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Background: A strategy for reducing adverse pregnancy outcomes is the expanded implementation of maternity waiting homes (MWHs). We assessed factors influencing MWH use, as well as the association between MWH stay and obstetric outcomes in a hospital in rural Ethiopia.Methods: Data from medical records of the Glenn C. Olson Memorial Primary Hospital obstetric ward were cross matched with records from the affiliated MWH between 1 and 2011 to 31 March 2014. Poisson regression with robust variance was conducted to estimate the relative risk (RR) of childbirth complications associated with MWH use vs. non-use. Five key informant interviews of a convenience sample of three MWH staff and two users were conducted and a thematic analysis performed of social, cultural, and economic factors underlying MWH use.Results: During the study period, 489 women gave birth at the hospital, 93 of whom were MWH users. Common reasons for using the MWH were post-term status, previous caesarean section/myomectomy, malposition/malpresentation, and low-lying placenta, placenta previa, or antepartum hemorrhage, and hypertension or preeclampsia. MWH users were more likely than non-users to have had a previous caesarean Sec. (15.1 % vs. 5.3 %, p < 0.001) and to be post-term (21.5 % vs. 3.8 %, p < 0.001). MWH users were also more likely to undergo a caesarean Sec. (51.0 % vs. 35.4 %, p < 0.05) and less likely (p < 0.05) to have a spontaneous vaginal delivery (49.0 % vs. 63.6 %), obstructed labor (6.5 % vs. 14.4 %) or stillbirth (1.1 % vs. 8.6 %). MWH use (N = 93) was associated with a 77 % (adjusted RR = 0.23, 95 % Confidence Interval (CI) 0.12-0.46, p < 0.001) lower risk of childbirth complications, a 94 % (adjusted RR = 0.06, 95 % CI 0.01-0.43, p = 0.005) lower risk of fetal and newborn complications, and a 73 % (adjusted RR = 0.27, 95 % CI 0.13-0.56, p < 0.001) lower risk of maternal complications compared to MWH non-users (N = 396). Birth weight [median 3.5 kg (interquartile range 3.0-3.8) vs. 3.2 kg (2.8-3.5), p < 0.001] and 5-min Apgar scores (adjusted difference = 0.25, 95 % CI 0.06-0.44, p < 0.001) were also higher in offspring of MWH users. Opportunity costs due to missed work and need to arrange for care of children at home, long travel times, and lack of entertainment were suggested as key barriers to MWH utilization.Conclusions: This observational, non-randomized study suggests that MWH usage was associated with significantly improved childbirth outcomes. Increasing facility quality, expanding services, and providing educational opportunities should be considered to increase MWH use. [ABSTRACT FROM AUTHOR]

Background: Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia.Methods: A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions.Results: Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22).Conclusions: Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women's use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated.Trial Registration: The trial was retrospectively registered on the Clinical Trials website ( https://clinicaltrials.gov ) on 3rd October 2017. The trial identifier is NCT03299491 . [ABSTRACT FROM AUTHOR]

Background: Maternity Waiting Homes (MWHs) are residential facilities located within hospitals or health centers to accommodate women in their final weeks of pregnancy to bridge the geographical gap in obstetric care. Little is known, however, about women's intentions to use MWHs. Thus, this study aimed to assess pregnant women's intentions to use MWHs and associated factors in East Bellesa district, northwest Ethiopia.Methods: A community-based cross-sectional study was conducted among 525 pregnant women in East Bellesa district from March to May 2018. Study participants were selected using systematic random sampling. Binary logistic regression was used for analysis. Adjusted Odds Ratio (aOR) with 95% Confidence Interval (CI), and p-value < 0.05 were used to identify factors associated with intentions to use MWHs.Results: In the study area, 326/499 (65.3%) pregnant women had the intention to use MWHs. Pregnant women who had good knowledge about maternal healthcare and obstetric complications (aOR 6.40; 95% CI 3.6-11.5), positive subjective norms related to women's perceptions of social pressure (aOR 5.14; 95% CI 2.9-9.2), positive perceived behavioral control of women on the extent to which women feel confident (aOR 4.74; 95% CI 2.7-8.4), rich wealth status (aOR 4.21; 95% CI 2.1-8.4), women who decided by themselves to use maternal services (aOR 2.74; 95% CI 1.2-6.2), attended antenatal care (aOR 2.24; 95% CI 1.2-4.1) and favorable attitudes towards women's overall evaluation of MWHs (aOR 1.86; 95% CI 1.0-3.4) had higher odds of intentions to use MWHs.Conclusion: Two thirds (65.3%) of pregnant women had intentions to use MWHs. Factors such as women's knowledge, subjective norms related to women's perceptions of social pressure, perceived behavioral control of women on the extent to which women feel confident to utilize, and wealth status, decision-making power, attending antenatal care and attitude towards women's overall evaluation of MWHs were significantly associated with the intention to use MWHs. Therefore, improving women's awareness by providing continuous health education during antenatal care visits, devising strategies to improve women's wealth status, and strengthening decision-making power may enhance their intention to use MWHs. [ABSTRACT FROM AUTHOR]

Copyright of Revista Internacional y Comparada de Relaciones Laborales y Derecho del Empleo is the property of ADAPT University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Luapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. To examine the experiences with maternity homes, formative research was undertaken in four districts of Luapula Province to assess women's and community's needs, use patterns, collaboration between maternity homes, facilities and communities, and promising practices and models in Central and Lusaka Provinces.Methods: A cross-sectional, mixed-methods design was used. In Luapula Province, qualitative data were collected through 21 focus group discussions with 210 pregnant women, mothers, elderly women, and Safe Motherhood Action Groups (SMAGs) and 79 interviews with health workers, traditional leaders, couples and partner agency staff. Health facility assessment tools, service abstraction forms and registers from 17 facilities supplied quantitative data. Additional qualitative data were collected from 26 SMAGs and 10 health workers in Central and Lusaka Provinces to contextualise findings. Qualitative transcripts were analysed thematically using Atlas-ti. Quantitative data were analysed descriptively using Stata.Results: Women who used maternity homes recognized the advantages of facility-based births. However, women and community groups requested better infrastructure, services, food, security, privacy, and transportation. SMAGs led the construction of maternity homes and advocated the benefits to women and communities in collaboration with health workers, but management responsibilities of the homes remained unassigned to SMAGs or staff. Community norms often influenced women's decisions to use maternity homes. Successful maternity homes in Central Province also relied on SMAGs for financial support, but the sustainability of these models was not certain.Conclusions: Women and communities in the selected facilities accept and value maternity homes. However, interventions are needed to address women's needs for better infrastructure, services, food, security, privacy and transportation. Strengthening relationships between the managers of the homes and their communities can serve as the foundation to meet the needs and expectations of pregnant women. Particular attention should be paid to ensuring that maternity homes meet quality standards and remain sustainable. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact of a maternity waiting home (MWH) by comparing pregnancy outcomes between users and non-users at hospitals with and without an MWH. Methods: We conducted a retrospective cohort study in Ethiopia comparing one hospital with an MWH (Attat) to a second hospital without one (Butajira). A structured questionnaire among sampled women in 2014 and hospital records from 2011 to 2014 were used to compare sociodemographic characteristics and pregnancy outcomes between Attat MWH users and non-MWH users, Attat MWH users and Butajira, and Attat non-MWH users and Butajira. χ2 or ORs with 95% CIs were calculated. Results: Compared with Attat non-MWH users (n=306) and Butajira women (n=153), Attat MWH users (n=244) were more often multiparous (multipara vs primigravida: OR 4.43 [95% CI 2.94 to 6.68] and OR 3.58 [95% CI 2.24 to 5.73]), less educated (no schooling vs secondary school: OR 2.62 [95% CI 1.53 to 4.46] and OR 5.21 [95% CI 2.83 to 9.61], primary vs secondary school: OR 4.84 [95% CI 2.84 to 8.25] and OR 5.19 [95% CI 2.91 to 9.27]), poor (poor vs wealthy: OR 8.94 [95% CI 5.13 to 15.61] and OR 12.34 [95% CI 6.78 to 22.44] and further from the hospital (2 h 27min vs 1 h 00 min and 1 h 12 min: OR 3.08 [95% CI 2.50 to 3.80] and OR 2.18 [95% CI 1.78 to 2.67]). Comparing hospital records of Attat MWH users (n=2784) with Attat non-users (n=5423) and Butajira women (n=9472), maternal deaths were 0 vs 20 (0.4%; p=0.001) and 31 (0.3%; p=0.003), stillbirths 38 (1.4%) vs 393 (7.2%) (OR 0.18 [95% CI 0.13 to 0.25]) and 717 (7.6%) (OR 0.17 [95% CI 0.12 to 0.24]) and uterine ruptures 2 (0.1%) vs 40 (1.1%) (OR 0.05 [95% CI 0.01 to 0.19]) and 122 (1.8%) (OR 0.04 (95% CI 0.01 to 0.16]). No significant differences were found regarding maternal deaths and stillbirths between Attat non-users and Butajira women. Conclusions: Attat MWH users had less favourable sociodemographic characteristics but better birth outcomes than Attat non-users and Butajira women. [ABSTRACT FROM AUTHOR]

Background: This study aimed to describe the prevalence trends of pre- and postnatal depression, via measures of the Edinburgh Postnatal Depression Scale (EPDS) total and factor scores, from 20 weeks' gestation to 3 months postpartum, stratified by parity, in a Japanese female population.Methods: A longitudinal, population-based study was conducted among perinatal women giving birth at maternity facilities in Setagaya area of Tokyo, Japan. Of the 1775 women who participated, 1311 women met the inclusion criteria of this analysis. All data, including EPDS, were collected via self-administrated questionnaires at 20 weeks' gestation and at 5 time points postpartum, from the first few days to 3 months postpartum. We divided EPDS items into three factors: "anxiety," "anhedonia," and "depression," according to factor analysis.Results: The prevalence of individuals exhibiting depressive symptoms, EPDS total score, and each factor score peaked at two weeks postpartum in primiparas (EPDS total = 5.58, anhedonia = 0.47, anxiety = 2.64, and depression = 1.23). In contrast, the EPDS total score and factor scores for "anxiety" and "depression" gradually decreased for multiparas, from the prenatal to postpartum period (EPDS total 3.33, 3.03, 3.03, 2.72, 2.76, and 2.37).Limitations: Each factor score was not weighted; instead, we simply added up the item scores ranging from 0 to 3 for each question. Additionally, the population representativeness of Japanese women was not high, although the sample was population-based and had a high follow-up rate.Conclusions: This study shows that the trends of EPDS total and factor scores differ by parity throughout the pre- and postnatal periods among a Japanese female population. [ABSTRACT FROM AUTHOR]

Limited quality of childbirth care in sub-Saharan Africa primarily affects the poor. Greater quality is available in facilities providing advanced management of childbirth complications. We aimed to determine whether Maternity Waiting Homes (MWHs) may be a tool to improve access of lower socio-economic women to such facilities. Secondary analysis of a cross-sectional hospital survey from Iringa District, Tanzania was carried out. Women who delivered between October 2011 and May 2012 in the only District facility providing comprehensive Emergency Obstetric Care were interviewed. Their socio-economic profile was obtained by comparison with District representative data. Multivariable logistic regression was used to compare women who had stayed in the MWH before delivery with those who had accessed the hospital directly. Out of 1072 study participants, 31.3% had accessed the MWH. In multivariable analysis, age, education, marital status and obstetric factors were not significantly associated with MWH stay. Adjusted odds ratios for MWH stay increased progressively with distance from the hospital (women living 6-25 km, OR 4.38; 26-50 km, OR 4.90; >50 km, OR 5.12). In adjusted analysis, poorer women were more likely to access the MWH before hospital delivery compared with the wealthiest quintile (OR 1.38). Policy makers should consider MWH as a tool to mitigate inequity in rural childbirth care. [ABSTRACT FROM AUTHOR]

Background: Maternity waiting homes (MWHs) are accommodations located near a health facility where women can stay towards the end of pregnancy and/or after birth to enable timely access to essential childbirth care or care for complications. Although MWHs have been implemented for over four decades, different operational models exist. This secondary thematic +analysis explores factors related to their implementation.Methods: A qualitative thematic analysis was conducted using 29 studies across 17 countries. The papers were identified through an existing Cochrane review and a mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and barriers and facilitators for implementation. The influence of contextual factors, the design of the MWHs, and the conditions under which they operated were examined.Results: Key problems of MWH implementation included challenges in MWH maintenance and utilization by pregnant women. Poor utilization was due to lack of knowledge and acceptance of the MWH among women and communities, long distances to reach the MWH, and culturally inappropriate care. Poor MWH structures were identified by almost all studies as a major barrier, and included poor toilets and kitchens, and a lack of space for family and companions. Facilitators included reduced or removal of costs associated with using a MWH, community involvement in the design and upkeep of the MWHs, activities to raise awareness and acceptance among family and community members, and integrating culturally-appropriate practices into the provision of maternal and newborn care at the MWHs and the health facilities to which they are linked.Conclusion: MWHs should not be designed as an isolated intervention but using a health systems perspective, taking account of women and community perspectives, the quality of the MWH structure and the care provided at the health facility. Careful tailoring of the MWH to women's accommodation, social and dietary needs; low direct and indirect costs; and a functioning health system are key considerations when implementing MWH. Improved and harmonized documentation of implementation experiences would provide a better understanding of the factors that impact on successful implementation. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality ratio remains high in Nigeria and the Presence of skilled birth attendants at delivery is a key strategy towards reducing the rate. Objective: To determine the rate and factors that affect utilization of skilled birth attendants (SBA) among Igbo women in Nnewi, South- Eastern Nigeria. Methodology: A cross sectional survey of 400 market women using semi structured questionnaires and focus group discussions. Results: The rate of utilization of SBAs at birth was 88.4%. Majority (72.8%) of the women delivered in the private health facilities while 15.6% delivered in a government health facility. Majority of the women who did not assess SBAs at their last delivery, delivered in the maternity homes (65.2%), followed by Traditional Birth Attendant's place (26.1%; n=12). The main reasons for non-utilization of SBA at delivery were the long distance to the health facilities (65.0%), exorbitant hospital fees (34.8%), culturally unacceptable hospital practices (32.6%) and unfriendly attitude of the hospital staff (26.1%). Women aged 24-29 years(X²=25.84; P=0.00) and those who had attained tertiary education (X²=8.39; P=0.03) were significantly more likely to utilize SBAs at delivery than the other women Marital status (X²=1.42; P=0.48), occupation (X²=7.34; P=0.12) and religion (X²=0.87; P=0.92) did not significantly affect the utilization of SBAs at delivery. Most focus group discussants indicated that distant location of the hospitals; high cost of services and the unfriendly attitude of the workers were the major reasons for not utilizing SBAs at deliveries. Conclusion: There is a good rate of utilization of SBAs among Igbo women in Southeast Nigeria. There is need for even distribution of health facilities and reduction in the cost of services to further improve the rate of utilization. [ABSTRACT FROM AUTHOR]

Objective: To explore men's experience and beliefs regarding the use of maternity waiting homes (MWHs) in Kalomo District, Zambia.Methods: As part of a qualitative study, in-depth interviews with the husbands/partners of women attending the under-five clinic at a health center with a MWH were conducted between April 1 and May 31, 2014. Men aged 18-50 years whose partner/wife was of reproductive age and who had lived in the area for more than 6 months were eligible for inclusion.Results: Overall, 24 husbands/partners were interviewed in seven rural health centers. Men perceived many potential benefits of MWHs, including improved access to facility-based skilled delivery services and treatment in case of labor complications. Their many roles included decision making and securing funds for transport, food, cleaning materials, and clothes for the mother and the neonate to use during and after labor. However, limited financial resources made it difficult for them to provide for their wives and newborns, and usually led to delays in their decisions about MWH use. Poor conditions in MWHs and the lack of basic social and healthcare needs meant some men had forbidden their wives/partners from using the facilities.Conclusion: Important intervention targets for improving access to MWHs and skilled birth attendance have been identified. [ABSTRACT FROM AUTHOR]

In Brazil, hospital birth care is available to all, but there are important differences between hospitals in the public and private sectors, geographical regions and capitals/inland cities, resulting in inequalities of infant health. To assess the hospital structure for birth care in Brazil and analyze hospital adequacy to care for newborns according to levels of risk. Data were collected as part of a nationwide hospital-based cohort study, 'Birth in Brazil'. The hospitals were classified according to whether they had a neonatal intensive care unit and divided into two models of governance: public and private financing. Three structure domains were assessed: human resources, medications and equipment for post-natal women and newborn emergency care. Newborns were classified according to the obstetric risk. There are more NICUs in private hospitals and they cater mostly for low obstetric risk newborns; the public sector serves 50% of at-risk patients in hospitals without an NICU. The differences between hospital service structures according to geographic region and capital/inland cities were evident. Hospitals in less developed regions and inland cities had poorer adequacy in the three domains. The distribution of neonatal care to Brazilian infants varied between the public and private sectors. The public sector offered less complex services for newborns at risk, and infants without obstetric risk were born in facilities with an NICU, creating the possibility of unnecessary intervention, especially in the private sector. [ABSTRACT FROM AUTHOR]

Copyright of Socialno Delo is the property of Socialno Delo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The 19th century was an era of social reform, particularly in regard to women. Religious middle- to upper-class women joined forces in an effort to end prostitution and immoral crimes. In an attempt to “heal” prostitutes and other delinquents, reformers founded institutions including maternity homes. The Evansville Home for the Friendless was one such maternity home, established in 1870 and operating for almost 100 years. The Home for the Friendless housed unmarried mothers and wrote logbook entries detailing the lives of others whom the women judged to be morally felonious. The matrons in charge of the Home for the Friendless and similar maternity homes wrote descriptions of “inmates,” and their records reveal as much about the writers as about the inmates. The judgments and biases shown by matrons toward the “fallen women” are astounding and expose unexpected and unexplored sexism. Evansville’s Home for the Friendless serves as a prime example of how female reformers harmed the women they were trying to assist using methods that have transcended time and are still in use today. [ABSTRACT FROM AUTHOR]

This article analyzes maternity homes in post-WWII Ontario and British Columbia in terms of age, space, and place. The majority of residents during this period were teenage girls, a shift that reflected the growing number of unmarried pregnancies among teens, but also the preference of homes themselves. Maternity homes tried to adapt to their new clientele, but their goal of providing a real "home away from home" for teenage girls was difficult to achieve. Finally, during this time from 1945-1960, homes which had long promised "seclusion" became less isolationist, a trend which reflected changing thinking about the treatment of unmarried motherhood. The same trend would ultimately bring about the demise of the maternity home as a solution to the challenges of unmarried pregnancy. [ABSTRACT FROM AUTHOR]

Background During 2008, the Royal Brisbane and Women's Hospital became the first public hospital in Australia to have a da Vinci Surgical Robot purchased by government funding. The cost of performing robotic surgery in the public sector is a contentious issue. This study is a single centre, cost analysis comparing open radical prostatectomy ( RRP) and robotic-assisted radical prostatectomy ( RALP) based on the newly introduced pure case-mix funding model. Methods A retrospective chart review was performed for the first 100 RALPs and the previous 100 RRPs. Estimates of tangible costing and funding were generated for each admission and readmission, using the Royal Brisbane Hospital Transition II database, based on pure case-mix funding. Results The average cost for admission for RRP was A$13 605, compared to A$17 582 for the RALP. The average funding received for a RRP was A$11 781 compared to A$5496 for a RALP based on the newly introduced case-mix model. The average length of stay for RRP was 4.4 days (2-14) and for RALP, 1.2 days (1-4). The total cost of readmissions for RRP patients was A$70 487, compared to that of the RALP patients, A$7160. These were funded at A$55 639 and A$7624, respectively. Conclusions RALP has shown a significant advantage with respect to length of stay and readmission rate. Based on the case-mix funding model RALP is poorly funded compared to its open equivalent. Queensland Health needs to plan on how robotic surgery is implemented and assess whether this technology is truly affordable in the public sector. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Les plaies de la filière génitale sont responsables d’hémorragies potentiellement graves du post-partum et sont souvent sous-estimées. L’objectif de ce travail a été d’analyser les particularités de prise en charge dans un centre d’accueil de référence des plaies de la filière génitale associées à une hémorragie grave de la délivrance (HDD). Patientes et méthodes: Toutes les femmes transférées pour prise en charge d’une HDD liée à une plaie de la filière génitale entre janvier 2008 et avril 2011 ont été incluses dans cette étude observationnelle. Deux populations de patientes avec plaie de la filière génitale ont été définies : patientes avec plaie dite « complexe » et patientes avec plaie dite « simple ». Résultats: Quarante-quatre patientes ont été prises en charge pour une plaie de la filière génitale. L’âge moyen des patientes était de 30,6ans (17–41ans). Toutes les patientes ont accouché par voie vaginale, avec l’aide d’une extraction instrumentale dans 70,5 % des cas. À l’exception d’une patiente, toutes les patientes avaient eu une révision du col et de la filière vaginale sous valve avant transfert. Vingt neuf patientes (70,7 %) avaient bénéficié d’une suture de la filière génitale dans leur maternité d’origine. Sur le site de transfert, les patientes, ayant une plaie dite « simple » ont, dans 54,5 % des cas, eu une prise en charge réanimatoire seule contre 33,3 % pour celles ayant une plaie dite « complexe ». Dans 39,4 % des cas une embolisation artérielle a été nécessaire pour le groupe de patientes avec plaies « complexe » contre 9,1 % dans le groupe plaie « simple ». Discussion et conclusion: Les plaies de la filière génitale sont une cause grave d’HDD. Leur prise en charge doit être multidisciplinaire associant des mesures rapides et adaptées (réanimation, embolisation et/ou chirurgie). La séquence de ces différents traitements est fonction de l’état clinique de la patiente et justifie d’un transfert dans un centre de référence surtout en cas de lésions compliquées de la filière génitale. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Maternity waiting homes (MWHs) can reduce maternal morbidity and mortality by increasing access to skilled birth attendants (SBAs). The present analysis was conducted to determine whether MWHs increase the use of SBAs at rural primary health clinics in Liberia; to determine whether traditional midwives (TMs) are able to work with SBAs as a team and to describe the perceptions of TMs as they engage with SBAs; and to determine whether MWHs decrease maternal and child morbidity and mortality. Methods: The present analysis was conducted halfway through a large cohort study in which 5 Liberian communities received the intervention (establishment of an MWH) and 5 Liberian communities did not (control group). Focus groups were conducted to examine the views of TMs on their integration into health teams. Results: Communities with MWHs experienced a significant increase in team births from baseline to post-intervention (10.8% versus 95.2%, P <0.001), with greater TM engagement. Lower rates of maternal and perinatal death were reported from communities with MWHs. Conclusion: The reduction in morbidity and mortality indicates that the establishment of MWHs is an effective strategy to increase the use of SBAs, improve the collaboration between SBAs and TMs, and improve maternal and neonatal health. [Copyright &y& Elsevier]

Introduction: The extent of acceptance of contraceptive methods still varies within societies. Reliance on sterilisation is appearing earlier in marriage and among ever-younger ages and lower parities. Aim and Objective: To study the family planning practices adopted by women who undergo tubectomy before the acceptance of tubectomy. Material and Methods: Cross-sectional study of tubectomy acceptors who attended a corporation referral maternity home in Bangalore, India by interview method using a pre-designed a pre-tested structured questionnaire. Results: Majority 295(73.9%) of the study subjects had not practised any method of contraception before they underwent sterilisation. Increase in the education levels of the study subjects was associated with an increase in the contraceptive use (temporary methods) before they accepted tubectomy; this association was found to be statistically significant (p<0.0001). [ABSTRACT FROM AUTHOR]

Objective. To determine maternal indicators and adverse perinatal outcomes among late-preterm infants during birth hospitalization in a low-income country. Methods. Cross-sectional study of late-preterm and term survivors in a tertiary maternity hospital in southwest Nigeria using multivariable logistic regression analysis and population attributable risk (PAR) percentage. Adjusted odds ratios (OR) and 95%% confidence intervals (CI) of significant factors are stated. Results. Of 4176 infants enrolled, 731 (17.5%%) were late preterm and 3445 (82.5%%) were full-term. Late-preterm delivery was independently associated with mothers who were unmarried (OR: 1.71, CI: 1.06-2.75), lacked formal education (OR: 1.75, CI: 1.06-2.89), human immunodeficiency virus positive (OR: 1.61, CI: 1.17-2.20), with hypertensive disorders (OR: 3.07, CI: 2.32-4.08), antepartum hemorrhage (OR: 3.66, CI: 1.97-6.84), and were unlikely to have induced labor (OR: 0.010, CI: 0.01-0.69). Hypertensive disorders and antepartum hemorrhage had a combined PAR of 48.4%%. Infants born late preterm were more likely to have low 5-min Apgar scores (OR: 1.70, CI: 1.01-2.83), sepsis (OR: 1.62, CI: 1.05-2.50), hyperbilirubinemia (OR: 1.56, CI: 1.05-2.33), admission into special care baby unit (OR: 1.85, CI: 1.38-2.48), and nonexclusive breast-feeding (OR: 1.49, CI: 1.49, CI: 1.18-1.89). Conclusions. These findings suggest that late-preterm infants in low-resource settings are at risk of severe morbidity and suboptimal feeding. Education and close monitoring of high-risk mothers are warranted to prevent avoidable late-preterm delivery and facilitate the proactive management of unavoidable late-preterm births. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare maternal and midwifery manpower effects of policies for induction of labour (IOL) postdates, using a retrospective cohort design, in a level two maternity unit in a district hospital in South-West England. Primary outcome measures included mode of delivery, admission--delivery interval, midwifery manpower use. Group I consisted of 124 women who underwent IOL at 40++10. Group II were 104 women who underwent IOL at 42 weeks' gestation and 123 women who laboured spontaneously between 40++10 and 42 weeks' gestation. The nulliparous women had a shorter admission--delivery interval when induction was planned for 42 weeks, compared with 40++10 ( p == 0.003), and required less frequent use of syntocinon ( p == 0.04) and of continuous fetal monitoring ( p == 0.02). The caesarean rate was higher in Group I than in Group II ( p == 0.04) for nulliparous women only. The earlier induction policy was associated with a higher midwifery manpower requirement for nulliparae ( p == 0.002). For parous women, the only difference was the greater use of oxytocin in labour. There was no difference between the groups in duration of labour, analgesia, Apgar scores, admission to neonatal care and meconium aspiration. In conclusion, delaying planned induction by three days was associated with lower medicalisation of labour and manpower needs for nulliparous women. [ABSTRACT FROM AUTHOR]

Abstract: Single mothers represent about a quarter of French single-parent families. Within the population of single mothers, those who seek shelter in institutions such as maternity homes constitute a high-risk group. Grounded on two field studies with this population, and on our own clinical experience of joint psychotherapy of these mothers and their infant, this paper discusses the complex work realized by maternity homes. It emerges that maternity homes, as institutions, are brought to play, on the one hand, a maternal role that includes the holding, a “protective shield” role against excitation, and the safety of the mother to be and her infant. In this protected and stable environment, the mother will be able to develop her competencies to raise her infant and to build an affective bond with him. On the other hand, maternity homes should also act as a “father”, mediating the mother-infant relationship and, in doing that, they have to engage, as much as possible, the infant''s father himself. In this “paternal role”, the institution should open the mother and her infant to the outside world, (re)integrating them in a social and affective network, and preventing them to relapse into the isolation or the multiple deprivations experienced by the preceding generations. [Copyright &y& Elsevier]

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Background: Maternal mortality rates are very high in Nigeria. Increased level of awareness and perception will reduce maternal mortality rates. Objective: The study was aimed at assessing the awareness and perception of maternal mortality among women in the reproductive age group at Ogunu community in Warri South Local Government Area of Delta State. Methodology: This was a descriptive cross-sectional study that was carried out in Ogunu town in Delta State. A simple random sampling technique was used to select 400 women, who gave consent to be enrolled in the study. They were assisted in filling a semi-structured questionnaire containing questions on awareness and perception of maternal mortality among women in the community. Information generated was recorded on a data collection sheet designed for the study. The coded data were fed into the computer using the SPSS program to determine the mean values and frequencies. Results: A total of 400 questionnaires were distributed; of these, 349 were completely filled and returned. The mean age of the study subjects was 31.6 7.7 years. Among these subjects, 54.7% were married, while 32.7%, 28.7% and 26.5% had tertiary, secondary and primary education, respectively. The study revealed that 96.3% of the subjects felt that death can occur from pregnancy-related problems, while 69.1% were aware of maternal mortality. Majority of the subjects agreed that one or more forms of delay could be responsible for their death. This study shows that a good proportion of subjects was aware of maternal mortality and also had a good perception of it. Conclusion: Efforts should be directed towards educating women about the risk of delivering in homes of traditional birth attendants, maternity homes and health centers, and the concept of early referral of women to the hospital should be reinforced. Providing information to women on prevention of maternal mortality and community participation and mobilization will help prevent maternal mortality to some extent in Nigeria. [ABSTRACT FROM AUTHOR]

The concept of maternity waiting homes (MWH) has a long history spanning over 100 years. The research reported here was conducted in the Thateng District of Sekong Province in southern Lao People's Democratic Republic (PDR) to establish whether the MWH concept would be affordable, accessible, and most importantly acceptable, as a strategy to improve maternal outcomes in the remote communities of Thateng with a high proportion of the population from ethnic minority groups. The research suggested that there were major barriers to minority ethnic groups using existing maternal health services (reflected in very low usage of trained birth attendants and hospitals and clinics) in Thateng. Unless MWH are adapted to overcome these potential barriers, such initiatives will suffer the same fate as existing maternal facilities. Consequently, the Lao iteration of the concept, as operationalized in the Silk Homes project in southern Lao PDR is unique in combining maternal and infant health services with opportunities for micro credit and income generating activities and allowing non-harmful traditional practices to co-exist alongside modern medical protocols. These innovative approaches to the MWH concept address the major economic, social and cultural barriers to usage of safe birthing options in remote communities of southern Lao PDR. [ABSTRACT FROM AUTHOR]

Objective. To reveal the effect of cultural practices on the way in which normal birth is conducted in a public hospital in Brazil. Material and Methods. This article about a public maternity hospital in Salvador, Brazil, compares the points of view of providers and users on four technological normal childbirth procedures: trichotomy, episiotomy, oxytocin infusion, and epidural analgesia. Fieldwork carried out from 2002 to 2003 combined qualitative and quantitative methods. Results. Institutional practices make childbirth unnecessarily difficult for women. Nonetheless, most women accept the conditions because the medical procedures make sense according to their cultural understandings. Service providers support the use of such procedures, although doctors are aware that they contradict recommendations found in scientific medical literature. This article argues that from the perspective of both providers and users, the technological procedures are infused with a culturally specific set of meanings and values. Conclusions. Policymakers must address the cultural understandings of both users and health care professionals in order to improve maternal healthcare in public hospitals in Brazil. [ABSTRACT FROM AUTHOR]

Objectives: To prevent perinatal HIV transmission, providers must identify HIV status for all women in labor and newborns, and provide timely antiretroviral therapy if necessary. The objective of this study is to evaluate the availability and accessibility of zidovudine (AZT) in Illinois birthing hospitals. Methods: We surveyed all Illinois birthing hospital pharmacies by telephone in February 2005 regarding availability, accessibility, and protocols surrounding AZT use in the perinatal period. Results: All 137 pharmacies participated. Only 43.1% reported having syrup and IV AZT available and only 37.2% indicated the ability to have AZT available on labor and delivery within 30 min during off hours. Protocols for treating HIV positive women in labor and exposed newborns were available in only 37.2% of pharmacies while 72.4% had protocols for antiretroviral therapy for occupational post-exposure prophylaxis. Variables associated with pharmacies having AZT available included being a major academic hospital and serving a predominately (greater than 96%) white patient population. Timely provision of AZT was more likely to occur in urban, major academic hospitals serving a predominately white population. Conclusions: In order to further reduce perinatal HIV transmission, availability and timely access to both syrup and IV AZT must be improved in Illinois birthing hospitals. [ABSTRACT FROM AUTHOR]

Abstract: Background: Few investigations have considered evaluating the effects of certain combinations of ward routines like swaddling of the baby and separation of mother and baby on infant variables such as neonatal weight loss. Aims: To study the effect of different ward routines in respect to proximity to mother and type of infant apparel, on breastfeeding parameters (amount of ingested milk, volume of supplements, number of breastfeeds, total duration of breastfeeding time) day 4 after birth as well as recovery from neonatal weight loss and infant''s weight on day 5. Study design and subjects: In a randomized trial with factorial design four treatment groups including 176 mother–infant dyads were studied 25–120 min after birth. Randomized treatments focused on care routines administered to the infants after delivery and later in the maternity ward as well as to the type of clothing the infants received. Group 1 infants were placed skin-to-skin with their mothers after delivery, and had rooming-in while in the maternity ward. Group 2 infants were dressed and placed in their mothers'' arms after delivery, and roomed-in with mothers in the maternity ward. Group 3 infants were kept in the nursery both after birth and while their mothers were in the maternity ward. Group 4 infants were kept in the nursery after birth, but roomed-in with their mothers in the maternity ward. Equal numbers of infants were either swaddled or clothed in baby attire. Breastfeeding parameters were documented during day 4 after birth. Infant''s weight was measured daily. Results: Babies who were kept in the nursery received significantly more formula and significantly less breast-milk, than did babies who roomed-in with their mothers. Swaddling did not influence the breastfeeding parameters measured. However, swaddled babies who had experienced a 2-h separation period after birth and then were reunited with their mothers tended to have a delayed recovery of weight loss compared to those infants who were exposed to the same treatment but dressed in clothes. Furthermore, swaddled babies who were kept in the nursery and received breast-milk supplements had a significantly delayed recovery of weight loss after birth when compared to those infants ingesting only breast-milk. On day 5, regression analyses of predicted weight gain in the exclusively breastfed infants indicated a significant increase per 100 ml breast-milk (59 g), compared to the predicted weight gain on day 5 per 100 ml supplements in the swaddled babies (14 g) (P =0.001). Conclusion: Supplements given to the infants in the nursery had a negative influence on the amount of milk ingested. In addition, supplement feeding or a short separation after birth when combined with swaddling was shown to have a negative consequence to infant weight gain. [Copyright &y& Elsevier]

This is the third of three articles describing the work of the Birth Place Choices (BPC) Project, a Department of Health funded project carried out between May 2003 and May 2005 as a collaboration between Southampton University Hospitals NHS Trust and Portsmouth Hospitals NHS Trust. The BPC Project had three aims: 1. To identify factors which influence women's decisions about where to give birth. 2. To determine whether the introduction of specially designed information and educational initiatives increase women's knowledge of choices for place of birth. 3. To determine whether implementation of these initiatives was associated with an increase in the number of women choosing to give birth outside main consultant-led maternity units. This article describes the evaluation process carried out during phase two of the BPC Project, as well as the key successes of the BPC Project and the barriers which limited its effectiveness. [ABSTRACT FROM AUTHOR]

Pregnant women, revealed by good antenatal screening to be without obstetric risk, may prefer to deliver at home rather than in hospital. However, the possibility of unanticipated complications requires for their safety the presence of two health professionals in the home and the existence of an emergency flying squad. As these may not always be available, it is suggested that such deliveries might alternatively be conducted in 'maternity homes' close to, but independent and separate from, the maternity hospital. These homes would be staffed by midwives and family doctors. Expectant mothers would occupy their own suite (with or without partner and family). Should complications then arise, obstetric/paediatric skills would be readily available nearby. [ABSTRACT FROM AUTHOR]

Background: To determine current clinical practice among different maternity units in the United Kingdom for the management of major postpartum hemorrhage.Methods: A postal questionnaire was sent to 258 maternity units in the UK. It was developed to identify the definition of major postpartum hemorrhage, and to identify the medical and surgical interventions used for postpartum hemorrhage, as considered by each unit, and the type and use of thromboprophylaxis following surgery for major hemorrhage after delivery.Results: A total of 212 (82%) returned the questionnaire, but 13 units indicated that the questionnaire was not applicable to them, leaving 199 (82%) for analysis. There was a lack of agreement between the different units regarding the definition and interventions for major postpartum hemorrhage. The majority of the units use oxytocin, ergometrine and carboprost as a 'first-line' for the treatment of postpartum hemorrhage. Hysterectomy was the most common surgical procedure (89% of units had performed at least one hysterectomy for major hemorrhage in the last 5 years). There was a lack of agreement regarding the use and choice of thromboprophylaxis following surgery for major hemorrhage.Conclusions: Current management of major postpartum hemorrhage varies considerably. There is an urgent need to identify protocols that will reduce the need for hysterectomy in women with major hemorrhage who are unresponsive to conventional medical therapy. [ABSTRACT FROM AUTHOR]

Background: The study aims to report the short-term outcome for the mothers and newborns for all pregnancies accepted for birth at maternity homes in Norway.Methods: A 2-year prospective study of all mothers in labor in maternity homes, i.e. all births including women and newborns transferred to hospital intra partum or the first week post partum.Results: The study included 1275 women who started labor in the maternity homes in Norway; 1% of all births in Norway during this period. Of those who started labor in a maternity home, 1217 (95.5%) also delivered there while 58 (4.5%) women were transferred to hospital during labor. In the post partum period there were 57 (4.7%) transferrals of mother and baby. Nine women had a vacuum extraction, one had a forceps and three had a vaginal breech (1.1% operative vaginal births in the maternity homes). Five babies (0.4%) had an Apgar score below 7 at 5 min. There were two (0.2%) neonatal deaths; both babies were born with a serious group B streptococcal infection.Conclusion: Midwives and general practitioners working in the districts can identify a low-risk population (estimated at 35%) of all pregnant women in the catchment areas who can deliver safely at the maternity homes in Norway. Only 4.5% of those who started labor in the maternity homes had to be transferred to hospital during labor. [ABSTRACT FROM AUTHOR]

Examines the perceived health-related needs of women who spent part of their pregnancy, labor, delivery and immediate postpartum days in a maternity residence that provided adoption placement services. Studies in pregnancy and health needs; Anticipated health needs perceived by women during antepartum, intrapartum and postpartum; Health needs perceived by nurses.

The article presents information on model licensing proposals for residential services for pregnant and parenting adolescents. These are the rules that represent minimum basic requirements, which are needed to operate any program related to concerned human services. The model rules therefore applies to all treatment homes where at least one pregnant adolescent or adolescent mother or both are under care, which can be group homes, maternity homes and residential centers. The operation of these licensing proposals is categorized into four areas of services including staff and training, staff-client ratio, program and health requirements and services to fathers.

The article examines maternity homes, their services, their facilities, and their future role in obstetrical and gynecological services in the U.S. In the late eighteen-hundreds and early and middle nineteen-hundreds, maternity homes played an important role in providing shelter and care for unmarried pregnant girls and women in this country. Since the nineteen-sixties, with the change in sexual mores and the increase in out-of-wedlock pregnancy, alternate services have been developed in large, local communities to begin to meet the needs of girls and women pregnant out-of-wedlock.