Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality.Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994–2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.     

Grandparents' Education and Infant Health: Pathways Across Generations

Using data from the Fragile Families and Child Wellbeing survey linked to respondents' medical records (N = 2,870), this study examines the association between grandparents' education and birth outcomes and explores potential pathways underlying this relationship. Results show that having a grandfather with less than a high school education was associated with a 93 gram reduction in birth weight, a 59% increase in the odds of low birth weight, and a 136% increase in the odds of a neonatal health condition when compared with having a grandfather with a high school education or more. These associations were partially accounted for by mother's educational attainment and marital status as well as by prenatal history of depression, hypertension, and prenatal health behaviors, depending on the specific outcome. The findings from this study call for heightened attention to the multigenerational influences of educational attainment for infant health.     

Sexually Experienced Adolescents’ Thoughts About Sexual Pleasure

Little research on adolescents has examined developmentally normative facets of sexuality that are not obviously linked to physical health. The purpose of this secondary data analysis was to qualitatively analyze adolescents’ thoughts about and experiences with sexual pleasure. The study sample consisted of 56 sexually experienced, ethnically diverse, predominantly female adolescents who were participating in a Web-based intervention to promote healthy sexual decision making. Comments on one message board, “Sexual Pleasure: Does It Matter to You?,” provided an opportunity to examine adolescents’ thoughts about and experiences with sexual pleasure, as well as their communication with partners about that topic. Adolescents’ comments demonstrated that they experience difficulties with pleasure in their sexual relationships. Adolescents generally believed that men are more likely than women to feel pleasure due to differences that include biology, understanding of one’s body, and control over partnered sexual behavior. Adolescents defined inequality of received pleasure differently and discussed contexts in which inequality may be acceptable. Adolescents expressed motivation to communicate with partners about sexual pleasure. However, their statements suggested they often lack the skills to do so. Future prevention and intervention programs should equip adolescents with skills to communicate with partners about sexual pleasure.     

Peer paradox: the tensions that peer relationships raise for vulnerable youth

The contribution peer relationships make to positive adolescent development is well recognized. Accordingly, peer problem measures typically assess youth with few age‐appropriate peers as having peer problems. Yet, youth facing high levels of personal and/or social adversity may reduce their association with antisocial peers as part of coping or risk mitigation strategies. While such strategies will result in higher scores on peer problem measures, they may also facilitate resilience and constitute a resource social workers can draw on in their work with youth. To test this proposition of peer adaptation as a risk mitigation strategy, mixed‐methods data relating to two groups of youth who were exposed to different levels of adversity were compared on a standardized peer problem measure and a range of risk measures. Qualitative interviews extended this data and explored vulnerable youth perceptions of social withdrawal as a coping strategy. Results from the survey and qualitative data indicated that a subgroup of youth facing high levels of adversity restricted association with antisocial peers to reduce their behavioural risks. However, without adequate support from adults in both formal support systems and youths' social ecologies to compensate for the loss of peer friendships, this strategy did not reduce behavioural risk in the medium term. The social withdrawal strategy also appeared to heighten mental health concerns for these youth. The implications of this finding for the development of policy and practice with vulnerable youth are discussed.     

“I Had to Go to the Streets to Get Love”: Pathways From Parental Rejection to HIV Risk Among Young Gay and Bisexual Men

Young, gay, and bisexual men (YGBM) are at increased risk of family rejection, which is related to HIV infection. What remains unknown is how family rejection leads to HIV risk. In this exploratory study, qualitative interviews were conducted with 21 HIV-positive YGBM aged 18 to 24. Most participants reported family rejection, which decreased instrumental and emotional support and resulted in participants using riskier ways to support themselves, such as engaging in survival sex. Conceptualizing the findings using a family systems framework, we present a tentative conceptual model to describe the potential relationships between family rejection and HIV risk for YGBM.