Maternal care

This paper explores the meaning of higher risk status to women undergoing prenatal maternal screening for chromosomal anomalies. Quotations from lightly structured interviews and transcripts of pre-screening consultations are used to illustrate pregnant women's diverse responses to the offer of screening, and to entering, living with and exiting from higher risk status. Some women reject screening in order to avoid the psychosocial and medical risks associated with higher risk status, or because they rule out pregnancy termination. They may question the risk selection built implicitly into the provision of preventative systems for some health problems but not others. Women who screen at higher risk may challenge this designation by questioning the system-specific probability used to separate them from the lower risk population. However, some experience distress even when they appreciate the precautionary basis on which their higher risk designation is based. They may find disengagement from higher risk status difficult after a diagnostic test has ruled out chromosomal anomalies. The findings highlight the complexity of communicating risk information to pregnant women and other screened populations, the need to support those living with higher risk status and the benefits of keeping the time lived with this status as short as possible.

Background-Appropriate home management can alleviate many of the consequences of diarrhea including malnutrition, impaired development, growth faltering, and mortality. Maternal cognitive ability, years of schooling, and acquired academic skills are hypothesized to improve child health by improving maternal child care practices, such as illness management. Methods-Using information collected longitudinally in 1996-1999 from 466 rural Guatemalan women with children < 36 months, we examined the independent associations between maternal years of schooling, academic skills, and scores on the Raven's Progressive Matrices and an illness management index (IMI). Results-Women scoring in the lowest and middle tertiles of academic skills scored lower on the IMI compared to women in the highest tertile (-0.24 [95%CI: -0.54, 0.07]; -0.30 [95%CI: -0.54, -0.06], respectively) independent of sociodemographic factors, schooling, and Raven's scores. Among mothers with less than one year of schooling, scoring in the lowest tertile on the Raven's Progressive Matrices compared to the highest was significantly associated with scoring one point lower on the IMI (-1.18 [95% CI: -2.20, -0.17]). Conclusions-Greater academic skills were independently associated with maternal care during episodes of infant diarrhea. Schooling of young girls and/or community based programs that provide women with academic skills such as literacy, numeracy and knowledge could potentially improve mothers' care giving practices.

Ethanol experiences, during late gestation as well as during nursing, modify the behavioral dynamics of the dam/pup dyad, and leads to heightened ethanol intake in the offspring. This study focuses on: a) behavioral and metabolic changes in intoxicated dams with previous exposure to ethanol during pregnancy and b) infantile consumption of milk when the dam is either under the effects of ethanol or sober. Pregnant rats received water, 1.0 or 2.0 g/kg ethanol, and were administered with water or ethanol during the postpartum period. Intoxication during nursing disrupted the capability of the dam to retrieve the pups and to adopt a crouching posture. These disruptions were attenuated when dams had exposure to ethanol during pregnancy. Ethanol experiences during gestation did not affect pharmacokinetic processes during nursing, whereas progressive postpartum ethanol experience resulted in metabolic tolerance. Pups suckling from intoxicated dams, with previous ethanol experiences, ingested more milk than did infants suckling from ethanol-intoxicated dams without such experience. Ethanol gestational experience results in subsequent resistance to the drug's disruptions in maternal care. Consequently, better maternal care by an intoxicated dam with ethanol experience during gestation facilitates access of pups to milk which could be contaminated with ethanol.

Research has increasingly highlighted the role that developmental plasticity—the ability of a particular genotype to produce variable phenotypes in response to different early environments—plays as an adaptive mechanism. One of the most widely studied genetic contributors to developmental plasticity in humans and rhesus macaques is a serotonin transporter gene-linked polymorphic region (5-HTTLPR), which determines transcriptional efficiency of the serotonin transporter gene &lt;i&gt;in vitro&lt;/i&gt; and modifies the availability of synaptic serotonin in these species. A majority of studies to date have shown that carriers of a loss-of-function variant of the 5-HTTLPR, the short (s) allele, develop a stress-reactive phenotype in response to adverse early environments compared with long (l) allele homozygotes, leading to the prevalent conceptualization of the s-allele as a vulnerability allele. However, this framework fails to address the independent evolution of these loss-of-funct...

Short-term strategy #1: Create provisions for payment of care coordination based on a set of common tasks delineating qualifying providers for payment and providing payment with supporting documentation. Short-term strategy #2: advocate for inclusion of team-based accountability and transparency.

Background: Maternal health and newborn health are closely linked to each other. Most of maternal mortality causes are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care in pregnancy, and during and after childbirth Methodology: A descriptive research design was adopted. Non probability purposive sampling technique was used to select 41 beneficiary women as samples. The tool was divided in to three sections, sociodemographic knowledge, clinical variables and self-structured questionnaire to assess the knowledge regarding JSY. Results: Major findings of the study revealed that among the 41 beneficiary women 8(19.5%) had poor knowledge 31(75.6%) had average knowledge and 2(4.8%) had good knowledge. It was found that there was no association between knowledge score of beneficiary women with the demographic variables. Conclusion: It was concluded from the study that in order to reduce the maternal mortality and morbidity rate it is very essential that the health care services are properly provided at the grassroot level.

An emerging topic of interest for those studying the effects of social loss and separation in non-human animals converges upon whether non-human animals experience the negative emotions of losing an attachment figure to death. Following screening for inclusion criteria, we systematically reviewed 40 scientifically documented accounts of grief-like reactions around loss, primarily involving mother and young but also including several unrelated adults, in various animal taxa including primates, marine mammals, elephants, a canid species, and an avian species. Most accounts involved animals in the wild, but animals in captivity were also included. We summarized information about behavioral frequencies and durations and physiological responses before and after the loss, causes of loss, time lived together, and observation period. Distress behaviors such as self-grooming, allogrooming, grooming the carcass, and vocalizations were the most reported behaviors, followed by carrying, physical contact, and staying with the dead. Based on this body of evidence, we conclude that at least some non-human animals can experience grief-like emotions, making grief not exclusively a human phenomenon and, thus, worthy of animal welfare concern.

Introduction: Fourteen percent of maternal deaths globally occur in Nigeria. Low utilization of maternal health services for delivery may partially explain the high maternal mortality. The aim of this study was to examine the contribution of community factors in explaining variations in the use of health facilities for delivery in Nigeria. Methods: Our sample consisted of 17,542 women aged 15-49 years drawn from 2008 Nigeria Demographic and Health Survey, who had had their last birth in the five years before the survey. We employed multilevel analysis to identify community factors related to the use of delivery care. Results: In addition to several individual factors, region of residence was significantly associated with facility delivery. Women who lived in Northern Nigeria were less likely to deliver in a health facility than those who resided in the Southern part of the country. Residence in communities with a high proportion of women who had secondary and higher education significantly increased the odds of facility delivery whereas ethnic diversity was negatively associated with health facility delivery. Conclusion: Interventions aimed at promoting the use of health facility for childbirth should not only be implemented at the individual level but also tailored to the community level as interventions conceived without consideration for community context are likely to have limited impact. Increasing women's education in disadvantaged communities and region-specific interventions that increase access to health facilities are likely to have far-reaching impacts in reducing maternal mortality.

Social Science, as a Discipline, is responsible to pertain general methods and theories to improve the quality of human life in the context of surroundings. Applied social science has always been regarded the problems of inter group fictions or conflicts, and ultimately global conflicts, as central. In recent year, academically, cross-national comparative social research has become a major trait of applied social science regarding intercontinental contexts. For researchers adopting a normative perception, comparisons have served as a device for developing classifications of societal phenomena and for establishing whether shared phenomena can be explained by the same causes. The cross national study implies that one or more units in two or more societies, cultures and countries are compared in respect of the same concepts and concerning the systematic analysis of phenomena, usually with the intention of explaining them and generalizing. The deductive approach of the study attempts to reveal the methodological dimensions and challenges of cross-national social research.

Research shows that maternity care practices are important to promoting breastfeeding in the early post partum period; however, little is known about the association between maternity care practices and breastfeeding among different racial and ethnic groups. We examined the association between maternity care practices and breastfeeding duration to C10 weeks overall and among various racial and ethnic groups using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS). PRAMS is a state, population-based surveillance system that collects information on maternal behaviors. We used maternity care practices data from 11 states and New York City with response rates C70% from 2004 to 2006. Multiple maternity care practices were examined and the analysis adjusted for demographic characteristics, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), lifestyle, and infant variables. The outcome variable for multivariable analysis was breastfeeding duration to \10 weeks or C10 weeks. PRAMS data show that 22.1% of women did not breastfeed, about 27.7% breastfed for \10 weeks and 50.2% breastfed for C10 weeks. Breastfeeding patterns varied with white and Hispanic women reporting highest breastfeeding initiation and duration prevalence. Overall, practices positively associated with C10 duration were: breastfeeding initiated within the first hour after birth (adjusted OR [AOR] = 1.29; 95% CI: 1.16-1.45); fed breast milk only (AOR = 2.40; 95% CI: 2.15-2.68); breastfed on demand (AOR = 1.23; 95% CI 1.08-1.40) and receiving telephone support (AOR = 1.20; 95% CI: 1.03-1.39). Maternity care practices associated with breastfeeding to C10 weeks varied across three racial/ ethnic groups. One practice, that of giving newborns breast milk only, was positively associated with breastfeeding duration of C10 weeks across all three groups. Maternity care practices associated with breastfeeding continuation to C10 weeks varied by race/ethnicity. For example: breastfeeding within the first hour, baby given a pacifier, and assistance from hospital staff, were significantly associated with breastfeeding duration among black and white women and not Hispanics. The practice of breastfeeding on demand was significantly associated with breastfeeding to C10 weeks for black and Hispanic women and not for whites. Hospitals may want to examine the implementation of specific practices in relation to the cultural backgrounds of women to promote breastfeeding.

Kerala has a unique model of social sector development. Its achievements in health indicators are highly remarkable. Maternal Mortality Ratio (MMR) is one such indicator that shows how better the reproductive health of women in the state is. Kerala has a very low MMR compared to other States of India. As per the SRS data for 2018-20, Kerala's MMR was 19, whereas it was 97 nationally. Many health and non-health factors have led the state in this regard. Along with the development of the healthcare sector, the major non-health factors include emphasis given to female education, land reforms in the past, outcomes of various socio-political movements, a decentralized system of governance based on participatory planning, and so on. The percentage of health expenditure to Gross Domestic Product (GSDP) exhibits a rising trend in Kerala. Around 2.30 percent of the total GSDP has been allocated to health and family welfare during the 2021-22 periods. Higher rates of institutional deliveries, focus on antenatal and postnatal care, spreading awareness on reproductive health, etc, have played no lesser role in maintaining a low MMR in the state.

Objective. To develop a reliable and valid questionnaire to evaluate satisfaction with maternity care in Sylheti-speaking Bangladeshi women. Design. Two-stage, psychometric study. Firstly, focus groups, in-depth interviews and iterative methods for translation and cultural adaptation were used to develop a Sylheti questionnaire, called the survey of Bangladeshi women's experience of maternity services from an English language questionnaire. Secondly, quantitative psychometric methods were used to field test and evaluate the acceptability, reliability and validity of this questionnaire. Setting. Four hospitals providing maternity services in London, UK. Study participants. Two hundred and forty-two women from the London Bangladeshi communities, who were in the antenatal (at least 4 months pregnant) or postnatal phase (up to 6 months after delivery). Women spoke Sylheti; a language with no accepted written form. Two purposive samples of 40 women in the antenatal or postnatal phase, one convenience sample of six women in the antenatal phase and three consecutive samples of 60 women in the postnatal phase participated in stage one. In stage two, 135 women (main sample) completed the questionnaire two months after delivery (82% response rate); 50 women (retest sample) from the main sample completed a second questionnaire two weeks later (96% response rate). Main outcome measures. Women's views about maternity care elicited by qualitative methods and measured quantitatively using the survey of Bangladeshi women's experience of maternity services. Results. The 121-item questionnaire was acceptable to women and showed good internal consistency (Cronbach's alphas 0.76-0.91), stability (test-retest reliability 0.72-0.84) and construct validity (e.g. able to detect group differences). By combining qualitative and quantitative methods, it is possible to adapt an instrument to provide an acceptable, reliable and valid Sylheti questionnaire. The approach taken in developing this questionnaire provides a model for developing outcome measures for use with other minority ethnic communities.

Objective. To develop a reliable and valid questionnaire to evaluate satisfaction with maternity care in Sylheti-speaking Bangladeshi women. Design. Two-stage, psychometric study. Firstly, focus groups, in-depth interviews and iterative methods for translation and cultural adaptation were used to develop a Sylheti questionnaire, called the survey of Bangladeshi women's experience of maternity services from an English language questionnaire. Secondly, quantitative psychometric methods were used to field test and evaluate the acceptability, reliability and validity of this questionnaire. Setting. Four hospitals providing maternity services in London, UK. Study participants. Two hundred and forty-two women from the London Bangladeshi communities, who were in the antenatal (at least 4 months pregnant) or postnatal phase (up to 6 months after delivery). Women spoke Sylheti; a language with no accepted written form. Two purposive samples of 40 women in the antenatal or postnatal phase, one convenience sample of six women in the antenatal phase and three consecutive samples of 60 women in the postnatal phase participated in stage one. In stage two, 135 women (main sample) completed the questionnaire two months after delivery (82% response rate); 50 women (retest sample) from the main sample completed a second questionnaire two weeks later (96% response rate). Main outcome measures. Women's views about maternity care elicited by qualitative methods and measured quantitatively using the survey of Bangladeshi women's experience of maternity services. Results. The 121-item questionnaire was acceptable to women and showed good internal consistency (Cronbach's alphas 0.76-0.91), stability (test-retest reliability 0.72-0.84) and construct validity (e.g. able to detect group differences). By combining qualitative and quantitative methods, it is possible to adapt an instrument to provide an acceptable, reliable and valid Sylheti questionnaire. The approach taken in developing this questionnaire provides a model for developing outcome measures for use with other minority ethnic communities.

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Setting: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. Objectives: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors. Design: Retrospective cross-sectional study using routine programme data. Results: During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions.

This article is basically a commentary on some sections on infant and maternal healthcare of the 2008 demographic and health survey of Ghana. The attention of both policy makers and academics are drawn to the need to ensure the expansion of the maternal and infant healthcare in Ghana. In same commentary, attention of readers have been drawn to the proclivity of the free maternal health policy to positively shape maternal and infant care in Ghana.

Background and Objective: This case report examines the effects of hypnotherapy on labor duration and maternal well-being in a primigravida patient with childbirth-related anxiety.
Case Presentation: The patient, a 28-year-old woman, underwent 8 hypnotherapy sessions during the third trimester, with the final session occurring during active labor. Each session, based on Hammond’s protocol, focused on deepening relaxation, managing pain, and enhancing coping strategies. The patient demonstrated a significant anxiety reduction, with a 69% decrease in Vandenberg pregnancy anxiety questionnaire (PRAQ) scores. Upon hospital admission at 8 cm dilation, labor progressed rapidly, and delivery completed within 30 minutes, suggesting that hypnotherapy may have contributed to a shortened labor.
Conclusion: The patient reported a positive childbirth experience, minimal discomfort, and effective postpartum recovery. These findings support the potential of hypnotherapy as a non-invasive approach to reduce anxiety and improve childbirth outcomes, although further research with larger samples is needed to generalize these results.

Prenatal lipopolysaccharide (LPS) exposure causes reproductive, behavioral and neurochemical defects in both dams and pups. The present study evaluated male rats prenatally treated with LPS for behavioral and neurological effects related to the olfactory system, which is the main sensorial path in rodents. Pregnant Wistar rats received 100 μg/kg of LPS intraperitoneally (i.p.) on gestational day (GD) 9.5, and maternal behavior was evaluated. Pups were evaluated for (1) maternal odor preference, (2) aversion to cat odor, (3) monoamine levels and turnover in the olfactory bulb (OB) and (4) protein expression (via immunoblotting) within the OB dopaminergic system and glial cells. Results showed that prenatal LPS exposure impaired maternal preference and cat odor aversion and decreased dopamine (DA) levels in the OB. This dopaminergic impairment may have been due to defects in another brain area given that protein expression of the first enzyme in the DA biosynthetic pathway was unchanged in the OB. Moreover, there was no change in the protein expression of the DA receptors. The fact that the number of astrocytes and microglia was not increased suggests that prenatal LPS did not induce neuroinflammation in the OB. Furthermore, given that maternal care was not impaired, abnormalities in the offspring were not the result of reduced maternal care.

The main strategy for decreasing maternal morbidity and mortality has been antenatal care (ANC). ANC aims to monitor and maintain the health and safety of the mother and the fetus, detect all complications of pregnancy and take the necessary actions, respond to complaints, prepare for birth, and promote a healthy lifestyle. This study aims to analyze interregional disparities in �4 ANC visits during pregnancy in Indonesia. Data was acquired from the 2017 Indonesian Demographic and Health Survey (IDHS). The unit of analysis was women aged 15-49 years old, and a sample of 15,351 women was obtained. In addition to ANC as the dependent variable, the other variables analyzed in this study were a place of residence, age, husband/partner, education, parity, wealth status, and health insurance. For the final analysis, binary logistic regression was used to determine disparity. With the Papua region as a reference, all regions showed a gap except for the Maluku region, which was not significantly different in the use of ANC compared to the Papua region. Women in the Nusa Tenggara have 4.365 times the chance of making �4 ANC visits compared to those in the Papua region (95% CI 3.229-5.899). Women in Java-Bali have 3.607 times the chance of making �4 ANC visits compared to women in the Papua region (95% CI 2.741-4.746). Women in Sumatra have 1.370 times the chance of making �4 ANC visits compared to women in the Papua region (95% CI 1.066-1.761). Women in Kalimantan have 2.232 times the chance of making �4 ANC visits compared to women in the Papua region (1.664-2.994). Women in Sulawesi have 1.980 times more chance of making �4 ANC visits compared to women in the Papua region (1.523-2.574). In addition to the region category, other variables that contributed to the predictor were age, husband/partner, education, parity, wealth and insurance.

Background: Intensive Care Unit (ICU) management is a critical care and may be lifesaving in critically ill obstetric patients, but mortality remains high in low-resource countries. Objective: To review obstetric admissions into a tertiary hospital ICU. Design: Retrospective descriptive study.

Resumo: A presente pesquisa teve como objetivo avaliar conhecimentos que mães primíparas têm ao longo de primeiro ano de vida de seu filho sobre o processo de desenvolvimento infantil. Participaram da pesquisa 109 mães primíparas, maiores de 18 anos, com filho ou filha de até um ano de vida e que viviam na cidade de Itajaí (SC). Para sua realização foi utilizado o KIDI (Knowledge of Infant Development Inventory) e para identificar o nível socioeconômico dos pais foi utilizada a Escala de Avaliação de Status Socioeconômico de Hollingshead. Através de análise estatística, foi verificado que fatores sócio-demográficos, tais como: escolaridade e ocupação da mãe estão correlacionados significativamente com seu conhecimento sobre cuidados parentais. Foi constatado que o maior conhecimento das mães é sobre cuidados parentais (crenças, estratégias e comportamentos dos pais). Conclui-se que o status socioeconômico é um fator importante na determinação do conhecimento da mãe sobre sua criança. Palavras-chave: Mães primíparas. Desenvolvimento infantil. Contexto sócio-econômico. Crenças parentais. Conhecimentos acerca do desenvolvimento infantil e da criação de filhos ocupam um papel central no sistema de crenças parentais e exercem influência significativa sobre o estabelecimento de interações entre pais e filhos e sobre o próprio desenvolvimento infantil 1,2 . Mães com maiores acessos a informações sobre crianças teriam maiores possibilidades de intera-gir de forma positiva com seus filhos 3 . Esses autores acrescentam também que mães com expectativas não realísticas tendem a experienciar problemas de relacionamento com os filhos, tais como conflitos e estresse. A importância do conhecimento sobre desenvolvimento infantil pode ser verificado, por exemplo, na Convenção sobre os Direitos da Criança promulgada pela Organização para as Nações Unidas 4 . De acordo com essa conven- † O presente artigo tem como base a dissertação de mestrado da primeira autora e que foi defendida no Programa de Pós-graduação em Psicologia da Universidade Federal de Santa Catarina.

In an era of fiscal constraint, growing poverty, increased uninsuredness, medical liability problems, and increasing costs of maternity care, public and private financing mechanisms are changing rapidly and the service delivery system is increasingly fragmented. Despite the almost mercurial changes in the system, data from national studies show that access to care is a major problem affecting all childbearing women. This paper describes the three groups of women who require comprehensive maternity care, their insurance coverage, and the gaps for each group. It describes proposals which are currently under development to reduce uninsuredness and produce universal access and, in addition, presents an alternative plan for universal maternity care.

Background: Cervical cancer is a leading cause of death among women in both developed and developing countries. It is one of commonest malignancy and prime cause of cancer death among women in Nepal. Nepal Government has prioritized prevention of cervical cancer through screening but still coverage rate for cervical cancer screening service is very low due to the lack of awareness among them. So the objective of the study is to find out awareness on cervical cancer among reproductive aged women. Methodology: A descriptive cross-sectional study was conducted among reproductive aged women (15-49 years) of Budhanilkantha Municipality of Kathmandu with the sample size 173.Non-probability purposive sampling method was used to select the sample. Structured questionnaire was used and face to face interview technique was adopted for data collection. Data was analyzed using statistical package for social science (SPSS) 16.0 version. Result: This study revealed that only 17.9% had highest, 71...

El yacimiento arqueológico de Resa ocupa un amplio espacio a orillas del Ebro. Ha sido estudiado mediante una metodología interdisciplinar que combina prospección superficial y geofísica, excavación estratigráfica, análisis arqueosedimentarios y dataciones radiocarbónicas. Todo ello permite trazar una periodización del yacimiento en cuatro fases: una villa romana de cronología altoimperial; una fase de transformaciones ambientales y sociales durante el Bajo Imperio; el periodo alto y plenomedieval, caracterizado por la presencia de un complejo eclesiástico; y un periodo de declive que condujo a su despoblamiento en época bajomedieval. Todo ello ofrece nuevas líneas de reflexión en torno a una serie de temáticas hasta ahora poco tratadas por la Arqueología navarra, con un notable potencial de desarrollo futuro.

Background: In Australia and internationally, there is concern about the growing proportion of women giving birth by caesarean section. There is evidence of increased risk of placenta accreta and percreta in subsequent pregnancies as well as decreased fertility; and significant resource implications. Randomised controlled trials (RCTs) of continuity of midwifery care have reported reduced caesareans and other interventions in labour, as well as increased maternal satisfaction, with no statistically significant differences in perinatal morbidity or mortality. RCTs conducted in the UK and in Australia have largely measured the effect of teams of care providers (commonly 6-12 midwives) with very few testing caseload (one-to-one) midwifery care. This study aims to determine whether caseload (one-to-one) midwifery care for women at low risk of medical complications decreases the proportion of women delivering by caesarean section compared with women receiving 'standard' care. This paper presents the trial protocol in detail. A two-arm RCT design will be used. Women who are identified at low medical risk will be recruited from the antenatal booking clinics of a tertiary women's hospital in Melbourne, Australia. Baseline data will be collected, then women randomised to caseload midwifery or standard low risk care. Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a designated primary midwife with one or two antenatal visits conducted by a 'back-up' midwife. The midwives will collaborate with obstetricians and other health professionals as necessary. If the woman has an extended labour, or if the primary midwife is unavailable, care will be provided by the back-up midwife. For women allocated to standard care, options include midwifery-led care with varying levels of continuity, junior obstetric care and community based general medical practitioner care. Data will be collected at recruitment (self administered survey) and at 2 and 6 months postpartum by postal survey. Medical/obstetric outcomes will be abstracted from the medical record. The sample size of 2008 was calculated to identify a decrease in caesarean birth from 19 to 14% and detect a range of other significant clinical differences. Comprehensive process and economic evaluations will be conducted.

State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers&#39; perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding) and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a struc...

Recent data suggest that MS, performed prior to the stress hyporesponsive period (SHRP) of the HPA axis (PND1-3), induces a reduction in the dendritic spine density of the pyramidal neurons from layer 3 of prefrontal cortex (PFC) ; whereas MS carried out during the SHRP (PND5-7) does not cause any changes in the dendritic morphology of the aforementioned region. In addition, the SHRP is characterized by low basal levels of stress hormones and a relative non-responsiveness to external stressors Levine, 2002), and was proposed to protect

Early life experiences shape an individual's physical and mental health across the lifespan. Not surprisingly, an upbringing that is associated with adversity can produce detrimental effects on health. A central theme that arises from studies in human and nonhuman species is that the effects of adversity are mediated by the interactions between a mother and her young. In this review we describe some of the long-term effects of maternal care on the offspring and we focus on the impact of naturally occurring variations in the behavior of female rats. Of particular interest are mothers that engage in high or low amounts of licking/grooming (LG) and arched-back nursing (ABN) of their pups, but do so within the normal range for this species. Such variations in LG-ABN can alter the function of the hypothalamic-pituitary-adrenal (HPA) axis, and cognitive and emotional development by directly affecting the underlying neural mechanisms. At the heart of these mechanisms is gene expression. By studying the hippocampal glucocorticoid receptor gene, we have identified that maternal care regulates its expression by changing two processes: the acetylation of histones H3-K9, and the methylation of the NGFI-A consensus sequence on the exon 1 7 promoter. Sustained "maternal effects" appear elsewhere in biology, including plants, insects, and lizards, and may have evolved to program advantages in the environments that the offspring will likely face as adults. Given the importance of early life and parent-child interactions to later behavior, prevention and intervention programs should target this critical phase of development.

A comparative study of the breeding behaviour of the Augur Buzzard Buteo augur was made in two contrasting areas on the southern side of Lake Naivasha, Kenya. Hell's Gate National Park represented a natural site, and the lake environs an agricultural site. Locations of adult birds and their activity time budget during the breeding cycle were studied from April to October 1995. Factors influencing prey delivery and nestling feeding rates, and intra/inter-specific interactions were given special attention. Augur Buzzard pairs in the lake environs spent more time caring for chicks than their counterparts in Hell's Gate. This was apparent in the increased maternal care and paternal foraging which resulted in larger broods and more prey deliveries to nests respectively. Prey and biomass delivery rates to nests showed an increasing trend as the nestling period progressed. This was significant in the lake environs where brood sizes were larger than in Hell's Gate. Overall nestling feeding rates were also significantly greater in the lake environs than in Hell's Gate. Augur Buzzards in Hell's Gate spent significantly more time interacting with conspecifics and other species compared to those in the lake environs. We suggest that reduced predation pressure from conspecifics and other raptors in the lake environs as a result of lower inter/intra-specific interactions enabled Augur Buzzards to maximise provisioning of their young hence potentially increasing productivity.

A comparative study of the breeding behaviour of the Augur Buzzard Buteo augur was made in two contrasting areas on the southern side of Lake Naivasha, Kenya. Hell's Gate National Park represented a natural site, and the lake environs an agricultural site. Locations of adult birds and their activity time budget during the breeding cycle were studied from April to October 1995. Factors influencing prey delivery and nestling feeding rates, and intra/inter-specific interactions were given special attention. Augur Buzzard pairs in the lake environs spent more time caring for chicks than their counterparts in Hell's Gate. This was apparent in the increased maternal care and paternal foraging which resulted in larger broods and more prey deliveries to nests respectively. Prey and biomass delivery rates to nests showed an increasing trend as the nestling period progressed. This was significant in the lake environs where brood sizes were larger than in Hell's Gate. Overall nestling feeding rates were also significantly greater in the lake environs than in Hell's Gate. Augur Buzzards in Hell's Gate spent significantly more time interacting with conspecifics and other species compared to those in the lake environs. We suggest that reduced predation pressure from conspecifics and other raptors in the lake environs as a result of lower inter/intra-specific interactions enabled Augur Buzzards to maximise provisioning of their young hence potentially increasing productivity.

We have studied pup-directed maternal behavior in mice carrying a germ line null mutation of the PRL receptor (PRLR) gene. Homozygous mutant and heterozygous mutant nulliparous females show a deficiency in pup-induced maternal behavior. Moreover, primiparous heterozygous females exhibit a profound deficit in maternal care when challenged with foster pups. Morris maze studies revealed normal configural learning in the heterozygous and homozygous animals. Eating, locomotor activity, sexual behavior, and exploration (all processes regulated by the hypothalamus) are normal in PRLR mutant mice. Olfactory function was tested in an aversive conditioning paradigm, results indicating that heterozygous and homozygous PRLR mutant mice are not anosmic. These studies clearly establish the PRLR as a regulator of maternal behavior. (Endocrinology 139: [4102][4103][4104][4105][4106][4107] 1998)

In April 2016, Burkina Faso introduced a free health care policy for women. Instead of reimbursing health facilities, as many sub-Saharan countries do, the government paid them prospectively for covered services to avoid reimbursement delays, which are cited as a reason for the persistence of out-of-pocket (OOP) payments. This study aimed to (i) estimate the direct expenditures of deliveries and covered obstetric care, (ii) determine the OOP payments, and (iii) identify the patient and health facility characteristics associated with OOP payments. Methods: A national cross-sectional study was conducted in September and October 2016 in 395 randomly selected health facilities. A structured questionnaire was administered to women (n = 593) who had delivered or received obstetric care on the day of the survey. The direct health expenditures included fees for consultations, prescriptions, paraclinical examinations, hospitalization and ambulance transport. A two-part model with robust variances was performed to identify the factors associated with OOP payments. Results: A total of 587 women were included in the analysis. The median direct health expenses were US$5.38 [interquartile range (IQR):4.35-6.65], US$24.72 [IQR:16.57-46.09] and ] for normal delivery, dystocia and cesarean section, respectively. Nearly one-third (29.6%, n = 174) of the women reported having paid for their care. OOP payments ranged from US$0.08 to US$98.67, with a median of US$1.77 [IQR:0.83-7.08]). Overall, 17.5% (n = 103) of the women had purchased drugs at private pharmacies, and 11.4% (n = 67) had purchased cleaning products for a room or equipment. OOP payments were more frequent with age, for emergency obstetric care and among women who work. The women's health region of origin was also significantly associated with OOP payments. For those who made OOP payments, the amounts paid decreased with age but were higher in urban areas, in hospitals, and among the most educated women. The amounts paid were lower among students and were associated with health region. The policy is effective for financial protection. However, improvements in the management and supply system of health facilities' pharmacies could further reduce OOP payments in the context of the free health care policy in Burkina Faso.

Background: Itinerant migrants, particularly women and adolescent girls, are increasingly a significant category in West Africa due to climate change and political instability. This has led to a surge in cross-border migration into Ghana, potentially impacting their access to prenatal care. However, cultural and personal factors make female itinerant migrants (FIMs) less privileged and constrained in access to maternal care in Ghana. A lot of research has been conducted into female itinerant trade and retail businesses and the business environment, yet little is known about maternal healthcare services utilisation among FIMs in Ghana, with specific focus on antenatal care (ANC). Knowledge about the complexities around maternal care uptake among FIMs is important for policy and programming. Objective: We aimed to understand the factors faced by female itinerant migrants (also known as "Zabarima") in receiving health facility antenatal care in Wa municipality, Ghana. Methods: This was a qualitative exploratory study, involving 66 participants of 51 female itinerant migrants (FIMs), and 15 midwives. Of the total number of FIMs, 19 participated in both individual in-depth interviews and two focus group discussions. Participants were purposively selected to provide relevant data for the study. Written informed consent was obtained from all participants. Interviews and focus group discussions were audio-taped and transcribed. Transcripts were validated and coded using Mural and Dedoose qualitative analytical software/platforms. Based on Thaddeus and Maine's conceptualisation of the "three-delay" model, a consistent framework was created and applied to the data analysis. To develop themes around the "third delay," we used deductive coding. Both manual and computer coding were applied. We conducted both content and thematic analysis of the data. Results: From the iteration of the data together with priori codes relative to the "third delay" of the three-delay model, four broad themes emerged: "educational and ANC literacy of FIMs", "language barrier between provider and FIMs", "provider attitude and maltreatment of FIMs", and "discrimination and stigma". This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified. We reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause. We observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA. 1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta. 2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data.

This Implementation Guide focuses on the stakeholder engagement efforts in Georgia, Idaho, and Massachusetts, and is designed to help State officials and other program administrators engage and partner with stakeholders in their own child health care quality improvement initiatives.

To estimate prevalence and assess the association of types of trauma with posttraumatic stress disorder (PTSD) in a sociodemographically and racially mixed sample of women from both predominantly Medicaid and privately insured settings who are expecting their first infant. Structured telephone diagnostic interview data were analyzed for prevalence of trauma exposure, PTSD, comorbidity, risk behaviors, and treatment-seeking among 1,581 diverse English-speaking nulliparous women. The overall rate of lifetime PTSD was 20.2%, 17% in the predominantly private-payer settings, and 24% in the predominantly public-payer settings. The overall rate of current PTSD was 7.9%, 2.7% in the predominantly private-payer settings and 13.9% in the predominantly public-payer settings. Those with current PTSD were more likely to be African American, pregnant as a teen, living in poverty, with high school education or less, and living in higher-crime areas. Adjusted odds of having current PTSD were highest among those whose worst trauma exposure was abuse (odds ratio 11.9, 95% confidence interval 3.6 -39.9), followed by reproductive trauma (odds ratio 6.1, 95% confidence interval 1.5-24.4). Health risk behaviors and exposures were concentrated among those with PTSD. CONCLUSION: These findings affirm that PTSD affects pregnant women. Women with PTSD in pregnancy were more likely to have had exposures to childhood abuse and prior traumatic reproductive event, to have cumulative sociodemographic risk factors, comorbid depression and anxiety, and to have sought mental health treatment in the past. Obstetric risk behaviors occur more in women with PTSD.

Intelligent high-achievers, who believe they are less intelligent and less competent than others perceive them, may suffer from the phenomenon. The phenomenon refers to the belief held by many accomplished women that they do not deserve the success and recognition that they have earned. (Clance, 1995, p. 27). This study used a descriptive correlational design to determine the incidence of the phenomenon among high-achieving female college faculty in the United States. One hundred and thirty-one high-achieving female college faculty at various United States institutions for higher education (N=131) completed a two-part questionnaire, consisting of the Clance Phenomenon Scale and demographical items. Using parametric and non-parametric statistics and descriptive methods, data analysis revealed that about 110 (84%) subjects met criteria for possessing moderate, frequent or intense impostor feelings. While this showed a positive correlation between IP and faculty women it did not show a statistically significant finding between IP and the academic discipline in which these females are identified.

OBJETIVO: Conhecer as experiências e percepções de mães cujas filhas engravidaram durante a adolescência. MÉTODOS: Pesquisa de abordagem qualitativa, realizada em hospital de ensino na cidade de São Paulo, com coleta de dados realizada por meio de roteiro de entrevista semiestruturada e com participação de dez mães de adolescentes. RESULTADOS: Antes da gravidez, as mães orientaram as filhas a respeito da sexualidade, o que originou sentimentos de surpresa quando souberam da gravidez. Apesar disso, as mães fizeram-se presentes em todo o processo gravídicopuerperal. Não foram identificadas mudanças significativas no relacionamento familiar em função da gravidez precoce. CONCLUSÃO: A figura materna surge como representativa, tanto durante como após a gestação da adolescente, fato que propicia o suporte, a fim de que a adolescente tenha gestação mais segura e para que possa retomar seus projetos de vida.

Background: Maternal medical care (prenatal and postpartum) involves a set of clinical interventions addressing risk factors associated with important maternal and infant outcomes. Programs to increase the rate of delivery of these interventions in clinical practice have not been widely implemented. Methods: A practice-based research network focused on developing continuous quality improvement (CQI) processes for maternal care among 10 family medicine residency training sites in the northeastern United States (the IMPLICIT Network) from January 2003 through September 2007. Documented delivery of 5 standard maternal care interventions was assessed before and after initiating a program to increase their frequency. Proportion chart analyses were conducted comparing the period before and after implementation of the CQI interventions. Results: Data were available for 3936 pregnancies during the course of the study period. Results varied across the clinical interventions. Significant improvement in care processes was seen for 3 screening activities: (1) prenatal depression symptomatology (by 15 weeks' gestation); (2) screening for smoking at 30 weeks' gestation; (3) and postpartum contraception planning. Screening for smoking by 15 weeks' gestation and testing for asymptomatic bacteriuria were already conducted >90% of the time during the baseline period and did not increase significantly after initiating the CQI program. Screening for postpartum depression symptomatology was recorded in 50% to 60% of women before the CQI program and did not increase significantly. Conclusions: A practice-based research network of family medicine residency practices focused on CQI outcomes was successful in increasing the delivery of some maternal care interventions. (J Am

Inactivation of expression of the paternal allele at two maternally silent imprinted loci has recently been reported to diminish the quality of care that female mice lavish on their offspring. This suggests that there can be disagreement between the maternally and paternally derived genomes of mothers over how much care for offspring is appropriate, with the paternally derived genome favoring greater care. The reason for such disagreement is not obvious because the maternally and paternally derived alleles at a locus have equal probabilities of being transmitted to each of the mother's ova and, therefore, would appear to have equal interests in a mother's offspring. However, if a female mates with a related male, her two alleles may have different probabilities of being present in the sperm that fertilize her ova. Natural selection can favor silencing of the maternally derived allele at a locus that enhances the quality of maternal care if the average patrilineal relatedness between a female and her mates decreases more rapidly than the average matrilineal relatedness. Just such an asymmetrical decrease in relatedness over time would be expected in a structured population in which patrilineal inbreeding is more common than matrilineal inbreeding.

Collaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth. We performed a cross-sectional web- and paper-based survey of 549 obstetricians, 897 family physicians (400 antepartum only, 497 intrapartum), 545 nurses, 400 midwives, and 192 doulas. Participants responded to 43 Likert-type attitudinal questions. Nine themes were identified: electronic fetal monitoring, epidural analgesia, episiotomy, doula roles, Caesarean section benefits, factors decreasing Caesarean section rates, maternal choice, fear of vaginal birth, and safety of birth mode and place. Obstetrician scores reflected positive attitudes towards use of technology, in contrast to midwives&#39; and doulas&#39; scores. Family physicians providing only antenatal care had attitudinal scores similar to obstetricians; famil...

Changes in the ability of midwives to perform practical skills, after completion of the Maternal Care Manual of the Perinatal Education Program, were determined. A prospective, controlled trial in a study town and two control towns. The practical skills of midwives caring for pregnant women in the towns were determined. Subsequently, the Maternal Care Manual was studied by midwives in the study town, and the skills of all midwives were subsequently evaluated. A total of 34 midwives in the study town and 39 midwives in the two control towns were studied. The marks showed a significant (p Յ 0.000) improvement in the study town when comparing the pre-and postintervention marks. The mean improvement in the study town was 36.6%. The practical skills of midwives improved significantly. The Perinatal Education Program can be implemented with confidence as a distance learning program that is especially suited to the needs of health workers in remote regions.

A concrete and useful way to create an action plan for improving the quality of maternity care in the United States is to start with a view of the desired result, a common definition and a shared vision for a high-quality, high-value maternity care system. In this paper, we present a long-term vision for the future of maternity care in the United States. We present overarching values and principles and specific attributes of a high-performing maternity care system. We put forth the ''2020 Vision for a High-Quality, High-Value Maternity Care System'' to serve as a positive starting place for a fruitful collaborative process to develop specific action steps for broad-based maternity care system improvement.

Background:  Recent policy debates about the challenges facing maternity services in Australia provide an opportunity to reflect on current care practices.Aims:  To identify the provision of primary maternity care models in two Australian states: South Australia (SA) and Victoria.Methods:  All public and private hospitals with maternity facilities in SA and Victoria were mailed a survey requesting information about the organisation and provision of maternity care.Results:  All hospitals in SA (35) and 99% (75/76) in Victoria completed the survey. Among public hospitals, approximately 50% (14/30 in SA and 29/56 in Victoria) reported primary care arrangements where all antenatal care is provided by medical practitioners working in the community. The vast majority of hospitals offering this type of care were located outside metropolitan areas. Twenty per cent of public hospitals in SA (6/30) and 36% in Victoria (20/59) reported offering primary midwifery models, such as team, caseload ...

Maternal mortality remains a pressing public health issue in Indonesia, particularly for mothers residing in rural regions who often forego postnatal health services due to traditional beliefs and practices. This qualitative research delved into the cultural perspectives of the local community to gain insight into the care practices of postpartum mothers in rural areas of NTT Province, Indonesia. The study involved in-depth interviews with nine participants, including four postpartum mothers, four family members, and one village midwife, with the interview data analyzed thematically. The research revealed that cultural beliefs and practices revolving around the postpartum period in NTT align with shared beliefs and traditional practices found in various Asian societies. This includes behavioral taboos and food restrictions. The study also identified two primary postpartum traditions aimed at restoring the postpartum mother's body heat and strength. All postpartum mothers adhere to traditional care practices because they believe in their benefits, pressure from family members, and fear of non-compliance consequences. However, postnatal mothers and their families have low postnatal care visits and do not receive adequate information about postpartum care. Health literacy for postpartum women and their families in rural areas needs to be improved and health workers should provide culturally sensitive maternal health services.