The effects of maternal smoking on infant health

Maternal smoking has serious consequences for the developing fetus and infant, including a higher probability that the infant will be born prematurely and at low birth weight, will require admission to neonatal intensive care, and die during infancy. Data from Alabama birth certificates for births occurring between 1988 and 1991 were analyzed using log linear methods to calculate relative risks of adverse pregnancy outcomes and infant death. Smoking by mothers during pregnancy is associated with an elevated risk of infant death, low birth weight, and prematurity, controlling for mother's educational attainment, age, marital status, race, and trimester prenatal care was initiated. Smoking was also associated with a higher rate of admission to neonatal intensive care and to deaths from SIDS and respiratory causes. Reducing maternal smoking can contribute to a reduction of premature and low weight births and infant deaths. Because of the difficulty of stopping smoking, efforts need to be directed at preventing younger women from beginning to smoke.An earlier version of this paper was presented at the Southern Demographic Association annual meeting in New Orleans in October 1993.     

Union Transitions Following the Birth of a Child to Cohabiting Parents

Despite a growing interest in the family trajectories of unmarried women, there has been limited research on union transitions among cohabiting parents. Using data from the 2002 National Survey of Family Growth, we examined how family complexity (including relationship and fertility histories), as well as characteristics of the union and birth, were associated with transitions to marriage or to separation among 1,105 women who had a birth in a cohabiting relationship. Cohabiting parents had complex relationship and fertility histories, which were tied to union transitions. Having a previous nonmarital birth was associated with a lower relative risk of marriage and a greater risk of separation. In contrast, a prior marriage or marital birth was linked to union stability (getting married or remaining cohabiting). Characteristics of the union and birth were also important. Important racial/ethnic differences emerged in the analyses. Black parents had the most complex family histories and the lowest relative risk of transitioning to marriage. Stable cohabitations were more common among Hispanic mothers, and measures of family complexity were particularly important to their relative risk of marriage. White mothers who began cohabiting after conception were the most likely to marry, suggesting that “shot-gun cohabitations” serve as a stepping-stone to marriage.     

Epidural analgesia during birth and adverse neonatal outcomes: A population-based cohort study

BackgroundIn general, epidural analgesia is considered a safe and efficient way to relieve pain during active labour and is increasingly used in childbirth. It is well documented that epidural analgesia during birth has benefits but also adverse effects. However, evidence is limited on how epidural analgesia influences neonatal outcome in a low-risk population of birthing women.AimTo examine low Apgar score, foetal hypoxia and admission to the neonatal intensive care unit in neonates of low-risk women receiving epidural analgesia during birth.MethodsA cohort study using registry data to investigate a population of 23,272 low-risk women giving birth at a university hospital.ResultsEpidural analgesia was used in 21.6% of low-risk women during birth. Low Apgar score, foetal hypoxia, and admission to the neonatal intensive care unit were found in 0.6%, 0.6%, and 10.0%, respectively in neonates of mothers receiving epidural analgesia during birth compared to 0.3%, 0.6%, and 5.6%, respectively in the non-exposed group. Epidural analgesia was associated with low Apgar score, adjusted odds ratio 1.76 (95% CI 1.07–2.90) and admission to the neonatal intensive care unit, adjusted odds ratio 1.43 (95% CI 1.26–1.62). A mediation analysis indicates the impact of epidural analgesia on adverse neonatal outcomes was mediated by obstetric complications like maternal fever, labour augmentation, and foetal malpresentation.ConclusionThis study found use of epidural analgesia during birth in low-risk pregnant women was associated with infant low Apgar score and admission to the neonatal intensive care unit.     

Who is holding the baby? Women's experiences of contact with their baby immediately after birth: An Australian population-based survey

BackgroundSeeing and holding their baby immediately after the birth is the pinnacle of the childbearing process for parents. Few studies have examined women's experiences of seeing and holding their baby immediately after birth. We investigated women's experiences of initial contact with their newborns using data from an Australian population-based survey.MethodsAll women who gave birth in September/October in 2007 in two Australian states were mailed questionnaires six months following the birth. Women were asked three questions about early newborn contact including where their baby was held in the first hour after birth and whether they were able to hold their baby as soon and for as long as they liked. We examined the association between model of maternity care and early newborn contact stratified by admission to SCN/NICU.ResultsThe majority (92%) of women whose babies remained with them reported holding their babies as soon and for as long as they liked in the first hour after birth. However, for women whose babies were admitted to SCN/NICU only a minority (47%) reported this. Women in public models of care (with the exception of primary midwifery care) whose babies remained with them were less likely to report holding their babies as soon and for as long as they liked compared to women in private care.ConclusionOur findings suggest that there is potential to increase the proportion of mothers and fathers who get to hold their baby immediately after the birth by modifying birth suite and operating room practices.     

The experiences of childbearing women who tested positive to COVID-19 during the pandemic in northern Italy

ProblemThe COVID-19 pandemic has significantly challenged maternity provision internationally. COVID-19 positive women are one of the childbearing groups most impacted by the pandemic due to drastic changes to maternity care pathways put in place.BackgroundSome quantitative research was conducted on clinical characteristics of pregnant women with COVID-19 and pregnant women’s concerns and birth expectations during the COVID-19 pandemic, but no qualitative findings on childbearing women’s experiences during the pandemic were published prior to our study.AimTo explore childbearing experiences of COVID-19 positive mothers who gave birth in the months of March and April 2020 in a Northern Italy maternity hospital.MethodsA qualitative interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 22 women. Thematic analysis was completed using NVivo software. Ethical approval was obtained from the research site’s Ethics Committee prior to commencing the study.FindingsThe findings include four main themes: 1) coping with unmet expectations; 2) reacting and adapting to the ‘new ordinary’; 3) ‘pandemic relationships’; 4) sharing a traumatic experience with long-lasting emotional impact.DiscussionThe most traumatic elements of women’s experiences were the sudden family separation, self-isolation, transfer to a referral centre, the partner not allowed to be present at birth and limited physical contact with the newborn.ConclusionKey elements of good practice including provision of compassionate care, presence of birth companions and transfer to referral centers only for the most severe COVID-19 cases should be considered when drafting maternity care pathways guidelines in view of future pandemic waves.     

Fathers’ Imprisonment and Mothers’ Multiple-Partner Fertility

We consider the intersection between two striking U.S. trends: dramatic increases in the imprisonment of fathers and increases in the proportion of mothers who have children with more than one partner (multiple-partner fertility, or MPF). Using matched longitudinal administrative data that provide unusually comprehensive and accurate information about the occurrence and timing of imprisonment, fertility, and MPF for the population of the state of Wisconsin, we consider the relationship between paternal imprisonment and MPF among unwed mothers. Employing discrete-time event history analysis with multinomial logistic regression, we model the occurrence and timing of the mother’s second birth, distinguishing between a birth with the same father and a birth with a different father, and distinguishing between current imprisonment and a history of imprisonment. We find that current imprisonment is associated with an increased likelihood of MPF and a decreased likelihood of fertility with the same father (compared with no additional birth) and that a history of imprisonment is associated with increased MPF in some models but not in our preferred model. To control for unobserved heterogeneity among mothers and assess the evidence of a causal effect of fathers’ imprisonment, we also employ the case-time-control method, a fixed-effects method for the analysis of nonrepeated events. Results suggest that fathers’ current imprisonment may increase mothers’ MPF. Policy implications are discussed.     

Large gaps in the quality of healthcare experienced by Swedish mothers during the COVID-19 pandemic: A cross-sectional study based on WHO standards

Background and ProblemExisting healthcare systems have been put under immense pressure during the COVID-19 pandemic. Disruptions in essential maternal and newborn services have come from even high-income countries within the World Health Organization (WHO) European Region.AimTo describe the quality of care during pregnancy and childbirth, as reported by the women themselves, during the COVID-19 pandemic in Sweden, using the WHO ‘Standards for improving quality of maternal and newborn care in health facilities’.MethodsUsing an anonymous, online questionnaire, women ≥18 years were invited to participate if they had given birth in Sweden from March 1, 2020 to June 30, 2021. The quality of maternal and newborn care was measured using 40 questions across four domains: provision of care, experience of care, availability of human/physical resources, and organisational changes due to COVID-19.FindingsOf the 5003 women included, n = 4528 experienced labour. Of these, 46.7% perceived a poorer quality of maternal and newborn care due to the COVID-19. Fundal pressure was applied in 22.2% of instrumental vaginal births, 36.8% received inadequate breastfeeding support and 6.9% reported some form of abuse. Findings were worse in women undergoing prelabour Caesarean section (CS) (n = 475). Multivariate analysis showed significant associations of the quality of maternal and newborn care to year of birth (P < 0.001), parity (P < 0.001), no pharmacological pain relief (P < 0.001), prelabour CS (P < 0.001), emergency CS (P < 0.001) and overall satisfaction (P < 0.001).ConclusionConsiderable gaps over many key quality measures and deviations from women-centred care were noted. Findings were worse in women with prelabour CS. Actions to promote high-quality, evidence-based and respectful care during childbirth for all mothers are urgently needed.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

The effect of marital status at first birth on marital dissolution among adolescent mothers

The sequencing of marriage and first birth was expected to play an important role in the stability of marriage among adolescent mothers. We hypothesized that adolescent women who married prior to conception would have the lowest rates of marital disruption, followed by those who married between conception and birth. Adolescent women who gave birth prior to marriage were expected to suffer the highest rates of marital dissolution. The results provide partial support for our hypotheses. There is little difference in the probability of separation between adolescent mothers who had a postmarital conception and those who had a premarital conception but married before the birth. Having a premarital birth, however, significantly increases the probability of marital dissolution. We also hypothesized that marital status at first birth would have less effect on the probability of marital dissolution for blacks than for whites. This, too, is generally supported by our findings. Among black females, those with a premarital birth are the first to suffer a marital disruption, but by the end of ten years there is little difference in the probability of separation among the three marital status groups. In contrast, among white females, those with a premarital birth are the first to experience a disruption, and this differential persists over all subsequent marriage duration intervals. Thus, the sequencing of marriage relative to birth has similar short term effects for whites and blacks, but the effect for blacks is evident only in the short term. Ten years after the marriage, black adolescent mothers have similar rates of marital stability regardless of the sequencing of marriage. This is consistent with the findings of previous research and with our hypothesis; with the black family pattern of lower rates of marriage, higher rates of illegitimacy and higher divorce rates, the sequencing of marriage has no long lasting consequences on marital stability. Finally, our predicted decline in the effect of marital status at first birth over historical time also finds partial support. For white females there has been a change in the effect of marriage-first birth sequencing on separation over time. In the period encompassed by the women in our study, white adolescent mothers who married subsequent to the birth have been the most likely to experience a separation at all marriage duration intervals, but this differential narrows as age at interview declines. Among black females there has been no change in the effect of a premarital birth over time.(ABSTRACT TRUNCATED AT 400 WORDS)     

Neonatal mortality and stillbirths in early twentieth century Derbyshire,England

Neonatal mortality and stillbirths are recognised to be subject to similar influences, but survival after a successful live birth is usually considered in isolation of foetal wastage. Moreover, individual-level data on age-specific influences and causes of death in a historical context are rare. This paper uses an unusual data set to compare the influences on neonatal mortality and stillbirths in early twentieth century Derbyshire, England. Multivariate hazard and logistic analyses are performed to examine the relative roles of various social, environmental, and demographic factors. The influences on and causal structures of neonatal mortality and stillbirths emerge as broadly similar, with previous reproductive history linked to a considerable amount of variation. The clustering of endogenous deaths was much greater than the clustering of exogenous and post-neonatal deaths, probably reflecting the cause-of-death structure and the relatively healthy social and environmental position of early twentieth century Derbyshire.     

Review of educational interventions to increase traditional birth attendants’ neonatal resuscitation self-efficacy

Background

Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality.

Falling Short of Highest Life Expectancy: How Many Americans Might Have Been Alive in the Twentieth Century?

Life expectancy at birth in the United States during the twentieth century was lower than in many other highly developed countries. We investigate how this mortality disadvantage in the last 100 years translates into the number of hypothetical lives lost and their sex and age structure. We estimate the hypothetical US population if it had experienced in each decade since 1900 the mortality level of the country with the then highest life expectancy and compare the results to the actual figures in 2000. By 2000, the number of additional people who could have been alive had the mortality levels in the United States been as low as those in countries with the highest life expectancy was 66 million. This number is distributed equally between males and females. Suboptimal mortality at reproductive ages is crucial for the cumulative effect of potential lives lost, resulting from premature deaths of women who could still become first‐time mothers or bear additional children. Out of the 66 million additional persons who could have been alive in 2000, 45 million are attributable to those indirect deaths. Although the differences in the composition of the population by sex and age under the two mortality regimes are minor, the majority of people who might have been alive—54 million—were of working age or younger.     

Prevalence and risk factors for postnatal depression in Sabah,Malaysia: A cohort study

BackgroundPostnatal depression can have serious consequences for both the mother and infant. However, epidemiological data required to implement appropriate early prevention are still lacking in Malaysia.AimTo investigate the prevalence of postnatal depression within six months postpartum and associated risk factors among women in Sabah, Malaysia.MethodsA prospective cohort study of 2072 women was conducted in Sabah during 2009–2010. Participants were recruited at 36–38 weeks of gestation and followed up at 1, 3 and 6 months postpartum. The presence of depressive symptoms was assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale. Logistic regression analyses were performed to ascertain risk factors associated with postnatal depression.FindingsOverall, 14.3% of mothers (95% confidence interval (CI) 12.5–16.2%) had experienced depression within the first six months postpartum. Women depressed during pregnancy (odds ratio (OR) 3.71, 95% CI 2.46–5.60) and those with consistent worries about the newborn (OR 1.68, 95% CI 1.16–2.42) were more likely to suffer from depression after childbirth. Women whose husband assisted with infant care (OR 0.43, 95% CI 0.20–0.97) and mothers who were satisfied with their marital relationship (OR 0.27, 95% CI 0.09–0.81) appeared to incur a reduced risk of postnatal depression.ConclusionA substantial proportion of mothers suffered from postnatal depression in Sabah, Malaysia. Screening and intervention programmes targeting vulnerable subgroups of women during antenatal and early postpartum periods are recommended to deal with the problem.     

Parental underinvestment: A link in the fertility-mortality continuum

Selective parental investment in siblings has been used to describe differential mortality rates. Using data from 986 Filipino women who had an average of 4.8 live births, a LISREL and six sets of regression models support the hypothesis that fertility is linked to underinvestment and that mortality, as a consequence, is linked to high birth order. The analysis also identifies intervening factors associated with this relationship. Age of mother at childbirth showed a strong influence on the relationship of birth order and infant and child mortality; correlations are stronger among older than youger mothers. However, even after the effect of age of mother at childbirth was partialled out, the effect of birth order on infant and child mortality remained significant and substantial. The conclusion is that parental underinvestment represents a link between fertility and mortality during infancy and early childhood that has not been described previously. Policy makers appear to have overlooked parental underinvestment in favor of more obvious economic and health mediators.     

The Emergence of a Positive Relation Between Education and Third Birth Rates in Norway with Supportive Evidence from the United States

Data derived from the Central Population Register of Norway and the 1988 National Survey of Families and Households show a positive association between mothers' educational level and rates of third births. Norwegian women who had a second birth during the late 1970s and had received more than 12 years of schooling gave birth to a third child more frequently than women who had only received the minimum compulsory education. Similar results were obtained for American women who had a second birth during the 1970s. Attempts to explain this positive effect of education in terms of economic status, or a differential impact of commitment to work by the mothers, have failed. It also seems that trends and variations in selection to parity 2 play a minor role.     

Guilty until proven innocent? – The Assumption of Care of a baby at birth

BackgroundThis paper provides an overview of the history of child protection, the associated law and the 2008 amendments to the Child and Young Persons (Care and Protection) Act 1998 in relation to the Assumption of Care at birth Practice.ObjectiveTo explore the current practice of an Assumption of Care (AOC) where a newborn baby is removed from his/her mother at the time of birth, particularly focussing on the impact of the AOC on midwives.DiscussionAssumption of Care practices in NSW raise significant issues for midwives in relation to the midwifery codes of ethics and conduct and importantly, to their ability to work in ways that honour a “woman-centred care” philosophy. When midwives are exposed to conflict between workplace and personal or professional values such as the practice of AOC cognitive dissonance can occur.ConclusionsFurther research is required to understand the impact of current Assumption of Care. Broader research to not only look at effect on the midwife but also on other health professionals involved and the women who personally experience the removal of their baby at the time of birth. Consideration must also be given to ways of working with vulnerable families to enhance the acceptability and efficacy of maternity services and with associated agencies will decrease the need for Assumption of Care at birth.     

Maternal,prenatal and traditional practice factors associated with perinatal mortality in Yemen

Background

Perinatal mortality remains a major international problem responsible for nearly six million stillbirths and neonatal deaths.

Pregnancy wantedness and the early initiation of prenatal care

The study examines the impact of the wantedness of a pregnancy on the demand for early prenatal care. Using a cohort of pregnant women in New York City, we estimate a prenatal care demand function in which we control for the probability of giving birth, given a woman is pregnant. We interpret this control as a measure of wantedness. The results indicate that if the black and Hispanic women who aborted had instead given birth, they would have delayed the initiation of prenatal care, on average, more than three-quarters of a month longer than the mean number of months of delay that were actually observed for the women who gave birth. By allowing women to terminate an unwanted pregnancy, induced abortion increases the average use of prenatal care among black and Hispanic women relative to what would have been observed if the women who aborted had instead given birth.     

Women and waterbirth: A systematic meta-synthesis of qualitative studies

BackgroundThe practice of waterbirth is increasing worldwide and has been a feature of maternity services in the United Kingdom for over twenty years. The body of literature surrounding the practice focusses on maternal and neonatal outcomes comparing birth in and out of water.AimTo undertake a review of qualitative studies exploring women’s experiences of waterbirth. This understanding is pertinent when supporting women who birth in water.MethodsA literature search was conducted in databases British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Maternity and Infant Care, Medline, Applied Social Sciences Index and Abstracts and Web of Science, using search terms waterbirth, labour/labor, childbirth, women, mothers, experience, perception and maternity care. Five primary research articles published between 2003 and 2018 which explored the views of women who had birthed in water were selected for inclusion. Using meta-ethnography, qualitative research studies were analysed and synthesised using the method of ‘reciprocal translational analysis’ identifying themes relating to women’s experiences of birthing in water.FindingsFour themes were identified: women’s knowledge of waterbirth; women’s perception of physiological birth; water, autonomy and control; and waterbirth: easing the transition.Discussion and conclusionDespite the paucity of qualitative studies exploring women’s experiences of waterbirth, meta-synthesis of those that do exist suggested women identify positively with the choice. The experience of birthing in water appears to enhance a woman’s sense of autonomy and control during childbirth suggesting waterbirth can be an empowering experience for women who choose it.