidural analgesia. Topics include effect of analgesia on method of delivery, timing of epidural analgesia, combined spinal-epidural analgesia and cesarean delivery, effects of epidural analgesia on mother and baby, complications of epidural analgesia, fasting during labor, and pain relief during and after a cesarean.

Objective. Epidural use has been associated with a higher rate of neonatal sepsis evaluation. Epidural-related fever explains some of the increase but not the excess of neonatal sepsis evaluations in afebrile women Methods. We studied 1109 women who had singleton term pregnancies and who presented in spontaneous labor and were afebrile during labor (24 hours or sustained fetal heart rate of >160 beats per minute. Minor criteria included a maternal temperature of 99.6 [degrees] F to 100.4 [degrees] F, rupture of membranes for 12 to 24 hours, maternal admission white blood cell count of >15 000 cells/ m[L.sup.3], or an Apgar score of Results. Infants of afebrile women with epidural analgesia were more likely to be evaluated for sepsis than infants of women without epidural (20.4% vs 8.9%), although not more likely to have neonatal sepsis. An increased risk of sepsis evaluation persisted in regression analysis (odds ratio: 3.1; 95% confidence interval: 2.0, 4.7) after controlling for confounders and was not explained by longer labors with epidural. Women with epidural were significantly more likely to have major and minor criteria for sepsis evaluation, including fetal tachycardia (4.4% vs 0.4%), rupture of membranes for >24 hours (6.2% vs 3.4%), low-grade fever of 99.6 [degrees] F to 100.4 [degrees] F (24.3% vs 5.2%), and rupture of membranes for 12 to 24 hours (21.4% vs 5.2%) than women without epidural. Conclusions. Epidural analgesia is associated with increased rates of major and minor criteria for neonatal sepsis evaluations in afebrile women. Pediatrics 2001; 108:1099-1102; epidural analgesia, pregnancy, labor, neonatal sepsis evaluation., ABBREVIATIONS. OR, odds ratio; CI, confidence interval; PROM, premature rupture of membranes. Epidural analgesia is the most effective form of pain relief available during labor and is preferred by more [...]

Maternal fever during delivery and possibility for infection in their newborns appears to be higher among women who receive epidurals during delivery than those who do not. Mothers' temperatures, rates of newborn infection, and treatment rates were compared among 1657 first-time mothers during uncomplicated vaginal deliveries with or without epidurals. More women who received epidurals had temperatures greater than 100.4 degrees F during delivery. Fevers in these women increased significantly as labor continued compared to those not receiving them. More infants born to mothers with epidurals were treated for infections., Objective. Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics. Methods. We studied 1657 nulliparous women with fern' pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever [is greater than]100.4[degrees]F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors. Results. Intrapartum fever [is greater than]100.4[degrees]F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors [is less than or equal to]6 hours to 36% for labors [is greater than]18 hours. Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3,95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group. Conclusions. Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment., Pediatrics 1997;99:415-419; epidural analgesia, fever, neonatal sepsis, length of labor. ABBREVIATIONS. RR, rate ratio; CI, confidence interval; OR, odds ratio. Maternal temperature during labor is carefully monitored, because fever can [...]

Active management of labor may not reduce the likelihood of cesarean section, but may lead to briefer labor and decrease the risk of fever in the mother. Active management of labor involves definitive diagnosis of labor and early rupture of membranes, administration of high doses of oxytocin if the uterus contracts inefficiently, and continuous attention to the mother during labor. Researchers compared the deliveries of 1,017 women with actively managed labor to those of 917 women who received usual care during labor. Cesarean deliveries occurred in approximately 19% of deliveries in both groups. Among women who had a low risk of cesarean delivery, the median time of labor was 6.2 hours in the actively managed group and 8.9 hours in the usual care group. In comparison to the usual care group, the actively managed group were less likely to develop a fever.

Objectively. This study was undertaken to evaluate the risk of small-for-gestational-age birth for women who stop smoking or begin to smoke during pregnancy. Methods. Women with term singleton pregnancies from a hospital-based cohort of 11 177 were classified as (1) nonsmokers: (2) smoked throughout pregnancy; (3) smoked during first trimester only; (4) smoked during first and second trimesters only; and (5) smoked during second and third trimesters or during third trimester only. Risk of small-for-gestational-age birth according to smoking category was estimated and adjusted for confounding factors by logistic regression. Results. Women who stopped smoking by the third trimester were not at increased risk of small-for-gestational-age birth compared with nonsmokers. Women who began smoking during the second or third trimester had an elevated risk of small-for-gestational-age birth (odds ratio [OR] = 1.83; 95% confidence interva] [CI] = 1.25, 2.67) similar to that for women who smoked throughout pregnancy (OR = 2.20; 95% CI = 1.90, 2.54). Risk of small-for-gestational-age birth increased with the number of cigarettes smoked during the third trimester. Conclusions. It is during the third trimester that smoking retards fetal growth, presenting a compelling opportunity for smoking cessation interventions. Programs must emphasize the importance of not resuming smoking late in pregnancy. (Am J Public Health. 1994;84:1127-1131), Women who stop smoking before the third trimester of pregnancy appear to significantly reduce their risk of giving birth to small-for-gestational-age (SGA) infants. Information on smoking habits during pregnancy was evaluated for 11,177 women who gave birth to live infants. Of these women, 3,367 (30%) gave birth to SGA infants. Seventy-three percent of these women (2,449) smoked throughout their pregnancy. Seven percent (228) began smoking during the second or third trimester and continued throughout the pregnancy. Twenty percent (690) quit smoking early in the pregnancy. Those who smoked throughout pregnancy were almost twice as likely to deliver SGA infants as those who did not smoke. Women who smoked only early in the pregnancy or who stopped before the third trimester had risks similar to women who did not smoke. The risk of delivering an SGA infant was similar for women who smoked throughout pregnancy and women who began smoking during the second or third trimester.