Unintended pregnancy and intimate partner violence around pregnancy in a population-based study

BackgroundIntimate partner violence (IPV) and unintended pregnancy are public health issues that can affect the health and well-being of women and their children. However, the relationship between IPV and women's ability to control their fertility has not been adequately explored.AimTo investigate the association between unintended pregnancy and emotional or physical violence perpetrated by partners around pregnancy.MethodsA population-based study was undertaken, recruiting women (n = 779) at the hospital obstetric departments and gathering social and family data. IPV was diagnosed by using the Index of Spouse Abuse (ISA). Data were gathered by trained midwives in 15 public hospitals in southern Spain and multivariate logistic regression analysis was performed.FindingsThe pregnancy was reported to be unintended by 118 (15.1%) of the study population. Unintended pregnancy was significantly associated with: physical and/or emotional IPV around pregnancy, age, marital status, cohabitation, educational level, and employment status. After adjusting for socio-demographic characteristics, emotional IPV around pregnancy was significantly associated with an unintended pregnancy (AOR = 2.5; 95% CI = 1.5–4.3). Being in a non-committed relationship was a risk factor (AOR = 3.5; 95% CI = 1.8–6.1) and being in employment a protective factor (AOR = 0.4; 95% CI = 0.2–0.8) for an unintended pregnancy.ConclusionWomen who report an unintended pregnancy may be experiencing emotional IPV. The risk of emotional IPV is higher if women reporting an unintended pregnancy are in a committed relationship, married, or in employment. A better understanding of the relationship between unintended pregnancy and violence can aid midwives about potential reproductive health risk factors associated with abuse.     

The profile of women who consult midwives in Australia

BackgroundThere is no Australian data on the characteristics of women who consult with midwives.AimTo determine the profile of women who consult midwives in Australia.MethodsThis cross-sectional research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH). Participants were the younger (31–36 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n = 801). The main outcome measure was consultation with a midwife.FindingsOf the 801 women who indicated that they were currently pregnant at the time of the survey, 19%, 42%, and 70% of women in the first, second and third trimesters respectively had consulted with a midwife. Women were more likely to consult a midwife if they: also consulted with a hospital doctor (OR = 2.70, 95% CI: 1.66, 4.40); also consulted with a complementary and alternative medicine practitioner (OR = 1.94, 95% CI: 1.25, 3.03); were depressed (OR = 1.84, 95% CI: 1.03, 3.28); constipated (OR = 1.80, 95% CI: 1.04, 3.13); or had been diagnosed or treated for hypertension during pregnancy (OR = 2.78, 95% CI: 1.27, 6.09). Women were less likely (OR = 0.34, 95% CI: 0.21, 0.56) to consult with a midwife if they had private health insurance.ConclusionWomen were more likely to consult with midwives in conjunction with consultations with hospital doctors or complementary and alternative medicine practitioners. Women with private health insurance were less likely to consult midwives. More research is necessary to determine the implications of the lack of midwifery care for these women.     

Prenatal stress,health, and health behaviours during the COVID-19 pandemic: An international survey

BackgroundPregnant women’s stress, mental and physical health, and health behaviours can have important implications for maternal and child health outcomes.AimTo examine pregnant women’s levels of stress, mental and physical health, and health behaviours during the COVID-19 pandemic.MethodsA cross-sectional survey was conducted online, with recruitment and data collection occurring between 16/6/20 and 17/7/20. Participants were pregnant women recruited via online pregnancy/parenting communities. Participants self-reported their levels of general stress, pregnancy-specific stress and COVID-19 related stress, mental and physical health, general health behaviours, and COVID-19 related health behaviours.Findings573 pregnant women participated in the survey. Participants were most commonly resident in the United States (42.6%, n = 243), Ireland (41.2%, n = 235) or the United Kingdom (10%, n = 57). The majority (80.0%, n = 457) were married and educated to degree level or above (79.3, n = 453). Pregnant women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Encouragingly, pregnant women in this study generally reported high levels of adherence to public health advice and pregnancy health behaviours. Stress and general mental health outcomes were best predicted by well-being factors (including stress and social support). Health impairing behaviours (e.g. poor diet) were predicted by both well-being and demographic factors.DiscussionInterventions targeting pregnancy- and pandemic-specific stress at the population level will be essential to support mental health and minimise adverse outcomes for women and children during the pandemic.     

Australian women's experiences of living with gestational diabetes

PurposeThe purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM.MethodsParticipants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes.ResultsOf 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p = 0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p = 0.061). Those diagnosed with GDM in a previous pregnancy (p = 0.034) and younger women (p = 0.054) were less likely to view the diagnosis as an opportunity to improve their health.ConclusionsThis study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.     

Tobacco use in the third trimester of pregnancy and its relationship to birth weight. A prospective study in Spain

BackgroundFew studies have been carried out in Spain examining the use of tobacco amongst expectant mothers and its effect on birth weight.AimsTo observe the proportion of expectant mothers who smoke during their pregnancy, and the impact of tobacco consumption on maternal and birth weight. We also aimed to identify the trimester of pregnancy in which tobacco use produced the greatest reduction in birth weight.MethodsProspective observational study in Spain. A random sampling strategy was used to select health centres and participant women. A total of 137 individuals were enrolled in the study. Exposure to tobacco was measured through a self-reported questionnaire. Regressions were performed to obtain a predictive model for birth weight related to smoking.FindingsOverall, 35% of study participants were smokers during the pre-gestational period (27% in the first trimester, 21.9% in the second and 21.2% in the third). 38.7% of smoking cessation attempts took place in the third-trimester. Pregnant women who smoked up to the third trimester had a higher risk of giving birth to a baby under 3000 g, compared to non-smokers (OR = 5.94, CI 95%: 1.94–18.16). Each additional unit of tobacco consumed daily in the 3rd trimester led to a 32 g reduction in birth weight.ConclusionAn important proportion of pregnant women in Spain smoke during pregnancy. Pregnant women exposed to tobacco have newborns with lower birth weight. Smoking during the 3rd trimester of pregnancy is associated with the greatest risk of lower birth weight.     

Antenatal care utilisation among Syrian refugees in Tehran: A respondent driven sampling method

AimTo assess the antenatal care utilisation among Syrian refugees in Tehran.MethodsThis cross-sectional study was performed in 2016 in Tehran. As the refugees live in the city, we used Respondent Driven Sampling method for finding participants. Data were collected from interviews by a newly graduated Syrian general practitioner.FindingsIn total, 231 women participated in the study. The mean (standard deviation) number of antenatal care visits was 3.73 (1.41) and 131(56.7%) women received at least four visits. The mean (standard deviation) number of antenatal care visits was higher among women with four or more living children compared with those with four or more: 3.47 (1.35); 95% confidence interval 3.28 to 3.66 vs. 2.82 (1.64); 95% confidence interval 2.25 to 3.40, p = 0.01. The mean (standard deviation) number of antenatal care visits was higher among women whose spouses had academic degrees compared with those with lower education: 4.13 (1.37); 95% confidence interval 3.86–4.40 vs. 3.28 (1.31); 95% confidence interval 3.05–3.52, p < 0.001.ConclusionsAntenatal care utilisation of Syrian women in Tehran complied with neither national guidelines of Iran nor the recommendations of World Health Organization. However, antenatal care utilisation of Syrian women in Tehran was higher than the main destinations of Syrian refugees. Syrian women kept their own cultural behaviour in terms of antenatal care utilisation.     

The impact of routine assessment of past or current mental health on help-seeking in the perinatal period

BackgroundClinical practice guidelines now recommend that women be asked about their past or current mental health as a routine component of maternity care. However, the value of this line of enquiry in increasing engagement with support services, as required, remains controversial.AimThe current study aimed to examine whether assessment of past or current mental health, received with or without referral for additional support, is associated with help-seeking during pregnancy and the postpartum.MethodsA subsample of women drawn from the Australian Longitudinal Study on Women's Health (young cohort) who reported experiencing significant emotional distress during pregnancy (N = 398) or in the 12 months following birth (N = 380) participated in the study.ResultsMultivariate analysis showed that women who were not asked about their emotional health were less likely to seek any formal help during both pregnancy (adjOR = 0.09, 95%CI: 0.04–0.24) and the postpartum (adjOR = 0.07, 95%CI: 0.02–0.13), as were women who were asked about these issues but who were not referred for additional support (antenatal: adjOR = 0.26, 95%CI: 0.15–0.45; postnatal: adjOR = 0.14, 95%CI: 0.07–0.27). However, considerable levels of consultation with general practitioners, midwives and child health nurses, even in the absence of referral, were evident.ConclusionThis study demonstrates that enquiry by a health professional about women's past or current mental health is associated with help-seeking throughout the perinatal period. The clinical and resource implications of these findings for the primary health care sector should be considered prior to the implementation of future routine perinatal depression screening or psychosocial assessment programmes.     

Pregnant women voice their concerns and birth expectations during the COVID-19 pandemic in Italy

BackgroundIn March 2020, COVID-19 was declared to be a pandemic. While data suggests that COVID-19 is not associated with significant adverse health outcomes for pregnant women and newborns, the psychological impact on pregnant women is likely to be high.AimThe aim was to explore the psychological impact of the COVID-19 pandemic on Italian pregnant women, especially regarding concerns and birth expectations.MethodsA cross-sectional online survey of pregnant women in Italy was conducted. Responses were analysed for all women and segregated into two groups depending on previous experience of pregnancy loss. Analysis of open text responses examined expectations and concerns before and after the onset of the pandemic.FindingsTwo hundred pregnant women responded to the first wave of the survey. Most (n = 157, 78.5%) had other children and 100 (50.0%) had a previous history of perinatal loss. ‘Joy’ was the most prevalent emotion expressed before COVID-19 (126, 63.0% before vs 34, 17.0% after; p < 0.05); fear was the most prevalent after (15, 7.5% before vs 98, 49.0% after; p < 0.05). Positive constructs were prevalent before COVID-19, while negative ones were dominant after (p < 0.05). Across the country, women were concerned about COVID-19 and a history of psychological disorders was significantly associated with higher concerns (p < 0.05). A previous pregnancy loss did not influence women’s concerns.ConclusionsWomen’s expectations and concerns regarding childbirth changed significantly as a result of the COVID-19 pandemic in Italy. Women with a history of psychological disorders need particular attention as they seem to experience higher levels of concern.     

The self-prescribed use of aromatherapy oils by pregnant women

BackgroundWhile some studies have reported effectiveness of aromatherapy oils use during labour there is no reported evidence of efficacy or risks of aromatherapy oils use for pregnancy-related symptoms or conditions. A number of aromatherapy oils are unsafe for use by pregnant women yet there is currently no research examining the prevalence and characteristics of women who use aromatherapy oils during pregnancy.AimTo conduct an empirical study of the prevalence and characteristics of women who use aromatherapy oils during pregnancy.MethodsThe research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH), focusing on the nationally representative sample of Australian women aged 31–36 years. Data were collected via a cross-sectional questionnaire (n = 8200) conducted in 2009.ResultsSelf-prescribed aromatherapy oils were used by 15.2% of pregnant women. Pregnant women were 1.57 (95% CI: 1.01, 2.43) times more likely to self-prescribe use of aromatherapy oils if they have allergies or hayfever, and 2.26 (95% CI: 1.34, 3.79) times more likely to self-prescribe use of aromatherapy oils if they have a urinary tract infection (UTI).ConclusionOur study highlights a considerable use of aromatherapy oils by pregnant women. There is a clear need for greater communication between practitioners and patients regarding the use of aromatherapy oils during pregnancy, as well a need for health care practitioners to be mindful that pregnant women in their care may be using aromatherapy oils, some of which may be unsafe.     

History of perinatal loss and maternal–fetal attachment behaviors

BackgroundMaternal–fetal attachment (MFA) is an important requirement for optimal maternal–infant adaptation. Current studies showed conflicting findings about whether a history of perinatal loss (fetal/neonatal death) affects maternal attachment in pregnancy.Research question“Does a history of perinatal loss affect maternal–fetal attachment behaviors?”MethodsOne hundred women with and without a history of PL were recruited using a convenience method of sampling, from prenatal care services affiliated to Shahid Behesti University of Medical Sciences. Data collected by questionnaires from a convenience sample of multiparous women in the 3rd trimester of pregnancy with no surviving children were compared with data from a selected cohort of primigravid women. The two groups of women were matched for health and literacy. The data collected included demographic characteristics and responses to 24 questions in five groups of behaviors on the Persian version of Cranly's Maternal–Fetal Attachment Scale. Data were analyzed by SPSS 13 and using t, ANOVA, Chi square, Pearson correlation and Mann–Whitney tests.FindingsFinding showed that total score of MFA for women with a history of PL (68.95 ± 9.20%) is not significantly different from this score for women without such a history (71.22 ± 11.75%; p < 0.05). Women with a history of PL had a significantly lower score for a subgroup of behaviors “differentiation of self from fetus” compared to women without of a history of PL (78.25 vs. 83.21%; p < 0.05). But, there were no statistically significant differences between two groups respecting to other subgroups of behaviors between two groups.ConclusionIn this study, a history of pregnancy loss was found to be associated with disturbances in the group of maternal–fetal attachment behaviors related to “differentiation of self from fetus” in a subsequent pregnancy.     

Midwives’ self-reported knowledge and skills to assess and promote maternal health literacy: A national cross-sectional survey

BackgroundLittle is known about midwives’ knowledge and skills to assess and promote maternal health literacy.AimsTo test the reliability and validity of a new tool to assess midwives’ health literacy knowledge, skills and attitudes.MethodsUsing a cross-sectional design, midwives were recruited through professional and social media networks. The online survey included demographic and professional questions and a new measure on midwives’ health literacy knowledge, skills and attitudes. Convergent validity was assessed using ten items from the Caring Assessment Scale. Perceived barriers to promoting maternal health literacy were sought.FindingsThree hundred and seven participants completed the survey. A two-factor solution accounted for 41% of variance and resulted in 14 items, including all attitude items, being removed. Cronbach’s alpha reliability was acceptable (Skills = .76; Knowledge = .66). Convergent validity was established. Most midwives (77.1%, n = 221) reported giving limited attention to formally assessing women’s health literacy. Between 30 to 60% of midwives never or only sometimes used specific techniques to promote maternal health literacy. Most (75%, n = 201) had not received education about health literacy.Discussion and ConclusionsThe new Transforming Maternity Care Collaborative Health Literacy tool was valid and reliable. Few midwives formally assessed or promoted women’s health literacy. Midwives require education about maternal health literacy assessment and promotion to ensure women understand information being conveyed. A large national survey of midwives using the new tool is recommended.     

An exploration of Australian midwives’ knowledge of intimate partner violence against women during pregnancy

BackgroundIntimate partner violence is recognised as a global public health issue. Living with intimate partner violence results in poorer health status with reduced quality of life and higher utilisation of health services. Increased awareness, education and training, and an understanding of multi-agency collaboration are vital in order for health practitioners to respond to women experiencing partner violence and abuse. Midwives are well placed to identify, provide immediate support, and refer women onto appropriate support agencies but may lack appropriate education, training or support.AimTo investigate midwives’ knowledge of intimate partner violence against women during pregnancy.MethodsAn online survey link was distributed through the Australian College of Midwives. The survey included personal, professional and practice details, and 25 questions that tested knowledge about intimate partner violence.Findings152 midwives completed the online questionnaire. Knowledge scores ranged from 27 to 48 (out of a possible 50), with the mean total score of 42.8 (SD = 3.3). Although 60% of participants scored 48, two-thirds did not know about the risks and signs of intimate partner violence. One-third of the midwives did not know about age risks associated with intimate partner violence. Around 25% incorrectly believed that perpetrators are violent because of alcohol or drug use. Nearly 90% (88%) of participants had some education or training about intimate partner violence. Those with some training achieved higher knowledge scores than those with no formal training (Mann–Whitney U = 1272, p = 0.003).ConclusionParticipating midwives generally reported a high level of knowledge about intimate partner violence but held misconceptions about risks and characteristics of perpetrators of violence. These knowledge gaps may adversely affect their ability to identify women at risk of violence. Education about intimate partner violence was associated with improved knowledge. Future training and education on intimate partner violence should target identified knowledge gaps.     

Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment

ProblemWhile routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician.AimsTo assess the impact of psychosocial risk, current symptoms and mode of assessment on women’s honesty of disclosure at psychosocial assessment.MethodsLogistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were ‘always honest’ and ‘not always honest’. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk.Findings10.8% (N = 193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR = 1.78, 95%CI: 1.18–2.67, p < 0.01) and lack of social and partner support (aOR = 1.74, 95%CI: 1.16–2.62, p < 0.05; aOR = 2.08, 95%CI: 1.11–3.90, p < 0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest.DiscussionA history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback.ConclusionGreater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.     

The views and attitudes of health professionals providing antenatal care to women with a high BMI: A qualitative research study

BackgroundThe prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m² and over.MethodsA qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n = 10), one with continuity of care midwives (n = 18) and one with obstetricians (n = 5). Data were analysed using Interpretative Phenomenological Analysis (IPA).FindingsSix dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women.ConclusionHealth professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals.     

Implementation of an obstetric triage decision aid into a maternity assessment unit and emergency department

BackgroundThe obstetric triage decision aid (OTDA) consists of 10 common pregnancy complaints with key signs and symptoms generating a triage score based on targeted questioning responses. It was developed to provide a standardised approach for obstetric triage conducted by midwives and emergency nurses as neither professional group are expert in the triage of pregnant and postpartum women.AimTo evaluate implementation of the OTDA into an emergency department (ED) and maternity assessment unit (MAU).MethodsThe OTDA was introduced to the ED and MAU of a hospital in Australia. A range of implementation strategies were utilised and assessed by pre and post staff survey, and a three-month post-audit of unscheduled maternity presentations. The primary outcome was adoption rate of the OTDA. Secondary outcomes were staff confidence and waiting times. Analyses were undertaken using SPSS (v24). Paired analysis was conducted on staff surveys.ResultsThere were a total of 2829 unscheduled presentations: ED (n = 708) and MAU (n = 2121), 88.1% were triaged using the OTDA, used more in the MAU than the ED (93.2% vs 72.7%; p < .001). In the MAU, women seen within 15 min of arrival improved significantly from 42.0% to 78.0%. There was improvement in the self-rated confidence (p = .002) and competence (p = .004) by nurses and midwives to conduct obstetric triage.ConclusionThe introduction of the OTDA required different approaches to change practice. There were improvements in staff self-rated confidence and competence, a reduction in clinical risk associated with under-triage in the ED and improved prioritisation of care in the MAU.     

Impact of having a high-risk pregnancy on future postpartum contraceptive method choice

BackgroundTo compare the knowledge and preference of preconceptional contraception to future postpartum contraceptive method choice in high-risk pregnancies.Research questionDoes a high-risk pregnancy condition affect future postpartum contraceptive method choice?MethodWomen hospitalised at the High Risk Pregnancy unit of a tertiary research and training hospital were asked to complete a self-reported questionnaire that included demographic characteristics, presence of unintended pregnancy, contraceptive method of choice before the current pregnancy, plans for contraceptive use following delivery and requests for any contraceptive counselling in the postpartum period.FindingsA total of 655 pregnant women were recruited. The mean age, gravidity and parity of the women were 27.48 ± 6.25 years, 2.81 ± 2.15 and 1.40 ± 1.77, respectively. High-risk pregnancy indications included 207 (31.6%) maternal, 396 (60.5%) foetal and 52 (7.9%) uterine factors. All postpartum contraceptive choices except for combined oral contraceptives (COCs) usage were significantly different from preconceptional contraceptive preferences (p < 0.001). High-risk pregnancy indications, future child bearing, ideal number of children, income and education levels were the most important factors influencing postpartum contraceptive choices. While the leading contraceptive method in the postpartum period was long-acting reversible contraceptive methods (non-hormonal copper intrauterine device Cu-IUD, the levonorgestrel-releasing intrauterine system (LNG-IUS) (40%), the least preferred method was COCs use (5.2%) and preference of COCs use showed no difference between the preconceptional and postpartum periods (p = 0.202). Overall 73.7% of the women wanted to receive contraceptive counselling before their discharge.ConclusionA high-risk pregnancy condition may change the opinion and preference of contraceptive use, and also seems to affect the awareness of family planning methods.     

Caesarean delivery before 39 weeks associated with selecting an auspicious time for birth in Taiwan

BackgroundCaesarean delivery before 39 weeks of gestation increases the risk of morbidity among infants. Taiwan has one of the highest caesarean rates in the world, but little attention has been paid to this issue. This study aimed to describe the rate of caesarean delivery before 39 weeks gestation among women who did not have labour signs and had a non-emergency caesarean delivery in Taiwan and to examine whether the phenomenon was associated with the Chinese cultural practice of selecting an auspicious time for birth.MethodsWe recruited women at 15–28 weeks of pregnancy at 5 hospitals in northern Taiwan and followed them at 4 or 5 weeks after delivery using structured questionnaires. This analysis included 150 primiparous mothers with a singleton pregnancy who had a non-emergency caesarean delivery without the presence of labour signs.ResultsNinety-three of these women (62.0%) had caesarean deliveries before 39 weeks of gestation. Logistic regression analysis showed that women who had selected an auspicious time for delivery (OR = 2.82, 95% CI: 1.15–6.95) and delivered in medical centres (OR = 5.26, 95% CI: 2.25–12.26) were more likely to deliver before 39 weeks of gestation.ConclusionNon-emergency caesarean delivery before 39 weeks of gestation was common among the study women, and was related to the Chinese cultural practice of selecting an auspicious time for birth. Further studies are needed to examine the risks and benefits associated with timing of caesarean delivery in Taiwan in order to generate a consensus among obstetricians and give pregnant women appropriate information.     

Comparison of breastfeeding in rural areas of Sweden and Australia – a cohort study

BackgroundBreastfeeding rates in Sweden and Australia appears to be decreasing in both countries. National statistics shows that 87% of infants in Sweden and 73% in Australia receive any breastfeeding two months of age.AimTo compare women's experiences of breastfeeding in Sweden and Australia and to identify factors associated with breastfeeding two months after birth.MethodsA cohort study in two rural hospitals in mid Sweden (n = 300) and north-eastern Victoria in Australia (n = 91) during 2007–2009. Participants responded to questionnaires in mid pregnancy and two months after birth. Crude and adjusted odds ratios with a 95% confidence interval were used to detect differences between women in both cohorts.FindingsWomen in Sweden (88.3%) were more likely to report any breastfeeding of the baby two months after birth (OR 2.41; 95% CI: 1.33–4.38) compared to women in Australia (75.8%) but were less satisfied with breastfeeding support and information. The most important factor associated with breastfeeding at two months postpartum for the Swedish women was to have received sufficient information about breastfeeding on the postnatal ward (OR 2.3; 95% CI 1.41–4.76) while for the Australian women receiving the best possible help when breastfeeding for the first time was most important (OR 4.3; 95% CI 1.50–12.46).ConclusionThe results indicate that Swedish women were more likely than their Australian counterparts to breastfeed the baby two months after birth. The findings demonstrated the importance of sufficient information and help when breastfeeding is initiated.     

Pregnancy care and birth outcomes for women with moderate to super-extreme obesity

PurposeTo describe the health service utilisation and birth outcomes of pregnant women with moderate to super-extreme obesity.BackgroundMaternal obesity is increasingly recognised as a key risk factor for adverse outcomes for both women and their babies. Little is known about the service utilisation and perinatal outcomes of women with obesity beyond a body mass index of 40.MethodWomen with a self-reported pre-pregnancy BMI of 40 or more, who had received care and birthed a baby at the study site between 1 January 2009 and 31 December 2010. Clinical audit was used to identify the health service utilisation and birth outcomes of these women.Results153 women had a BMI of 40 or more. Women saw 6 different health professionals during pregnancy (1–16). Most of their visits were with a medical practitioner, often with limited experience, and almost all women only saw a midwife once at their booking visit (n = 150, 98.0%). While the majority of women experienced a normal pregnancy, free from any complications, almost half the women in this study experienced a caesarean section (n = 74, 48.4%).ConclusionClinical audit has been useful in providing additional information which suggests current maternity care provision is not meeting the needs of this group of women. The model of antenatal care provision may be a mediating factor in the birth outcomes experienced by obese women. The development of effective, targeted antenatal care, designed to meet the needs of these women is recommended.