Maternal and Child Health Commons^™

A Call For Better Care: The Impact Of Postnatal Contact Services On Women’S Parenting Confidence And Experiences Of Postpartum Care In Queensland, Australia, Yvette D. Miller, Aimée C C. Dane, Rachel Thompson

Dartmouth Scholarship

BackgroundUniversal postnatal contact services are provided in several Australian states, but their impact on women’s postnatal care experience has not been evaluated. Furthermore, there is lack of evidence or consensus about the optimal type and amount of postpartum care after hospital discharge for maternal outcomes. This study aimed to assess the impact of providing Universal Postnatal Contact Service (UPNCS) funding to public birthing facilities in Queensland, Australia on women’s postna

Ideas For A Healthy Baby--Reducing Disparities In Use Of Publicly Reported Quality Data: Study Protocol For A Randomized Controlled Trial, Sarah L. Goff, Penelope S. Pekow, Katharine O. White, Tara Lagu, Kathleen M. Mazor, Peter K. Lindenauer

Peter Lindenauer MD

BACKGROUND: Publicly reported performance on quality measures is intended to enable patients to make more informed choices. Despite the growing availability of these reports, patients' use remains limited and disparities exist. Low health literacy and numeracy are two barriers that may contribute to these disparities. Patient navigators have helped patients overcome barriers such as these in other areas, such as cancer care and may prove useful for overcoming barriers to using publicly reported quality data. METHODS/DESIGN: The goals of this study are: to determine the efficacy of a patient navigator intervention to assist low-income pregnant women in the use of …

Implementation Of Evidence-Based Antenatal Care In Mozambique: A Cluster Randomized Controlled Trial: Study Protocol, Leonardo Chavane, Mario Merialdi, Ana Pilar Betrán, Jennifer Requejo-Harris, Eduardo Bergel, Alicia Aleman, Mercedes Colomar, Maria Luisa Cafferata, Alicia Carbonell, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of …

Sexual And Reproductive Health And Rights Of Aymara Women In The Intercultural Health System In Chile / Salud Y Derechos Sexuales Y Reproductivos De Las Mujeres Aymara En El Sistema De Salud Intercultural De Chile, Ariela Schnyer

Independent Study Project (ISP) Collection

This investigation seeks to understand how Aymara women navigate their sexual and reproductive health and rights (SRHR) in Chile’s intercultural health care model. Indigenous communities have their own practices that complicate the provision of sexual and reproductive health by requiring health care providers to be aware of two different worldviews and how they may conflict, as well as what is necessary to provide respectful care. However, an ethnically and culturally pertinent framework is vital to actually assuring successful SRHR provision, whose tenants include autonomous choice and care free of discrimination, coercion or violence. These interactions were investigated through semi-structured interviews …

Perspectives From Community-Based Doulas And Mothers: Neighborhood Context And Pregnancy, Dara D. Mendez, Jessica Burke, Jennifer Jones, Cynthia Salter

Journal of Health Disparities Research and Practice

Objectives: Limited research explores the potential pathways by which neighborhoods influence pregnancy or how community members conceptualize and interpret how neighborhood contexts and living environments influence pregnancy and birth.

Study Design: We applied participatory Concept Mapping and a series of focused discussions with community-based doulas and mothers.

Methods: We collaborated with a community-based doula program to investigate how mothers and community doulas perceived the neighborhood to influence reproductive health. We conducted a series of focused discussions including ‘Brainstorming’ to uncover key themes related to how neighborhood context influenced pregnancy, ‘Sorting and Rating’ of key themes in association with pregnancy and …

Role Of Multiple Births In Very Low Birth Weight And Infant Mortality, B. Magee

B. Dale Magee

OBJECTIVE: To determine the percentage of very-low-birth-weight (VLBW) infants (g) and infant deaths attributable to multiple births in the general population and in women aged 35+. STUDY DESIGN: The year 2000 Massachusetts birth certificate database with linked births-deaths was examined. Etiologic fractions (EF) for VLBW and infant mortality attributable to multiples were calculated for the general population and the 35+ age group. The percentages of multiples occurring in the 35+ age group were calculated. Infant deaths due to congenital anomalies and "perinatal conditions" were calculated. RESULTS: There were 81,582 resident births in Massachusetts in 2000. Of them 4.3% were multiples. …

Doing The Best With What We Have: We Need Better: Informing Obstetric Policy With Administrative Data, Tiffany Moore Simas, B. Magee, Ellen Delpapa

B. Dale Magee

In this issue of Medical Care, Backes Kozhimannil and colleagues present data from the National Inpatient Sample on differences between rural and urban obstetric care. We applaud their efforts in examining this issue and agree that all women should be afforded safe deliveries, and ideally each woman’s experience would not be different. That being said, there are some practical considerations that must be applied to their analyses and recommendations. We would like to take this opportunity to capitalize on their efforts and speak to 2 other highly related implications for policy and practice.

Role Of Smoking In Low Birth Weight, B. Magee, Dale Hattis, Nancy Kivel

B. Dale Magee

OBJECTIVE: To assess the role of smoking on low birth weight (LBW). STUDY DESIGN: From Massachusetts for 1998, 79,904 birth certificates were reviewed. Birth weight, gestational age, plurality and maternal race were analyzed in relation to the mother's smoking status during the pregnancy. The etiologic fraction (EF) was calculated for smoking and LBW for the group as a whole as well as for various subgroups. RESULTS: A total of 11.7% of women acknowledged smoking during pregnancy. The overall LBW rate was 6.83%. The relative risk (RR) of LBW among smokers was 1.58. For all births the EF for smoking was …

Psychosocial Factors Affecting Pregnant Hispanic Women, Marushka L. Silveira

Doctoral Dissertations

Prenatal psychosocial stress, anxiety, and depression are common, with higher rates among Hispanic women. While evidence supports an adverse effect of psychosocial factors on glucose intolerance and oral health, studies during pregnancy are sparse, particularly among Hispanic women. Therefore, we examined correlates of psychosocial factors and their associations with glucose intolerance and oral health among pregnant women. The first project examined correlates of high stress among 1,426 pregnant Hispanic participants in Proyecto Buena Salud, a prospective cohort study. Cohen’s Perceived Stress Scale was administered in early, mid- and late pregnancy. Using multivariable logistic regression, we found that increasing age, pre-pregnancy …

Pregnancy Anxiety And Prenatal Cortisol Trajectories, Heidi S. Kane, Christine Dunkel Schetter, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Pregnancy anxiety is a potent predictor of adverse birth and infant outcomes. The goal of the current study was to examine one potential mechanism whereby these effects may occur by testing associations between pregnancy anxiety and maternal salivary cortisol on 4 occasions during pregnancy in a sample of 448 women. Higher mean levels of pregnancy anxiety over the course of pregnancy predicted steeper increases in cortisol trajectories compared to lower pregnancy anxiety. Significant differences between cortisol trajectories emerged between 30 to 31 weeks of gestation. Results remained significant when adjusted for state anxiety and perceived stress. Neither changes in pregnancy …

Why 'Down Under' Is A Cut Above: A Comparison Of Rates Of And Reasons For Caesarean Section In England And Australia, Samantha J. Prosser, Yvette D. Miller, Rachel Thompson, Maggie Redshaw

Dartmouth Scholarship

Background: Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point.

Methods: We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467).

Methamphetamine: The Effect On The Child From Womb, Birth And Beyond, Chiara L. Keune

Graduate Research - Criminal Justice

Globally the use of methamphetamine surpasses that of heroin and cocaine combined. As a drug that facilitates weight loss and provides the user with increased energy, it is particularly appealing to women. This raises concerns about its use by pregnant women. This poster highlights what is known about the effects of methamphetamine by pregnant women on the unborn child, and on the long term consequences for the children of these women.

2009 H1n1 And Seasonal Influenza Immunization Among Pregnant Women: A Comparison Of Different Sources Of Immunization Information, Bonny Specker, Betty Wey, Jill Fuller, Marie-Noel Sandoval, Maureen Durkin, Nancy Dole, Emmanuel B. Walter

Ethel Austin Martin Program Publications

Validity of prenatal immunization data from different sources has not been assessed. We evaluated prenatal 2009 H1N1 and seasonal influenza (FLU) data obtained from state immunization information systems (IIS), medical record abstraction (MRA), and participant recall using medical care logs (NCS-MCL). 2009 H1N1 and FLU data were obtained from IIS and MRA for 325 pregnant women participating in the National Children's Study at three locations (SD/MN, NC, WI). Women recalled immunizations at first pregnancy visit and at 16-17 and 36 weeks' gestation (NCS-MCL). The proportion of women with vaccine information obtainable from each data source was determined, and proportions immunized …

Selling Life To Abortion-Seekers: A Content Analysis Of Passive And Active Persuasion In Crisis Pregnancy Center Marketing, Alexander Kocman

Masters Theses

For supporters of the pro-life cause, crisis pregnancy centers (or CPC's) have become the "darlings of the movement," according to the New York Times (Belluck, 2013), offering women with unplanned pregnancies free advice, information, classes, childcare, and needed supplies. For abortion advocates, such establishments are intended to seduce vulnerable abortion-seekers into a situation where they will be counseled out of an abortion and possibly even proselytized. Yet for as much controversy as exists in the news media, medical community, and legal realm about CPC's, there is an unsettling lack of understanding of how--and why--CPC's market themselves the way they do. …