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1.
In this column, the author summarizes four research studies relevant to normal birth. The topics of the studies include the clinical and behavioral benefits of skin-to-skin contact after birth; the effect of a group model of prenatal care on preterm birth risk and breastfeeding success; the harmful effects of a brief interval of electronic fetal monitoring at hospital admission; and barriers to access to midwifery care.  相似文献   

2.
About one-third of adolescent mothers receive inadequate prenatal care, and babies born to young mothers are more likely to be of low birth weight. The objective of this study is to evaluate a peer-centered prenatal care program for adolescent mothers. Pregnant adolescents were randomly assigned to an experimental or control group in a mastery modeling peer-support intervention designed to improve long- and short-term perinatal outcomes. A sample of 282 urban pregnant adolescents (94% African American, 4% Caucasian, 2% other) participated in the study. Participants were recruited from five clinics located mainly in Detroit, Michigan. Participants in the experimental group received care in a small group setting and learned to perform critical measurements with a peer partner during prenatal visits. Participants in the control group received individual prenatal care in the same clinics. Outcome measures included birth weight, years of schooling completed at one year postpartum, planned and unplanned pregnancy at one year postpartum, and employment and school attendance at one year postpartum. Mothers in the experimental group had a lower rate of low birth weight (6.6% vs. 12.5%, p=0.08). The rate of unplanned pregnancy was also lower for adolescents in the experimental group (13.4% vs. 15.9%), although this difference was not statistically significant. Adolescents who participated in the intervention were more likely to have continued their education during the pregnancy and the postpartum year. The mastery modeling, peer-centered, prenatal care program produced some positive pregnancy outcomes for adolescent mothers.  相似文献   

3.
This article reports original research that describes new mothers'' experiences of birth and maternity care. Qualitative data were collected through a survey on birth satisfaction, which included space for women to provide comments about their birth and experience of care. Thirty-nine women provided comments that were analyzed using the thematic analysis method. Two themes emerged from the women''s experiences: “Unexpected birth processes: expectations and reality” and “Coping with birth: the role of health-care staff.” Participants described unexpected birthing processes, their experiences of care, and maternity care staff''s contributions to coping with birth. Implications for practice for childbirth professionals include promotion of physiologic birth, respectful person-centered care during all phases of perinatal care, and the value of childbirth preparation.  相似文献   

4.
This article reports the findings from a mixed-methods study on factors that influence women’s decisions about birth, with the view that women’s decision making about birth can affect the use of cesarean surgery. Data was collected from focus groups and structured postpartum interviews and was analyzed using the Consensual Qualitative Research method. The findings relate specifically to the factors reported as influential in making decisions about birth including how the women categorized, prioritized, and/or favored certain types of knowledge about modes of birth. Four major information categories were identified but only stories about birth and/or attending a birth appeared to have a lasting effect on birth choices. These findings have implications for prenatal and perinatal education and nursing practice.  相似文献   

5.
The objective of this study was to examine the associations between attendance at childbirth education classes and maternal characteristics (age, income, educational level, single parent status), maternal psychological states (fear of birth, anxiety), rates of obstetric interventions, and breastfeeding initiation. Between women’s 35th and 39th weeks of gestation, we collected survey data about their childbirth fear, anxiety, attendance at childbirth education classes, choice of health-care provider, and expectations for interventions; we then linked women’s responses (n = 624) to their intrapartum records obtained through Perinatal Services British Columbia. Older, more educated, and nulliparous women were more likely to attend childbirth education classes than younger, less educated, and multiparous women. Attending prenatal education classes was associated with higher rates of vaginal births among women in the study sample. Rates of labor induction and augmentation and use of epidural anesthesia were not significantly associated with attendance at childbirth education classes. Future studies might explore the effect of specialized education programs on rates of interventions during labor and mode of birth.  相似文献   

6.
The dominant culture in labor and birth is the medical model, not the midwifery model of woman-centered care. Consensus among professional and governmental groups is that, based on the evidence, intermittent auscultation is safer to use in healthy women with uncomplicated pregnancies than electronic fetal monitoring (EFM). Barriers impact the laboring woman’s ability to give informed choice regarding fetal monitoring. Lack of informed choice denies a woman her right to be in control of her birth experience, and is in opposition to a woman’s right to autonomy and self-determination.  相似文献   

7.
The purpose of this study was to describe the reported perceptions of six midwife participants at different stages of their engagement in a multiphase process of adopting a new model of prenatal care. Midwives were interviewed at five different stages during the process of implementing CenteringPregnancy, a model of group prenatal care. The research methodology used in this study was phenomenology. The conceptual framework for exploring the participants' perceptions was based on the Institute for Healthcare Improvement's patient-centered model and on the International Institute for Restorative Practices' empowerment model. The five themes that emerged from the midwives' experiences mirrored the stages of change health education model. Suggestions for the implementation and sustainability of the CenteringPregnancy model of care are provided based on the five themes that emerged from this study's findings.  相似文献   

8.
Childhood maltreatment is common and has been increasingly studied in relation to perinatal outcomes. While retrospective self-report is convenient to use in studies assessing the impact of maltreatment on perinatal outcomes, it may be vulnerable to bias. We assessed bias in reporting of maltreatment with respect to women’s experiences of adverse perinatal outcomes in a cohort of 230 women enrolled in studies of maternal mental illness. Each woman provided a self-reported history of childhood maltreatment via the Childhood Trauma Questionnaire at two time points: 1) the preconception or prenatal period and 2) the postpartum period. While most women’s reports of maltreatment agreed, there was less agreement for physical neglect among women experiencing adverse perinatal outcomes. Further, among women who discrepantly reported maltreatment, those experiencing adverse pregnancy outcomes tended to report physical neglect after delivery but not before, and associations between physical neglect measured after delivery and adverse pregnancy outcomes were larger than associations that assessed physical neglect before delivery. There were larger associations between post-delivery measured maltreatment and perinatal outcomes among women who had not previously been pregnant and in those with higher postpartum depressive symptoms. Although additional larger studies in the general population are necessary to replicate these findings, they suggest retrospective reporting of childhood maltreatment, namely physical neglect, may be prone to systematic differential recall bias with respect to perinatal outcomes. Measures of childhood maltreatment reported before delivery may be needed to validly estimate associations between maternal exposure to childhood physical neglect and perinatal outcomes.  相似文献   

9.
The Resource Center for Young Parents-To-Be is a longstanding and successful grant-funded project that was initiated as a response to an identified community need. Senior-level baccalaureate nursing students and their maternity-nursing instructors are responsible for staffing the resource center''s weekly sessions, which take place at a public school site for pregnant adolescents. Childbirth educators interested in working with this population could assist in replicating this exemplary clinical project in order to provide prenatal education to this vulnerable and hard-to-reach group.  相似文献   

10.
目的：探讨孕中期产前筛查和产前诊断在临床中的应用和意义。方法：应用时间分辨法,以血清AFP、β-HCG作为指标,对4 760例在孕15～20＋6周孕妇进行产前筛查,对筛查为高风险的孕妇进行一对一的遗传咨询和产前诊断,并在产后3月内对其分娩结局进行随访观察。结果：随访中发现有不同程度畸形、流产、死胎等不良妊娠共29例：高风险者6例,低风险者23例。其中羊水染色体异常2例、超声检查检出各种畸形（开放性神经管畸形如脊柱裂、小头畸形、脑膨出等）6例、内脏畸形（如先心病、肾发育不良、胎儿宫内发育异常等）5例。不明原因死胎、晚期流产3例,21-三体新生儿1例（产前筛查唐氏高风险而拒绝羊水穿刺细胞学检查所致）。结论：孕中期产前筛查和产前诊断可降低出生缺陷的发生。  相似文献   

11.
The cost of prenatal care in a private nurse-midwifery practice was examined using the activity-based costing system. Findings suggest that the activities of the nurse-midwife (the health care provider) constitute the major cost driver of this practice and that the model of care and associated, time-related activities influence the cost. This pilot study information will be used in the development of a comparative study of prenatal care, client education, and self care.  相似文献   

12.
ABSTRACT

In England, ‘Virtual Schools’ oversee and support the educational progress of children in care. This paper reports on the analysis of 16 interviews with Virtual School headteachers that were part of two mixed methods research projects on the educational progress of children in care. These interviews explored their role; the types of support they offer young people in care; what they see as the key factors about a young person’s individual characteristics and care experiences that influence their educational outcomes; how schools support young people in care; and the influence of the foster carer/residential staff on the educational outcomes of these children. The interviews were analysed using NVivo and emerging themes were identified informed by the literature on the education of children in care. The paper draws out the main findings which explore the status and role of Virtual Schools in England, their functions, strategies, and what they see as their contribution to improving the educational outcomes of children in care.  相似文献   

13.
A qualitative nonexperimental thematic analysis was conducted at a hospital-based midwifery practice to explore the views of participants in group prenatal care and its impact on pregnancy, birth, and postnatal care. Ten women and three support people, recruited through purposive sampling, shared their feedback on the program. The findings conveyed three broad themes: program experience, midwife relationship, and support. Women enjoyed the opportunity for in-depth learning, and peer-group support led to normalizing of pregnancy concerns. Having support people as participants also helped during pregnancy, birth, and child care. The findings showed the enhanced opportunity for education, learning, and interpersonal support provided by CenteringPregnancy to expectant mothers had a positive impact on their pregnancy experiences.  相似文献   

14.
Leading maternity provider organizations in North America have been in conflict about birth at home and birth centers, debating issues related to safety, access, the value of obstetric intervention, and patient autonomy. In today’s environment, childbirth educators and doulas are often required to explain to parents why physiological birth and evidence-based, low-technology methods of labor and birth care are not available in every setting, and why maternity providers disagree about birth place. There are very few regions in the United States where home birth providers are integrated into interprofessional provider networks that allow for seamless care across birth settings. In October 2011, multidisciplinary leaders met at a Home Birth Consensus Summit in Warrenton, Virginia, to discuss the status of home birth within the greater context of maternity care in the United States. This article describes the intent and outcomes of the summit. Four of the nine consensus statements developed at the summit are of particular interest and importance to mothers and families and, hence, to childbirth educators and advocates. Consumers, educators, and birth advocates are encouraged to widen the circle, identify communications experts, lead individual projects, or serve as advisors.  相似文献   

15.
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16.
As the number of young dual language learners (DLLs) in early care and education (ECE) programs is increasing, it is critical to examine how well measures of the quality of practices in these settings reflect the needs of the diverse groups of children being served. This review of the research literature addressed these questions for ECE settings serving children birth-five: whether quality differs for settings serving high proportions of DLLs compared to typical samples, whether existing quality measures exhibit similar psychometric characteristics and associations with child outcomes in settings serving DLL and non-DLL children, and whether DLL-specific measures perform differently than general measures of quality. The search procedure produced 10 research studies that met the criteria for inclusion in the review out of approximately 3800 that were found initially and more than 300 that were reviewed. These studies included 10 out of 46 identified measures of ECE quality, including both general and DLL-specific measures. Findings suggested that widely used general ECE quality measures function similarly for DLLs compared to typical populations with regard to overall quality, psychometric characteristics, and child outcomes. Further research is needed to broaden the knowledge base for a wider variety of measures, beyond center-based settings, and beyond Spanish-speaking DLLs, as well as to enhance methodological approaches. There appear to be potential research opportunities through numerous existing studies that included DLL populations but had not analyzed their data in regard to these groups.  相似文献   

17.
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18.
ObjectiveThis study assessed infant disposition and health outcomes among offspring born to mothers without prenatal care, based on maternal characteristics and the reason for lack of prenatal care (i.e., denial of pregnancy, concealment of pregnancy, primary substance use, financial barriers and multiparity).MethodsA retrospective record review was completed at an urban academic medical center. Subjects were women who presented at delivery or immediately postpartum with no history of prenatal care (N = 211), and their infants.ResultsInfants of mothers with substance use problems had the highest rates of referral to child protective services and out-of-home placement at discharge, though mothers with other reasons for no prenatal care also experienced both referral and placement. Infants born to mothers using substances experienced the highest rates of neonatal intensive care unit admission, and the lowest mean birth weight.ConclusionsThough those without prenatal care experienced a variety of adverse outcomes, substance use problems were most frequently correlated with adverse infant outcomes. Mothers who either had lost custody of other children or with substance use problems were at highest risk of losing custody of their infants. Those who denied or concealed their pregnancy still frequently retained custody.Practice implicationsAmong mothers without prenatal care, those with substance use problems were least likely to retain custody of their infant at hospital discharge. Custody status of the mother's other children was also independently associated with infant custody. Mothers who denied or concealed their pregnancy still often retained custody. Referrals of mothers with no prenatal care for psychiatric evaluation were rare, though referrals to social work were frequent. Child protective services occasionally did not investigate referrals in the denial and concealment groups. Healthcare providers should be aware of the medical and psychological needs of this vulnerable population of infants and mothers.  相似文献   

19.
Nature intends that the physical and hormonal changes of pregnancy insure the growth and development not just of the baby but of the mother. The physical and emotional changes of pregnancy and, then, labor, birth, and breastfeeding play vital roles in guiding women on the journey of becoming a mother. Standard prenatal care and medicalized labor and birth interfere in powerful ways with nature''s plan and, consequently, women''s ability to negotiate this journey. In this column, these issues are explored, and implications for childbirth education are discussed.  相似文献   

20.
In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the “First, do no harm” principle in a different way. New research on the potentially harmful effects of intravenous lines demonstrates that refraining from routine interventions in labor protects the safety of women and babies. A new systematic review of movement and position changes in labor shows that eliminating unfounded restrictions also protects maternal and infant health and well-being. Finally, a study of patterns of use of neonatal intensive care units reveals how the organization of the maternity care system itself can affect the health outcomes of its beneficiaries.  相似文献   

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